Search

Internet of things (IoT) is commonly employed to detect different kinds of diseases in the health sector. Systemic lupus erythematosus (SLE) is an autoimmune illness that occurs when the body's immune system attacks its own connective tissues and organs. Because of the complicated interconnections between illness trigger exposure levels across time, humans have trouble predicting SLE symptom severity levels. An effective automated machine learning model that intakes IoT data was created to forecast SLE symptoms to solve this issue. IoT has several advantages in the healthcare industry, including interoperability, information exchange, machineto-machine networking, and data transmission. An SLE symptom-predicting machine learning model was designed by integrating the hybrid marine predator algorithm and atom search optimization with an artificial neural network. The network is trained by the Gene Expression Omnibus dataset as input, and the patients' data are used as input to predict symptoms. The experimental results demonstrate that the proposed model's accuracy is higher than state-of-the-art prediction models at approximately 99.70%

Video captioning exhibits a complex challenge, particularly due to the increased subject intensity within videos compared to image caption generation. The presence of redundant visual information in video data adds complexity for captioners, making it difficult to simplify various content and eliminate irrelevant elements. Additionally, this redundancy often results in misalignment with equivalent visual semantics in the ground truth, further complicating the video captioning process. In response to these challenges, this research introduces the Graylag Deep Kookaburra Reinforcement Learning (GDKRL) framework, which enhances video captioning through a multi-stage process. First, object detection is performed using the single-shot multi-box detector with generalized intersection over union for accurate object tracking and similarity calculation. Next, the gazelle autoencoder extracts and fuses features from video frames, integrating complex visual and temporal information into a unified representation. The residual convolved dual sparse graph attention network then generates detailed and contextually rich language descriptions by applying dual sparse attention mechanisms and residual convolutions. Finally, hybrid graylag and kookaburra optimization refine the captioning process, producing comprehensive and precise textual descriptions of the video content. Extensive experiments on MSVD yielded 81.79 BLEU-4, 51.2 METEOR, 133.3 CIDEr and 81.7 ROUGE-L; VATEX achieved 62.29 BLEU-4, 51.2 METEOR, 110.2 CIDEr and 78.45 ROUGE-L; and the MSR-VTT dataset obtained 44.52 BLEU-4, 33.35 METEOR, 63.9 CIDEr and 68.9 ROUGE-L, demonstrating that the proposed technique significantly outperforms previous approaches and highlights its effectiveness. [ABSTRACT FROM AUTHOR]

Breast cancer is a major cause of death among women in both developed and underdeveloped countries. Early detection and diagnosis of breast cancer are crucial for patients to receive proper treatment and increase their chances of survival. To improve the automatic detection and diagnosis of breast cancer, a new deep learning model called "Breast Cancer Prognosis Based Transfer Learning (BCP-TL)" has been developed. This model uses transfer learning, which applies the knowledge gained from solving one problem to another relevant problem. The model is based on a pre-trained convolutional neural network (CNN) that extracts features from the mammographic image analysis society (MIAS) dataset. Four different CNN architectures were used in this model: AlexNet, Xception, ResNeXt, and Channel Boosted CNN. The performance of the model was evaluated using six metrics, including accuracy, sensitivity, specificity, precision, F1-score, and the area under the ROC curve (AUC). The combination of Xception and Channel Boosted CNN showed excellent performance. By combining essential features from multiple iterations, the Channel Boosted CNN can achieve higher accuracy in breast cancer diagnosis, with an overall accuracy of 98.96%. This highlights the potential of the BCP-TL model in effectively detecting and diagnosing breast cancer. [ABSTRACT FROM AUTHOR]

INTRODUCTION Micronutrient deficiencies are common among populations in the developing world, particularly among children owing to their higher physiological requirements and lower consumption of nutrient-rich foods. (1) Available data from [...], BACKGROUND/OBJECTIVES: A multiple micronutrient-fortified drink could be an effective strategy to combating micronutrient deficiencies in school going children. To assess the efficacy of a multiple micronutrient-fortified drink in reducing iron deficiency (ID), ID anemia (IDA), anemia and improving micronutrient status among schoolchildren with low iron stores. The study employed a school-based, randomized, double-blind, placebo-controlled design. SUBJECTS/METHODS: Schoolchildren with low serum ferritin (SF RESULTS: Study groups at baseline were comparable, and compliance to the intervention was similar. The overall prevalence of ID, IDA and anemia was 64%, 19% and 24%, respectively. The prevalence of ID, IDA, vitamin C and vitamin [B.sub.12] deficiencies significantly reduced by 42%, 18%, 21% and 5%, respectively, in the intervention arm (P CONCLUSIONS: The multi micronutrient-fortified drink was efficacious in reducing the prevalence of ID, IDA, vitamin C and vitamin [B.sub.12] deficiency and improved micronutrient status in schoolchildren. European Journal of Clinical Nutrition (2013) 67, 36-41; doi: 10.1038/ejcn.2012.188; published online 12 December 2012 Keywords: fortification; micronutrients; children; iron deficiency; iron deficiency anemia; anemia

Nowadays, a massive amount of data leads to cause network traffic and inflexible mobility in future mobile networks. A new Group Mobility Model (GMM) named MoMo is introduced that addresses the issue of the aforementioned problems. Even though, software defined network (SDN) is functional with network-rooted mobility protocols that enhance the network efficiency. Some existing network-rooted mobility administration methods still undergo handover delay, packet loss, and high signaling cost through handover processing. In this research work, SDN-based fast handover for GMM is proposed. Here, the neighbor number of evolving node transition probabilities of the mobile node (MN) and their obtainable resource probabilities are estimated. This makes a mathematical framework to decide the preeminent number of the evolving nodes and then allot these to mobile nodes virtually with all associations finished by the exploit of Open-Flow tables. The performance examination demonstrates that the proposed SDN rooted GMM technique has the enhanced performance than the conventional handover process and further technique by handover latency, signaling cost, network throughput, and packet loss. [ABSTRACT FROM AUTHOR]

Urine microscopy for detecting pus cells is a common investigation ordered in hospitalized general medical patients as part of routine care. A few previous studies have shown that sterile pyuria is not uncommon in this population. We studied the prevalence of pyuria among patients hospitalized with non-urinary tract infection (UTI) diagnosis in the medical wards. We excluded patients with asymptomatic bacteriuria (ASB). Pyuria was quantified in uncentrifuged urine using the chamber counting method, and ≥ 10 pus cells per mm3 was considered significant. We also compared this method with the commonly used but less accurate method of counting pus cells/high power field using centrifuged urine (routine method). We studied 196 patients; 113 (57.7%) were males. Most (175[89.3%]) patients were hospitalized for an infection. We found that 18.4% of the study group had sterile pyuria, and it was strongly associated with the presence of concomitant microscopic hematuria (unadjusted odds ratio, 3.74 [1.65 to 8.50]; P=0.002). We found no association of pyuria with female gender, diabetes, acute kidney injury, or current antibiotic use. By routine method, 56 (28.6 %) patients had significant pyuria. In comparison to the chamber counting method, the routine method was 69.4(63—75.8) % sensitive and 80.6(75.1—86.2) % specific. The positive and negative predictive values were 44.6 (37.7— 51.6) % and 92.1 (88.4 — 95.9) %. We concluded that sterile pyuria and microscopic hematuria could be present in a proportion of hospitalized general medical patients without UTI or ASB. Clinical judgment is essential in interpreting the significance of abnormal urinalysis reports.

Background: Indwelling urinary catheters (IUCs) are commonly used in hospitalized patients, but often for inappropriate indications. Aims: We aimed to study the appropriateness of IUC insertion among patients admitted under the department of medicine in a tertiary care hospital in southern India. We also studied the proportion of patients in whom the continued use of IUC was unjustified. Methods: During June–August 2019, we prospectively studied adult patients admitted to the emergency and medicine wards in whom an IUC was inserted in the past 48 hours. Appropriateness of catheter use was determined based on predefined criteria. Results: We studied 132 patients; 96 (72%) were male. IUC insertion was found to be inappropriate in 16 (12%) patients. The most common reason for inappropriate use was placing an IUC to monitor urine output in noncritically-ill patients (50%, 8/16). Of the 74 patients with appropriate indications for IUC insertion who were followed up, continued use of IUC was found inappropriate in 23 (31%) patients. In patients without appropriate indications for continued IUC use, the catheter remained in situ longer for a mean duration of 2.9 (95% confidence interval 1.0–4.7) days. Conclusion: More than one in ten IUC insertions were found to be inappropriate. Even when the insertion was appropriate, IUCs were not removed in time in about a third of patients. Institutional policies and physician engagement are urgently needed to promote the appropriate use of IUCs.

Background: Shawarma, a popular meat-based fast food could be a source of foodborne outbreak due to non-typhoidal Salmonella (NTS). A clustering of acute gastrointestinal (GI) illness following intake of chicken shawarma occurred primarily among the staff and students of a tertiary care hospital in southern India. Methods: A case-control study was conducted among 348 undergraduate medical students (33 cases, 315 controls). Data was collected using direct interviews and a simple online questionnaire. Epidemiological associations of GI illness were evaluated at three levels of exposure namely-eating food from any restaurant, eating food from the implicated food outlet, eating chicken shawarma from the implicated outlet. Results: Of 33 cases, 26 had consumed food from a particular food outlet, 4 from other outlets, and 3 did not report eating out. Consumption of food from the suspected food outlet was significantly associated with GI illness (odds ratio 121.8 [95% CI 28.41 to 522.66]; P

Background: Shawarma, a popular meat-based fast food could be a source of foodborne outbreak due to non-typhoidal Salmonella (NTS). A clustering of acute gastrointestinal (GI) illness following intake of chicken shawarma occurred primarily among the staff and students of a tertiary care hospital in southern India. Methods: A case-control study was conducted among 348 undergraduate medical students (33 cases, 315 controls). Data was collected using direct interviews and a simple online questionnaire. Epidemiological associations of GI illness were evaluated at three levels of exposure namely-eating food from any restaurant, eating food from the implicated food outlet, eating chicken shawarma from the implicated outlet. Results: Of 33 cases, 26 had consumed food from a particular food outlet, 4 from other outlets, and 3 did not report eating out. Consumption of food from the suspected food outlet was significantly associated with GI illness (odds ratio 121.8 [95% CI 28.41 to 522.66]; P

BackgroundLocal envenomation following snakebites is accompanied by thermal changes, which could be visualized using infrared imaging. We explored whether infrared thermal imaging could be used to differentiate venomous snakebites from non-venomous and dry bites.MethodsWe prospectively enrolled adult patients with a history of snakebite in the past 24 hours presenting to the emergency of a teaching hospital in southern India. A standardized clinical evaluation for symptoms and signs of envenomation including 20-minute whole-blood clotting test and prothrombin time was performed to assess envenomation status. Infrared thermal imaging was done at enrolment, 6 hours, and 24 hours later using a smartphone-based device under ambient conditions. Processed infrared thermal images were independently interpreted twice by a reference rater and once by three novice raters.FindingsWe studied 89 patients; 60 (67%) of them were male. Median (IQR) time from bite to enrolment was 11 (6.5-15) hours; 21 (24%) patients were enrolled within 6 hours of snakebite. In all, 48 patients had local envenomation with/without systemic envenomation, and 35 patients were classified as non-venomous/dry bites. Envenomation status was unclear in six patients. At enrolment, area of increased temperature around the bite site (Hot spot) was evident on infrared thermal imaging in 45 of the 48 patients with envenomation, while hot spot was evident in only 6 of the 35 patients without envenomation. Presence of hot spot on baseline infrared thermal images had a sensitivity of 93.7% (95% CI 82.8% to 98.7%) and a specificity of 82.9% (66.3% to 93.4%) to differentiate envenomed patients from those without envenomation. Interrater agreement for identifying hot spots was more than substantial (Kappa statistic >0.85), and intrarater agreement was almost perfect (Kappa = 0.93). Paradoxical thermal changes were observed in 14 patients.ConclusionsPoint-of-care infrared thermal imaging could be useful in the early identification of non-venomous and dry snakebites.

Background: Frequent asymptomatic involvement of the prostate has been demonstrated in men with febrile urinary tract infection (fUTI). In view of this, men with fUTI are often given a longer duration of antibiotic treatment; however, evidence to support this is limited. Methods: We prospectively studied adult men with fUTI admitted under the Department of Medicine in a tertiary care hospital in southern India. fUTI was defined as fever of ≥38°C with at least one symptom/sign of UTI and pyuria, requiring hospitalization. We estimated serum total prostate-specific antigen (PSA) levels at enrollment, one month and three months after treatment completion. We assessed prostatic volume by transrectal ultrasonography (TRUS) and estimated the serum high sensitivity C-reactive protein (hs-CRP) levels at baseline and after three months. Results: We enrolled 64 men (median [IQR] age 53 [45-60] years); 50 patients completed follow-up. At baseline, 24 (38%) of 64 patients had elevated serum PSA values compared to age-specific upper limit. The median (IQR) serum PSA level was 2.15 (1.18-3.02) ng/mL and median (IQR) serum hs-CRP level was 2.23 (1.85-2.74) mg/dL (N=64). At three months, serum PSA levels decreased by ≥25% in 47 (94%) of 50 patients. The median (IQR) of prostatic volume was 25.4 (18.9-34) mL at baseline (N=64), and ≥10% decrease in prostatic volume was observed in 24 (48%) of 50 patients at three months. The change in the serum PSA levels did not correlate with clinical findings like prostatic tenderness or with prostatic volume changes. Further, serum PSA levels did not correlate with hs-CRP levels. On follow-up, seven patients had lower urinary tract symptoms; only one of them had recurrent fUTI. Conclusions: Asymptomatic prostatic involvement, although common in men with fUTI, does not seem to influence the treatment outcomes.

Abstract Objective Gastro-esophageal reflux disease (GERD) affects all age groups, and various lifestyle as well as psychological factors are recognized as risk factors for GERD. Undergraduate medical students are exposed to lifestyle changes and psychological stressors. We aimed to study the prevalence of GERD among undergraduate students of a medical school in southern India in a cross-sectional survey using a validated symptom score. Results A total of 358 undergraduate medical students participated in the study. There were 188 (52.5%) males and 170 (47.4%) females; the mean (SD) age of the participants was 20.3 (1.5) years. A total of 115 (31.2%) participants had at least one episode of heartburn per week, while 108 (30.1%) participants had at least one episode of regurgitation per week. Heartburn or regurgitation of at least mild severity was present in 115 (32.1%) and 108 (30.16%) of participants respectively. Based on the symptom score, a diagnosis of GERD was made in 18 (5.02%) students. Frequent consumption of carbonated drinks (OR = 3.63 [95% CI 1.39–9.5]; P = 0.008) and frequent consumption of tea or coffee (OR = 4.65 [95% CI 1.2–17.96]; P = 0.026) were significantly associated with a diagnosis of GERD.

ObjectivePrevious studies on diagnostic accuracy of dipstick testing for leukocyte esterase (LE) and nitrite to diagnose urinary tract infection (UTI) had used urine culture, which is an imperfect gold standard. Estimates of diagnostic accuracy obtained using the classical gold standard framework might not reflect the true diagnostic accuracy of dipstick tests.MethodsWe used the dataset from a prospective, observational study conducted in the emergency department of a teaching hospital in southern India. Patients with a clinical suspicion of UTI underwent dipstick testing for LE and nitrite, urine microscopy, and urine culture. Based on the results of urine microscopy and culture, UTI was classified into definite, probable, and possible. Patients with microscopic pyuria and a positive urine culture were adjudicated as definite UTI. Unequivocal imaging evidence of emphysematous pyelonephritis or perinephric collections was also considered definite UTI. We estimated the diagnostic accuracy of LE and nitrite tests using the classical analysis (assuming definite UTI as gold standard) and two different Bayesian latent class models (LCMs; 3-tests in 1-population and 2-tests in 2-populations models).ResultsWe studied 149 patients. Overall, 64 (43%) patients had definite, 76 (51%) had probable, and 2 (1.3%) had possible UTI; 7 (4.6%) had alternate diagnoses. In classical analysis, LE was more sensitive than nitrite (87.5% versus 70.5%), while nitrite was more specific (24% versus 58%). The 3-tests in 1-population Bayesian LCM indicated a substantially better sensitivity and specificity for LE (98.1% and 47.6%) and nitrite (88.2% and 97.7%). True sensitivity and specificity of urine culture as estimated by the model was 48.7% and 73.0%. Estimates of the 2-tests in 2-populations model were in agreement with the 3-tests in 1-population model.ConclusionsBayesian LCMs indicate a clinically important improvement in the true diagnostic accuracy of urine dipstick testing for LE and nitrite. Given this, a negative dipstick LE would rule-out UTI, while a positive dipstick nitrite would rule-in UTI in our study setting. True diagnostic accuracy of urine dipstick testing for UTI in various practice settings needs reevaluation using Bayesian LCMs.

OBJECTIVE:To evaluate whether stopping the effective antibiotic treatment following clinical improvement at Day 7 (Truncated treatment) would be non-inferior to continued treatment until Day 14 (Continued treatment) in patients with acute pyelonephritis (APN) requiring hospitalization treated with non-fluoroquinolone (non-FQ) antibiotics. METHODS:Hospitalized adult men and non-pregnant women with culture-confirmed APN were eligible for participation after they had clinically improved following empirical or culture-guided treatment with intravenous non-FQ antibiotic(s). We excluded patients with severe sepsis, abscesses, prostatitis, recurrent or catheter-associated urinary tract infection, or urinary tract obstruction. We randomized eligible patients on Day 7 of effective treatment and assessed them at Weeks 1 and 6 after treatment completion. The primary outcome was retreatment for recurrent urinary tract infection. The prespecified non-inferiority margin was 15%. RESULTS:Between March 17, 2015 and August 22, 2016, we randomly allocated 54 patients-27 patients in each arm. Twenty-four (44%) patients were male, and 26 (48%) had diabetes mellitus. Escherichia coli was the most common urinary isolate (47 [87%] patients); 36 (78%) were resistant to ciprofloxacin. In all, 41 (76%) patients received amikacin-based treatment. At the end of 6 weeks, no patient in the truncated treatment arm required retreatment, whereas 1 patient in the continued treatment arm was retreated. Difference (90% CI) in retreatment was -3.7% (-15.01% to 6.15%). Upper bound of the difference (6.15%) was below the prespecified limit, establishing non-inferiority of truncated treatment. Asymptomatic bacteriuria at Week 6 was similar between the two arms (3/24 vs. 3/26; P = 1.0). Patients in the truncated treatment arm had significantly shorter hospital stay (8 [7-10] vs. 14 [14-15] days; P < 0.001) and less antibiotic consumption per patient (8.4 ± 2.8 vs. 17.4 ± 8.3 DDDs; P < 0.001). CONCLUSION:Stopping the effective non-FQ antibiotics following clinical improvement at Day 7 is non-inferior to continued treatment until Day 14 in selected patients with APN requiring hospitalization. TRIAL REGISTRATION:Clinical Trials Registry-India; CTRI/2016/04/006810.

Mechanical ventilation is a resource intensive organ support treatment, and historical studies from low-resource settings had reported a high mortality. We aimed to study the outcomes in patients receiving mechanical ventilation in a contemporary low-resource setting.We prospectively studied the characteristics and outcomes (disease-related, mechanical ventilation-related, and process of care-related) in 237 adults mechanically ventilated for a medical illness at a teaching hospital in southern India during February 2011 to August 2012. Vital status of patients discharged from hospital was ascertained on Day 90 or later.Mean age of the patients was 40 ± 17 years; 140 (51%) were men. Poisoning and envenomation accounted for 98 (41%) of 237 admissions. In total, 87 (37%) patients died in-hospital; 16 (7%) died after discharge; 115 (49%) were alive at 90-day assessment; and 19 (8%) were lost to follow-up. Weaning was attempted in 171 (72%) patients; most patients (78 of 99 [79%]) failing the first attempt could be weaned off. Prolonged mechanical ventilation was required in 20 (8%) patients. Adherence to head-end elevation and deep vein thrombosis prophylaxis were 164 (69%) and 147 (62%) respectively. Risk of nosocomial infections particularly ventilator-associated pneumonia was high (57.2 per 1,000 ventilator-days). Higher APACHE II score quartiles (adjusted HR [95% CI] quartile 2, 2.65 [1.19-5.89]; quartile 3, 2.98 [1.24-7.15]; quartile 4, 5.78 [2.45-13.60]), and new-onset organ failure (2.98 [1.94-4.56]) were independently associated with the risk of death. Patients with poisoning had higher risk of reintubation (43% vs. 20%; P = 0.001) and ventilator-associated pneumonia (75% vs. 53%; P = 0.001). But, their mortality was significantly lower compared to the rest (24% vs. 44%; P = 0.002).The case-mix considerably differs from other settings. Mortality in this low-resource setting is similar to high-resource settings. But, further improvements in care processes and prevention of nosocomial infections are required.

Solar-light driven reduction of CO 2 to CH 4 is a complex process involving multiple electron and proton transfer processes with various intermediates. Therefore, achieving high CH 4 activity and selectivity remains a significant challenge. Covalent organic frameworks (COFs) represent an emerging class of photoactive semiconductors with molecular level structural tunability, modular band gaps, and high charge carrier generation and transport within the network. Here, we developed a new heterocyclic triazole ring containing COF, TFPB-TRZ, through the condensation reaction between 1,3,5-tris(4-formylphenyl)benzene (TFPB) and 3,5-diamino-1,2,4-triazole (TRZ). The TFPB-TRZ COF with multiple heteroatoms shows suitable visible light absorption, high CO 2 uptake capability and an appropriate band diagram for CO 2 photoreduction. Photocatalysis results reveal a maximum CO 2 to CH 4 conversion of 2.34 mmol g -1 with a rate of 128 μmol g -1 h -1 and high selectivity (∼99%) using 1-benzyl-1,4-dihydronicotinamide (BNAH) and triethylamine (TEA) as sacrificial agents. Under similar reaction conditions in the presence of direct sunlight, the TFPB-TRZ COF displays a maximum CH 4 yield of 493 μmol g -1 with a rate of 61.62 μmol g -1 h -1 , suggesting the robustness and light-harvesting ability of the COF photocatalyst. A femtosecond transient absorption (TA) spectroscopy study shows fast decay of excited state absorption (ESA) in the COF compared to the TFPB building unit due to efficient electron transfer to the catalytic site in the framework. The mechanism of CO 2 reduction to CH 4 is studied by DFT-based theoretical calculation, which is further supported by an in situ diffuse reflectance infrared Fourier transform spectroscopic (DRIFTS) study. The DFT results reveal that the lone pair of electrons on nitrogen heteroatoms present in the triazole ring of the TRZ moiety help in the stabilization of the CO intermediate during CO 2 to CH 4 conversion. Overall, this work demonstrates the use of a metal-free, recyclable COF-based photocatalytic system for solar energy storage by CO 2 reduction., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Hydatid disease is a zoonotic parasitic infestation caused by tapeworms, particularly Echinococcus granulosus . The lung is the second most site followed by liver accounting for 10%-30% of the cases. Rupture of hydatid cyst can occur into pleura or bronchus. Surgery remains the mainstay of treatment for pulmonary hydatid., Competing Interests: None declared., (© 2024 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.)

Microplastics (MP), small plastic particles under 5 mm, are pollutants known to carry heavy metals in ecosystems. Composts are a significant source of soil microplastics. This study examined MSW composts from Kochi and Kozhikode in India for microplastic concentrations and heavy metals' accumulation thereon. Microplastics were isolated using zinc chloride density separation, with Fenton's reagent used for organic matter oxidation. Resin types were identified using FTIR analysis that showed the presence of PE, PP, PS, nylon, PET, and allyl alcohol copolymer. In Kozhikode's compost, the average concentration of microplastics was 840 ± 30 items/kg, while Kochi had 1600 ± 111 items/kg, mainly polyethylene films. PE was the most prevalent resin, comprising 58.3% in Kozhikode and 73.37% in Kochi. Heavy metal analysis of MP showed significant concentrations of lead, cadmium, zinc, copper, and manganese adsorbed on the surface of microplastics. The concentrations of heavy metals in the MP before Fenton oxidation ranged from 1.02 to 2.02 times the corresponding concentrations in compost for Kozhikode and 1.23 to 2.85 times for Kochi. Source apportionment studies revealed that 64% of microplastics in Kozhikode and 77% in Kochi originated from single-use plastics. Ecological risk indices, PLI and PHI, showed that composts from both locations fall under hazard level V. The study revealed that compost from unsegregated MSW can act as a significant source of microplastics and heavy metals in the soil environment, with single-use plastics contributing major share of the issue., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Rehabilitation of lower limb amputation in developing countries is quite challenging. Though there are basic to highly advanced prostheses available in India, the set-up is still facing difficulties in developing countries. Prosthetic management is difficult due to lack of availability of prostheses and reduced affordability among low income populations. In this review we highlighted the lower limb amputation and prosthetic rehabilitation status in India. Currently, India is advancing well in the rehabilitation field, but further studies are required to provide more evidence and recommendation., Competing Interests: Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: It was observed that post-COVID patients reported persistent exertional dyspnea, cough, fatigue, or chest pain. About 10%-20% of patients may progress to pulmonary fibrosis. Pulmonary rehabilitation has been proven to be useful in improving effort tolerance and quality of life in chronic respiratory diseases., Objectives: The objective of this study was to assess the effectiveness of pulmonary rehabilitation in improving 6-min walk distance (6 MWD), peak flow, fatigue, anxiety, and depression in early postacute COVID disease., Materials and Methods: This quasi-experimental study was conducted during January 2021 to March 2021. The patients who recovered from COVID-19 and having persistent exertional dyspnea and fatigue after 3 weeks of recovery were included in the study. Baseline and postintervention assessment of 6 MWD, Visual Analog Scale for Fatigue (VAS-F), peak flow, and Hamilton rating scales (HAM) scales after 4 weeks were done. Compliance was ensured with weakly telemonitoring., Results: Significant improvement in peak flow, 6 MWD, Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), and VAS-F (P < 0.01) after 4 weeks of pulmonary rehabilitation., Conclusion: Early pulmonary rehabilitation in post-COVID syndrome can contribute to statistically significant improvement in functional and psychological parameters as well as post-COVID fatigue., Competing Interests: None

Background: The change in FEV 1 after administration of a short-acting bronchodilator has been widely used for diagnosis of obstructive airway diseases. Many factors can influence the post bronchodilator reversibility., Aim: The aim of the present study was to estimate the presence of reversibility among the patients of obstructive airway disease and to identify the factors affecting it., Methods: Patients who presented to the department of respiratory medicine with symptoms of dyspnea were evaluated with spirometry. Spirometry and post bronchodilator reversibility (BDR) was defined as per international guidelines. SPSS 17 was used for statistical analysis and P < 0.05 was considered significant., Results: Out of 100 patients studied, 33 had BDR. Median age of the population was 58 ± 17 years. There were 72 non-smokers and 58 men. A total of 32 had chronic obstructive pulmonary disease (COPD), 56 had asthma, and 12 had normal spirometry. The median pre and post bronchodilator FEV1 was 1.34L/Sec and 1.46 L/sec respectively. Twenty-seven of asthma (41%) and 6 of COPD (19%) had BDR (P = 0.05). Other factors associated with BDR were smoking (P = 0.035). There was no statistically significant correlation found between eosinophilia, gender, severity of obstruction, BMI, height, weight and age., Conclusion: The prevalence of post BDR in the study population was 33%. The factors affecting BDR were smoking status, and asthma. The study did not show any significant correlation between BDR and eosinophilia, gender, height and age., Competing Interests: None

Astrocytes extend endfeet that enwrap the vasculature, and disruptions to this association which may occur in disease coincide with breaches in blood-brain barrier (BBB) integrity. Here we investigate if focal ablation of astrocytes is sufficient to disrupt the BBB in mice. Targeted two-photon chemical apoptotic ablation of astrocytes induced a plasticity response whereby surrounding astrocytes extended processes to cover vascular vacancies. In young animals, replacement processes occur in advance of endfoot retraction, but this is delayed in aged animals. Stimulation of replacement astrocytes results in constriction of pre-capillary arterioles, suggesting that replacement astrocytes are functional. Pharmacological inhibition of pSTAT3, as well as astrocyte specific deletion of pSTAT3, reduces astrocyte replacement post-ablation, without perturbations to BBB integrity. Similar endfoot replacement occurs following astrocyte cell death due to reperfusion in a stroke model. Together, these studies uncover the ability of astrocytes to maintain cerebrovascular coverage via substitution from nearby cells., (© 2022. The Author(s).)

Amyloid β (Aβ) is a peptide known to form amyloid fibrils in the brain of patients suffering from Alzheimer's disease. A complete mechanistic understanding how Aβ peptides form neurotoxic assemblies and how they kill neurons has not yet been achieved. Previous analysis of various Aβ 40 mutants could reveal the significant importance of the hydrophobic contact between the residues Phe 19 and Leu 34 for cell toxicity. For some mutations at Phe 19 , toxicity was completely abolished. In the current study, we assessed if perturbations introduced by mutations in the direct proximity of the Phe 19 /Leu 34 contact would have similar relevance for the fibrillation kinetics, structure, dynamics and toxicity of the Aβ assemblies. To this end, we rationally modified positions Phe 20 or Gly 33 . A small library of Aβ 40 peptides with Phe 20 mutated to Lys, Tyr or the non-proteinogenic cyclohexylalanine (Cha) or Gly 33 mutated to Ala was synthesized. We used electron microscopy, circular dichroism, X-ray diffraction, solid-state NMR spectroscopy, ThT fluorescence and MTT cell toxicity assays to comprehensively investigate the physicochemical properties of the Aβ fibrils formed by the modified peptides as well as toxicity to a neuronal cell line. Single mutations of either Phe 20 or Gly 33 led to relatively drastic alterations in the Aβ fibrillation kinetics but left the global, as well as the local structure, of the fibrils largely unchanged. Furthermore, the introduced perturbations caused a severe decrease or loss of cell toxicity compared to wildtype Aβ 40 . We suggest that perturbations at position Phe 20 and Gly 33 affect the fibrillation pathway of Aβ 40 and, thereby, influence the especially toxic oligomeric species manifesting so that the region around the Phe 19 /Leu 34 hydrophobic contact provides a promising site for the design of small molecules interfering with the Aβ fibrillation pathway.

Objective: Urinary tract infection (UTI) is a common cause of morbidity and hospitalisation in the population worldwide. Upper UTI is indolent and causes subclinical acute kidney injury (AKI) resulting in preventable cause of scarring of renal parenchyma. We explored urinary and serum levels of kidney injury molecule-1 (KIM-1), haematological parameters and quantitative urine microscopy parameters to predict kidney injury., Methods: Neutrophil-lymphocyte ratio (NLR) is obtained by dividing absolute neutrophil count with absolute lymphocyte count. Quantitative urine sediment microscopy was performed and correlated with clinical, biochemical and haematological findings to predict AKI in patients with UTI. Quantitative ELISA was performed for serum and urine levels of KIM-1. Seventy two adult patients with UTI were enrolled, 45 of whom had AKI while 27 were in the non-AKI group., Results: NLR ( p =0.005) and renal tubular epithelial cell-granular cast score in quantitative urine microscopy ( p =0.008) are strong predictors of AKI in patients with UTI while rest of quantitative urine microscopy parameters and serum and urinary levels of KIM-1 molecule were not found to be useful in prediction of AKI., Conclusion: NLR in haemogram is a novel and useful biomarker for predicting AKI in patients with UTI., Competing Interests: The authors declare no conflict of interest., (© 2021 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V.)

A 41-year-old woman presented with paresthesia and inability to walk for 7 days. She had history of fatigue, polyarthralgia and difficulty in swallowing food for the last 1 year. She became edentulous over the last 5 years and wore dentures for the same. She appeared pale, emaciated and had oral thrush. She had areflexic quadriparesis with weakness more in lower limbs compared with upper limbs. With the initial diagnosis of Guillian-Barre syndrome, she was given five cycles of plasmapheresis following which there was a significant improvement in power. Sjogren's syndrome was suspected based on edentulous state in a middle-aged woman with multisystem involvement. Evaluation with Schirmer's test, parotid scintigraphy and labial minor salivary gland biopsy confirmed the diagnosis. She was treated with steroids following which a dramatic improvement in haemoglobin and total leucocyte count was noted. We report a varied presentation of primary Sjogren's syndrome., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

A 16-years-old girl presented to our institution with history of severe bilateral headache for 5 days associated with vomiting. She also had fever for 2 months without any localising symptoms and skin lesions for 1 month. Examination revealed erythematous rash over bridge of nose and ear lobes, ulcer over hard palate and tenderness of small joints of both hands. Systemic examination was unremarkable except for bilateral papilloedema. Investigations revealed anaemia, leucopenia and elevated erythrocyte sedimentation rate. Cranial imaging revealed diffuse pachymeningeal enhancement with subdural effusion. Lumbar puncture revealed no abnormal findings in cerebrospinal fluid except low opening pressure. Antinuclear antibody was 4+ with anti-Sm antibody positive. She was diagnosed to have spontaneous intracranial hypotension associated with pachymeningeal enhancement secondary to s y stemic lupus erythematosus. She showed dramatic improvement with steroid and azathioprine therapy. She continues to be asymptomatic after 2 years of follow-up., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)