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The Gallbladder Reporting and Data System (GB-RADS) ultrasound (US) risk stratification is proposed to improve consistency in US interpretations, reporting, and assessment of risk of malignancy in gallbladder wall thickening in non-acute setting. It was developed based on a systematic review of the literature and the consensus of an international multidisciplinary committee comprising expert radiologists, gastroenterologists, gastrointestinal surgeons, surgical oncologists, medical oncologists, and pathologists using modified Delphi method. For risk stratification, the GB-RADS system recommends six categories (GB-RADS 0–5) of gallbladder wall thickening with gradually increasing risk of malignancy. GB-RADS is based on gallbladder wall features on US including symmetry and extent (focal vs. circumferential) of involvement, layered appearance, intramural features (including intramural cysts and echogenic foci), and interface with the liver. GB-RADS represents the first collaborative effort at risk stratifying the gallbladder wall thickening. This concept is in line with the other US-based risk stratification systems which have been shown to increase the accuracy of detection of malignant lesions and improve management. Graphical abstract: [Figure not available: see fulltext.].

Background: A point-of-care diagnostic test for acute pancreatitis could help in early triage and management of this condition. Materials & methods: Urine trypsinogen dipstick test (UTDT) was performed in consecutive cases suspected to have acute pancreatitis and diagnostic accuracy calculated. Results: Of 187 patients, 90 were have acute pancreatitis and UTDT was positive in 61 (67.7%). In the 97 non pancreatitis cases, UTDT was positive in nine (9.3%). The sensitivity and specificity of UTDT for acute pancreatitis was 67.8% and 90.7%, respectively. In patients presenting within 3 days of abdominal pain, sensitivity and specificity were 72.7% and 91.8%, respectively. Discussion: While offering the possibility of a point of care diagnosis, the low sensitivity of UTDT could be a concern with its routine use.

BACKGROUND Chyle leak is a rare but morbid complication of esophagectomy. We assessed the feasibility of visualization and prophylactic ligation of the opacified thoracic duct (TD) after administration of 50 ml of olive oil. METHODS This prospective single center study considered all patients with carcinoma of the middle and lower thirds of the thoracic esophagus including the gastroesophageal junction (GEJ), managed from January 2018 to December 2019, for inclusion. All patients underwent McKeown minimally invasive esophagectomy. After anesthesia and endotracheal intubation, 50 ml of olive oil was administered through a nasogastric (NG) tube. During thoracoscopic esophageal mobilization, the opacified thoracic duct was identified and ligated using Weck Hem-o-lok clips immediately above the diaphragmatic hiatus. Postoperatively, the nature, volume, and triglyceride levels of the fluid from the chest drain were recorded. RESULTS Forty-three patients with carcinoma of the esophagus were assessed for inclusion and eventually, 33 were enrolled. The median age of the study population was 55 years, and there were 20 males. The tumor site was the lower esophagus in 24 (72.7%) patients. The most common histolopathological finding was squamous cell carcinoma (97%). The opacified thoracic duct could be identified and ligated in 31 (93.9%) patients. The median duration from the administration of olive oil to the ligation of the thoracic duct was 100 min. The median chest drain output and triglyceride levels on postoperative day (POD) one were 250 ml and 48 mg% respectively. No patient developed postoperative chylothorax. CONCLUSION Opacification and visualization of the thoracic duct during thoracoscopy can be aided by administering olive oil. Ligation of this opacified duct is feasible and safe.

Offline handwritten character recognition is a part of the arduous area of research in the domain of document analysis and recognition. In order to enhance the recognition results of offline handwritten Gurumukhi characters, the authors have applied hybrid features and adaptive boosting approach in this paper. On feature extraction stage, zoning, diagonal, centroid, and peak extent-based features have been taken into account for extracting the meaningful information about each character. On the classification stage, three classifiers, namely decision tree, random forest, and convolution neural network classifier, are used. For experimental work, the authors have collected 14,000 pre-segmented samples of Gurumukhi characters (35-class problem) written by 400 writers where they have used 70% data as training set and remaining 30% data as testing set. The authors have also explored fivefold cross-validation technique for experimental work. The AdaBoost approach along with the fivefold cross-validation strategy outstands the existing techniques in the relevant field with the recognition accuracy of 96.3%.

With the rapidly increase of population every day, it has become a major issue to fulfill everyone’s need for food products (i.e., vegetables, fruits, milk, wheat, etc.) due to limited production of food products. Moreover, healthy food utilization among people is the foremost requirement. The major factors that affect the food system includes increasing food shortage, decreasing quality, wastage, and loss of food products, limited natural resources, etc. This article addresses the various computer vision and machine learning based techniques, used to minimize the aforementioned issues. Image processing has become an effective technique for the analysis of many research applications. This study intends to focus on analysis of image processing based applications in food products and agriculture field. Such applications help in decision making , disease prediction, classification, fruit sorting, soil quality measurement, etc. Moreover, a comprehensive review has been accomplished for various computer vision and statistical approaches used in food production and agricultural field and concludes that Deep Learning (DL) based approaches produce better results, specifically for image processing applications. Additionally, an effort has been made to provide a list of publicly available datasets for the related study.

Formation of Gurmukhi character/akshara from the recognized strokes in online handwriting recognition systems is a challenging task. In this paper, the task of character and akshara formation in an unconstrained environment have been addressed. After the recognition of online handwritten strokes the Gurmukhi akshara is formed using a hybrid approach. Two classifiers, namely, Support Vector Machine (SVM) and Recurrent Neural Network (RNN) have been experimented in this study. The classifier, yielded the maximum cross-validation accuracy has been utilized for stroke recognition. A total of 52,500 word samples have been collected from 175 writers in order to train the classifiers. Three post processing algorithms have been proposed in this article for improving the character and akshara recognition accuracy. The proposed methodology when tested on a dataset of 21,500 aksharas, written by 50 new writers, achieved average the accuracy rate of 97.1% and 87.1% for base character and akshara recognition, respectively.

Transhiatal esophagectomy (THE) was popularized to reduce the morbidity of esophagectomy. Thoracoscopy-assisted esophagectomy (TAE) offers esophageal dissection under magnified vision. This study compares the short-term morbidity and oncological outcome following TAE and THE for esophageal carcinoma. This is a prospective comparative (January 2017–May 2018) study between TAE and THE for >cT1bN1 esophageal carcinoma. After neoadjuvant chemoradiotherapy (NACRT), responders and patients with stable diseases were subjected to surgery. Thoracoscopy in esophagectomy was performed in prone position. Follow-up duration was at least 4 weeks post-discharge. Thirty-three patients of esophageal carcinoma undergoing TAE (n = 18) or THE (n = 15) were included. Common locations of tumor were lower third of esophagus (72.7%) and esophagogastric junction (18.2%). Majority (73.3%) had squamous cell carcinoma. Median interval between NACRT and surgery was 13 weeks. The mean operating time was significantly more with TAE than THE (292.5 vs 207.33 min, p = 0.005). R0 resection rate in TAE was 83.3% compared with 66.7% in THE. There was no difference in the lymph node yield. There was non-significant trend towards lower incidence of major pulmonary complication (66.7% vs 80.0%), cardiac complications (27.8% vs 46.7%), anastomotic leak (27.8% vs 46.7%), recurrent laryngeal nerve palsy (16.7% vs 20.0%), and overall major morbidity (Clavien-Dindo ≥ III) (44.4% vs 66.7%) in TAE than THE. The chyle leak was observed more in TAE (16.7%) than THE (6.7%). TAE achieved higher R0 resection rate and better short-term morbidity than THE. Enrollment of small number of cases in the study precluded statistical significance. This study was registered in Clinical Trial Registry-India (CTRI registration no: CTRI/2018/05/013880) in 14-05-2018.

Handwriting recognition is one of the challenging tasks in the area of pattern recognition and machine learning. This paper presents the recognition of Online handwritten basic characters of Gurmukhi, an Indian script used by more than 100 million individuals. There are 41 basic characters (i.e., Consonants) in Gurmukhi and we have used a primary dataset of 52,570 Gurmukhi words, written by 175 different individuals. A total of 81 stroke-classes have been identified to represent the 41 basic characters. The handwritten data is stored and annotated at stroke-level. In order to train the classifier, we have taken 150–170 average samples of each identified stroke-class. After performing the training/testing experiments, an accuracy of 98.67% has been achieved for stroke classification using RNN classifier and 90.93% obtained as testing accuracy.

Optimization of process steam requirement in order to maximize sugar recovery and export power along with manpower optimization is a must for sugar factories to survive under difficult conditions and to earn additional revenues. The process steam demand of greenfield and revamped plants has been reduced to levels of 32–38% from originally more than 50% steam on cane in the case of the brownfield plants. In addition, significant improvement in the power requirement of the plants has been achieved. Bagasse drying offers a good potential to improve the power export. Different available concepts are compared with a focus on bagasse steam drying and low temperature bagasse drying. In order to set up an optimized highly efficient plant or to optimize an existing plant to achieve competitive benchmarks, good process design and the right equipment selection are very important. Experience has been gained with multiple stage or double effect crystallization in the beet sugar industry offering further steam optimization potential. Vapour recompression is also an option to substitute live steam by electrical power. This even provides options to reduce the steam demand from the power plant for the sugar process down to zero. Key aspects concerning the process design and equipment selection are described.

Evaluation of a combination of antibiotics as an adjuvant therapy in acute severe ulcerative colitis (ASUC). Patients with ASUC were randomized to either infusions of placebo or intravenous ceftriaxone and metronidazole in addition to standard care. Primary outcome was response on day three according to Oxford���s criteria. Secondary outcome measures included changes in partial Mayo score, CRP levels, fecal calprotectin (day three), and need for second-line therapy, hospital stay, and mortality (day 28). Fifty patients (25 in each group, median age: 33 years, 23 males) were included. The number of patients with fulminant disease in the antibiotic group were 16 (64%) as compared to 7 (28%) in the standard of care group. Complete response on day three was attained by 7 (28%) in the antibiotic and 6 (24%) standard of care group (p = 1.00). Three patients from the antibiotic group underwent colectomy and three received intravenous cyclosporine whereas four patients in the standard of care group received cyclosporine (p = 0.725). There was no significant difference in change in CRP, Partial Mayo score, and fecal calprotectin between the two groups on day three. Combination of intravenous ceftriaxone and metronidazole did not improve outcomes in ASUC. Acronym: AAASUC trial Registration Number: CTRI/2019/03/018196 and NCT03794765

Background Majority of predictors of postoperative pancreatic fistula (POPF) use intraoperative variables. We aimed to study the role of preoperative ultrasound shear wave elastography (USWE) to predict POPF. Methods The consecutive patients who underwent pancreaticoduodenectomy (PD) between January 2019 to March 2020 were prospectively enrolled. All patients underwent USWE assessment at the pancreatic neck level. Intraoperative variables including pancreatic texture, pancreatic duct diameter, blood loss and histological grading of fibrosis were also recorded. Associations between USWE and intraoperative variables and histological grading with the development of POPF were analyzed. Results Of the 62 patients assessed, 50 patients (mean age: 53 ± 14 years; 31 males) were included. POPF and clinically relevant POPF (CRPOPF) were observed in 22 (44%) and 7 (14%) patients respectively. Soft pancreas was an independent predictor of CRPOPF (p = 0.04). The mean USWE valve was significantly lower in patients with CRPOPF as compared to no CRPOPF (9.7 Kpa vs. 12.8Kpa, p = 0.016). At receiver operating characteristic curve analysis, USWE value of 12.65Kpa yielded sensitivity and specificity of 100% and 47%, respectively, for prediction of CRPOPF. USWE showed significant correlation with intraoperative pancreatic texture (Spearman’s rank correlation coefficient (ρ) = 0.565, p = 0.001). Conclusion USWE helps in preoperative prediction of CRPOPF. This may further help to customize management strategy in high risk patients.

Myopia (nearsightedness) is a vision disorder with a blurring of far objects, affect millions worldwide. 7-methylxanthine (7-MX) is a molecule that is presently under clinical investigation for the treatment of myopia. In the present study, we have investigated sub-chronic and chronic toxicity of 7-MX in comparison to other clinically used methylxanthines i.e., caffeine and theobromine as per OECD guidelines 408 and 452. 7-MX was administered orally for 90 days at three different doses of 250, 500, and 1000 mg/kg for sub-chronic toxicity evaluation, and at a limit dose of 1000 mg/kg in 180 days chronic toxicity evaluation in rats. In sub-chronic treatment, 7-MX showed no mortality and signs for toxicity in any group, whereas 10% and 40% mortality with signs for toxicity were observed in caffeine and theobromine treated groups, respectively. A similar, safety profile was observed with 7-MX in 180 days of chronic toxicity study. Further, to confirm any morphological changes in organs; ultrasound and X-rays analysis were performed and no changes in the size of organs, cyst formation, fluid retention, or crystal formation was observed. Thus, the repeated dose study of 7-MX for 180 days may augment the possibility of using 7-MX clinically for the safe and effective treatment of myopia.

Background Surgical management is considered one of the effective treatment modality for liver hydatid. However the choice of surgery is debatable. This study aims to compare the outcome of radical surgery (RS) and conservative surgery (CS) in liver hydatid disease. Methods This is retrospective analysis of prospectively maintained institutional data of surgically treated liver hydatid from January 2012 to January 2019. The basis of diagnosis was typical imaging, confirmatory Hydatid serology and/or Intraoperative details. The clinical presentation, radiological data, operative detail, post-operative outcome, post-operative recurrence data was analysed. Results Sixty-four patients underwent surgery during the study period and were included. RS was done in 27 (42.2%) patients and CS in 37 (57.8%) patients. The mean age was 35.6 (13–72) years. The mean size of the cyst was 10.3 ± 2.9 cm. The cyst location was peripheral in 81.5% and 56.8% in RS and CS groups respectively. Intraoperative Cyst biliary communication was detected in 48.1% of RS & 35.1% in CS group of patients. The post-operative bile leak was significantly less in RS group (7.4% vs 27.0%, p = 0.047). Postoperative endoscopic stenting for persistent biliary fistula was necessitated in five of CS and only one patient from RS group. None of RS patients had recurrence while 3 patients of CS developed recurrence. Conclusion Radical surgery reduces post-operative bile leak and prevents recurrence and may be preferable to conservative surgery.

Introduction: The ICU in a hospital has a vital role to play in delivering prompt, appropriate and adequate care to critically ill patients. Patients in ICU are at greatest risk of acquiring device associated hospital acquired infection (DA-HAI). Infection control practices are the need of hour to control these infections. Objectives: Aim and objective of present study was to assess the role of preventive interventions in reducing the hospital acquired infection in ICU. Materials and Methods: The present study was conducted over a period of one year from November 2017 to August 2018 in the Department of Anesthesiology, Guru Nanak Dev Hospital, Amritsar. The study was conducted into pre and post interventional period to assess the role of preventive interventions in reducing the device associated acquired infections and results were statistically analysed. Results: During pre interventional study period 16/262 (6.1%) patients developed device associated infection and rate per 1000 device days was 6.25/1000. After interventions 3/132(2.27%) patients developed device associated infection and rate was significantly reduced to 2.92/1000. Conclusion: The implementation of various infection control measures to control DA-HAIs is found to be effective during study. Systematically collected data and findings of our study can be utilized in the ICU setting as a basic step toward a better infection control strategy for improving patient care practices. Keywords: ICU, DA-HAIs, Preventive interventions.

BACKGROUND Response to antitubercular therapy (ATT) is often used to differentiate intestinal tuberculosis (ITB) from Crohn's disease. Role of non-invasive biomarkers to predict mucosal response to ATT is unclear. MATERIALS AND METHODS A prospective study to compare faecal calprotectin and serum C-reactive protein (CRP) levels at diagnosis, 2 and 6 months of ATT in patients with suspected ITB started on ATT was done. The patients were eventually divided into two groups: ITB or alternative diagnosis (OTH). Decline of calprotectin and CRP levels was used to compute area under the receiver operating characteristic (AUROC) to predict mucosal healing at 2 months. RESULTS Thirty-seven patients (mean age: 34.95 ± 16.35 years, 23 males) were included and 28 (75.67%) were diagnosed as ITB while nine (24.32%) had alternative diagnosis (OTH). The median faecal calprotectin values of ITB and OTH groups at baseline, 2 months and 6 months were 216 and 282 µg/g (P = 0.466), 43 and 216 µg/g (P = 0.003), and 26 and 213 µg/g (P < 0.001), respectively. The median CRP values at baseline, 2 months and 6 months were 18 and 30 mg/L (P = 0.767), 4.7 and 15 mg/L (P = 0.025), and 3 and 10.85 mg/L (P = 0.068), respectively. The AUROC of percent decline in faecal calprotectin and serum CRP at 2 months for mucosal healing were 0.8287 [95% confidence inteval (CI) 0.6472-1] and 0.6018 (95% CI 0.4079-0.7957), respectively. CONCLUSION Faecal calprotectin can help in assessing response to therapy in suspected ITB patients started on empirical ATT.

Handwriting recognition is one of the challenging tasks in the area of pattern recognition and machine learning. Handwriting recognition has two flavors, namely, Offline Handwriting Recognition and Online Handwriting Recognition. Though, saturation level has been achieved in machine printed (Offline) character recognition. Presently, due to dramatical development in IT sector, touch-based devices are available in the market with efficient processing capabilities. With this revolution, research in the area of handwriting recognition has become more popular in real-time (Online) mode. In this paper, a comprehensive review has been reported for online handwriting recognition of non-Indic and Indic scripts. The six non-Indic-scripts and eight Indic script namely, Arabic, Chinese, Japanese, Persian, Roman, Thai, and, Assamese, Bangla, Devanagari, Gurmukhi, Kannada, Malayalam, Tamil, Telugu, respectively have been considered in this article. This study comprises introduction of online handwriting recognition process, various challenges, motivations, feature extraction, and classification methodologies, used for recognizing the various scripting languages. Moreover, an effort has been made to provide the list of publicly available online handwritten dataset for various scripting languages. This study also provides the recognition and beneficial assistance to the novice researchers in field of handwriting recognition by providing a nut shell studies of various feature extraction strategies and classification techniques, used for the recognition of both Indic and non-Indic scripts.

Pseudo-obstruction, acquired megacolon and sigmoid volvulus constitute a group of benign lower gastrointestinal disorders that present as large bowel obstruction. In the Western society, these conditions commonly affect elderly patients with multiple comorbidities, who are often institutionalized therefore posing significant management challenges. Their clinical features, diagnosis and management will be covered in this article.

Pancreatitis is one of the important medical conditions. Gastrointestinal (GI) complications of pancreatitis are important and lead to significant morbidity and mortality. Diagnosis of these complications is difficult and may require a strong clinical suspicion coupled with various imaging features. This review provides an extensive update of the whole spectrum of GI complication of pancreatitis, both acute and chronic, from inflammation, ischemia, and necrosis to obstruction, perforation, and GI fistulae. The focus is on the clinical and imaging features of this less commonly described aspect of pancreatitis., Gastrointestinal complications of pancreatitis are important and lead to significant morbidity and mortality. Diagnosis of these complications is difficult and may require strong clinical suspicion coupled with various imaging features.

In December 2019, novel severe acute respiratory syndrome coronavirus 2 (nSARS-CoV-2) virus outbreaks emerged from Wuhan, China and spread all over the world, including India. Molecular diagnosis of Coronavirus Disease 2019 (COVID) 19 for densely and highly populated country like India is time consuming. Few of reports described the successful diagnosis of nSARS-CoV-2 virus from sewage and wastewater samples contaminated with faecal matter, suggesting the diagnosis of COVID 19 from same to alarm the community transmission of virus for implementation of evacuation and lockdown strategies. So far, the association between the detection of virus and its concentration in the stool samples with the severity of the disease and the presence or absence of gastrointestinal symptoms has been rarely reported. We led the search utilizing multiple databases, specifically PubMed (Medline), EMBASE, and Google Scholar. We did the literature survey on gastrointestinal infection and the spread of this virus through faecal-oral transmission. Reports suggested that existence and persistence of nSARS-CoV-2 in anal/rectal swabs and stool specimens for longer period of time than in nasopharyngeal swabs provides strong tenable outcome of gastrointestinal contamination and dissemination of this infection via potential faecal-oral transmission. This review may be helpful to conduct the further studies to address the enteric involvement and excretion of nSARS-CoV-2 RNA in faeces and control the community spread in both COVID-19 patients ahead of onset of symptoms and in asymptomatic individuals through wastewater and sewage surveillance as an early indication of infection. The existence of viral genome and active viral particle actively participate in genomic variations. Hence, we comprehended the enteric spread of different viruses amongst communities with special reference to nSARS-CoV-2. This article is protected by copyright. All rights reserved.

Yashtimadhu Churna is one of the traditional formulations used as antacid, anti-inflammatory, anticancer, antioxidant, analgesic, anti-stress, demulcent, antibacterial and anti-asthmatic agents. The formulation mainly contains Yastimadhu (Glycyrrhiza glabra) root extract. Present study described preliminary qualitative phytochemicals analysis and chromatographic fingerprinting of Yashtimadhu Churna using HPLC and HPTLC analysis. Study also presented anti-inflammatory potential of formulation using protein denaturation method. This study helps to establish standardization parameters of Yashtimadhu Churna and also confirmed anti-inflammatory potential of formulation.

Nowadays, Deep Neural Networks are very popular for solving computer vision problems. The motivation of this study is to explore the different deep learning-based architectures used for image classification and object detection. There are various Convolutional Neural Networks(CNNs) based models that perform well for image classification where images are very similar to the dataset. But these models have certain Limitations if tilted or rotated images are processed for classification. Moreover, CNNs are unable to identify the location of different objects in an image. Therefore, to identify the location and recognize the object in the image along with bounding box information, region proposal based object detection algorithms (i.e., R-CNN, Fast R-CNN, Faster R-CNN, and Mask R-CNN) come into the picture. In these object detection algorithms, a bounding box is drawn around the object of interest to locate it within the image. This research article has explored these region-based models along with their pros and cons. Moreover, the performance and purpose of utilization for these object detection-based deep neural network has also been analyzed. Eventually, a summary is provided about these deep neural network-based architectures, where the suitability of a model(s) to solve a particular problem has been discussed.

Aim Emergency laparotomy is a common procedure associated with high risk of mortality and morbidity. NELA risk score calculation for patients undergoing emergency laparotomy improves the quality of patient care and compares the organisation of patient care provided to the outcomes following surgery. The aim of this study was to determine if NELA score was calculated and documented pre-laparotomy. Methods A retrospective analysis was conducted for patients who had emergency laparotomy at a primary care hospital in England. This study included reviewing the case notes and consent forms to assess if NELA risk score was calculated. Following further education of the surgical team, the audit loop was closed.The primary outcome was to identify not only calculation but also that the score was documented. Results Measures taken to enhance NELA risk calculation included theatre co-ordinator asking for NELA risk score while booking for laparotomy and documentation on the booking form and posters on surgical ward. Consequently, 40% notes included Scoring which improved to 70% after making the above changes. Conclusion The NELA risk score should be calculated for all patients undergoing emergency laparotomy as it estimates an individual’s risk of death within 30 days of surgery. It also standardises the risk calculation among all laparotomy patients and aids in clinical decision making, therefore is vital to be calculated in pre-operative phase. To ensure it is correctly calculated at all times, regular teaching and updates of NELA score is recommended.

Background:Solid Pseudopapillary neoplasm (SPN) is uncommon and constitutes to 1-2% of pancreatic tumors. Owing to its rarity, literature is spare on its clinicopathological characteristics and surgical outcomes.MethodsOur study is a retrospective analysis of prospectively maintained data of patients with histologically proven SPN between January,2012 and December,2019. Patients Demography, clinical presentation, preoperative imaging, operative details, perioperative outcomes and long term follow up were recorded and analyzed. ResultsA total of 14 patients were included in the study, all were females with a median age of 19.5 years (range 15 - 35 years). All presented with pain abdomen. Eight (57.1%) out of 14 patients were correctly diagnosed with Contrast enhanced computed tomography (CECT) abdomen. CECT revealed sloid cystic well encapsulated lesions in 12(85.7%) and homogenous mass lesions without cystic changes in 2(14.2%) patients. The most common tumor location was Head/uncinate process (57.1%). Eight (57.1%) underwent pancreaticoduodenectomy and 6 (42.8%) had undergone distal pancreatectomy. The mean size of tumour was 9.5cm(2.8-14cm). The median postoperative stay was 9 days(range 4-20 days). Seven patients (50%) developed post-operative pancreatic fistula (Grade-A-6/7,Grade-B-1/7) and delayed gastric emptying (DGE) were noted in two (14.2%).R0 resection could be achieved in 13 patients (92.8%). Median follow up period was 49.5 months. One patient had postoperative recurrence after 48 months of surgery.ConclusionSPN is a rare tumor of pancreas. Lack of preoperative predictors for malignant potential complete oncological resections is essential for potential cure.

The sensitivity of single abdominal paracentesis for diagnosis of peritoneal carcinomatosis in patients with malignant ascites is 40-70%. Tumor cells shed from the peritoneum settle preferentially in certain recesses of the peritoneum. We aim to compare the standard technique of abdominal paracentesis versus a rollover technique in a randomized crossover study to assess the cytological yield in patients suspected to have peritoneal carcinomatosis. Each patient will serve as their own control and the outcome assessor (cytopathologist) will be blinded to the method of paracentesis performed. The primary objective will be to compare the tumor cell positivity between the standard paracentesis group and the rollover group among enrolled patients.Lay abstract Existing methods of diagnosing cancer-related ascites are dependent on microscopic evaluation of fluid obtained from the ascites. However, this may not diagnose all such cases because the fluid may not contain many tumor cells. This may be due to the settling of tumor cells in certain inaccessible locations of the peritoneum (the lining of the abdominal cavity). This trial will look at whether rolling the patient from side to side could be helpful in increasing the chances of finding tumor cells in the ascites.

Cloud-based platforms are helping organizations like health care systems to improve conditions of patients and saving their lives. Medical professionals are making use of cloud technology to collect information regarding patients more than before and exchange it over different geographical regions. However, the exchange of patient data and information is taking place via complex systems with huge vulnerabilities and risks. In this article, the authors have outlined a model for preserving privacy in data storage used in health care systems by validating access to the data through IP based detection and geographical location-based security techniques. Later, the privacy is enabled by using k-mean clustering technique for validating the user access and avail subscriptions whenever consumer want to use the organization services. The authors also provide the concept of using constant key length encryption technique to secure data on cloud storage irrespective of the type of user.

Oligonucleotide-based therapies are advanced novel interventions used in the management of various respiratory diseases such as asthma and Chronic Obstructive Pulmonary Disease (COPD). These agents primarily act by gene silencing or RNA interference. Better methodologies and techniques are the need of the hour that can deliver these agents to tissues and cells in a target specific manner by which their maximum potential can be reached in the management of chronic inflammatory diseases. Nanoparticles play an important role in the target-specific delivery of drugs. In addition, oligonucleotides also are extensively used for gene transfer in the form of polymeric, liposomal and inorganic carrier materials. Therefore, the current review focuses on various novel dosage forms like nanoparticles, liposomes that can be used efficiently for the delivery of various oligonucleotides such as siRNA and miRNA. We also discuss the future perspectives and targets for oligonucleotides in the management of respiratory diseases., Highlights • Oligonucleotides are polynucleic acids consists of five base pairs. • They act by altering gene expression of an affected individual. • In respiratory diseases they are emerging as a newer therapy.

The present study entails the toxicity evaluation of 7-methyl xanthine (7-MX), first of its kind molecule found effective in phase II clinical trials for the treatment of myopia, in comparison to other clinically used xanthines i.e., caffeine and theobromine. For acute toxicity evaluation, 7-MX was administered orally in two rodent species (rat and mice) at the doses of 300 mg/kg and 2000 mg/kg and for repeated dose 28-d oral toxicity, at 250, 500, and 1000 mg/kg in rats. Further, cellular toxicity was evaluated in normal breast epithelial (fR2), rat brain C6 glioma (C6 glioma) and human colorectal (Caco-2) cell lines. Also, the cell uptake assay to determine the intestinal permeability of drug was performed in Caco-2 cells. In acute toxicity, 7-MX treatment showed no mortality and toxicity, whereas 66.6% (mice) and 33.3% (rat) mortality was observed in both caffeine and theobromine treatment groups. In repeated dose 28-d oral toxicity, 7-MX treatment was found to have no-observed-adverse-effect level up to the dose of 1000 mg/kg in the present study conducted as per OECD guidelines 407. Also, very high IC

Background and aim Abdominal tuberculosis is an important form of extrapulmonary tuberculosis. Evidence from clinical trials suggests that 6 months of antitubercular therapy (ATT) is sufficient for abdominal tuberculosis. Methods We report real-world experience with 6 months of ATT based on a retrospective analysis of patients with abdominal tuberculosis seen at a large tertiary care hospital in India. Results Of 101 patients, 93 with complete records were included. The mean age was 35.90 ± 14.06 years, and 53 were males (56.98%). A total of 42 patients (45.16%) had intestinal involvement, 24 (25.08%) had peritoneal, 22 (23.65%) had combined involvement, and 5 patients (5.37%) had isolated lymph nodal involvement. Six patients received prolonged ATT. Six patients developed ATT-induced hepatitis. Of 64 patients with intestinal involvement, 45 had stricturing disease (70.3%), of whom 7 (15.5%) required surgery due to refractory symptoms. Overall, there was one death, and eight patients (including one with massive gastrointestinal bleeding) needed surgery. Conclusion Six months of ATT is associated with objective clinical response in most of the patients of abdominal tuberculosis.

Background Chyle leak is an uncommon form of ascites occurring due to the accumulation of lipid-rich lymph into the peritoneal cavity. Traumatic injury to the lymphatic system due to pancreaticobiliary surgery can lead to this phenomenon. Method We retrospectively evaluated the data of 159 patients of pancreticobiliary surgery from January 2012 to December 2016. Five patients (5/137, 3.6%) sustained a chylous leak following pancreaticoduodenectomy and one patient (1/22, 4.5%) sustained a chylous leak following Roux-en-Y hepaticojejunostomy for postcholecystectomy biliary stricture. Results Average daily output was 441 mL (range: 150-800 mL/day), and total duration of output was 16.5 days (range: 4-35 days). Mean hospital stay increased to 19.1 days (range: 10-40 days). All the patients were successfully managed conservatively with a combination of customized enteral feeds, supplemental parenteral nutrition, and octreotide. One patient required additional percutaneous drainage. Conclusion Chyle leak can be successfully treated with conservative management but at the cost of increased hospital stay.

Background: Prevention of triple negative breast cancer (TNBC) is hampered by lack of knowledge about the drivers of tumorigenesis. Methods: In order to identify molecular markers and their downstream networks that can potentially be targeted for TNBC prevention, we analyzed small RNA and RNA sequencing of a cell line model that represents early stages of TNBC development. We identified direct gene targets of an isomiRNA and using cell based and in vivo model systems we demonstrate the utility of targeting downstream pathways for prevention of TNBC. Results: These analyses showed that 5'isomiRNA of miR-140-3p (miR-140-3p-1) were deregulated in the normal-to- preneoplastic transition. We also identified novel direct gene targets of miR140-3p-1, HMG-CoA reductase (HMGCR) and HMG-CoA synthase 1(HMGCS1), key enzymes in the cholesterol biosynthesis pathway, and found that these too are deregulated in the normal to preneoplastic transition, resulting in activation of the cholesterol synthesis pathway. Upregulation in the cholesterol pathway creates a metabolic vulnerability that can be targeted with the statin class of inhibitors. Consistent with this hypothesis, we found direct targeting of miR-140-3p-1 and its downstream pathway by fluvastatin inhibits growth of these preneoplastic MCF10.AT1 cells. However, although, fluvastatin inhibited the growth of MCF10.AT1-derived xenografts, histological progression remained unchanged. The cholesterol pathway is highly regulated, and HMGCR enzymatic activity inhibition is known to trigger a feedback response leading to restoration of the pathway. Indeed, we found fluvastatin treatment induced HMGCR transcript levels in the explanted xenografts, with higher transcript induction directly correlated with the degree of histological progression of lesions, indicating an adaptive resistance mechanism that circumvents statin targeting of HMGCR. Therefore, we hypothesized that dual targeting of HMGCR and the feedback loops are necessary to overcome this adaptive resistance. To test this hypothesis, we generated MCF10AT1 cells resistant to fluvastatin. We then treated these resistance AT1 cells with an activator of AMP-activated protein kinase (AMPK), a brake in the cholesterol feedback pathway. AMPK activation by aspirin effectively abrogated the statin-induced upregulation of HMGCR and sensitized these resistant cells to fluvastatin. Conclusions: Our preclinical data suggests that the statin treatment induced homeostatic upregulation of the cholesterol pathway is a barrier to effective chemoprevention with statins. However, our results also suggest that this adaptive resistance mechanism can be abrogated by combined treatment with statin and AMPK activators such as aspirin. Clinical studies of this combined regimen should be considered in high risk patients. Citation Format: Bhardwaj A, Singh H, Trinidad CM, Albarracin C, Hunt KK, Bedrosian I. isomiR-140-3p-regulated mevalonic acid pathway as a potiental target for prevention of triple negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-12-02.

Duodenum is an uncommon site for the gastrointestinal stromal tumors (GISTs). Though the principles of management are the same of that elsewhere in the gastrointestinal tract, the anatomical complexity poses challenges in deciding the most appropriate treatment. A bleeding GIST further compounds the difficulty in managing such patients. A twenty-eight-year-old female presented with bleeding duodenal lesion secondary to mucosal ulceration. Imaging confirmed large heterogeneous lesion arising from the second part of duodenum. Surgery was planned in view of persistent blood transfusion requirement. Pancreaticoduodenectomy was done and the patient had an uneventful postoperative period. Review of literature of duodenal GIST especially regarding the tough decisions that have to be made in the diagnosis and management of bleeding lesions has been done. The availability of various options in addressing bleeding duodenal GIST should make the surgeon choose the best modality for the patient weighing the pros and cons of each modality.

Abdominal tuberculosis is a common problem for clinicians in the tropical world and may manifest with varying clinical scenarios. Intestinal tuberculosis could have intestinal ulcers, strictures, hypertrophic lesions like polyps and may be complicated by perforation, bleeding, and intestinal obstruction. Crohn’s disease is an important differential of intestinal tuberculosis which is closely mimics intestinal tuberculosis in clinical, endoscopic, radiological and histological presentation. Crohn’s disease is known to have a fistulising variant. We report the case of 23 year old lady who had disseminated tuberculosis with intestinal involvement and seemed to improve on anti-tubercular therapy (ATT) but present with intestinal obstruction in the third month of ATT. Surgical exploration revealed clumping of bowel loops with multiple ileo-ileal fistulae. The case is presented because of the presence of entero-enteric fistulae and also because it demonstrated that intestinal tuberculosis may need surgical intervention even after initial improvement because of complications like intestinal obstruction.

Speech is the most critical communication type in everyday life. Nonetheless, the reliance of interaction of human computer on written text and images makes the utilization of computers incomprehensible for visually and physically impaired and illiterate masses. Text-to-speech (TTS) synthesis helps researchers of speech processing to follow up on this issue by synthesizing speech (in Indian local languages e.g. Punjabi, Hindi, Tamil etc.) from written text in browsers, mobile phones etc. A TTS system is a computer system that converts text into speech, i.e. automatically reads the text when asked to do so. This system is a blend of both software and hardware. Generally text (sentence) is composed of collection of words, while words are combination of alphabets arranged in a meaningful way. In this research work, the authors implemented a translation system where Punjabi text is converted into speech by using nourish forwarding algorithm. The accuracy of text to speech conversion is compared with Splitting Algorithm and its efficiency is marginally enhanced.

Background: The relationship between diabetes mellitus and tuberculosis (TB) has received increasing attention, and diabetes may be associated with poor outcomes in pulmonary TB. Clinical relevance of HbA1c measurement in abdominal TB is unknown. Methods: We did a retrospective study of consecutive patients diagnosed with abdominal TB and treated with antitubercular therapy for 6 months. Patients were categorized as those with normal HbA1c (

The topographic anatomy of the sternum is similar in a healthy population. However, in a clinical subset of patients with comorbidities such as diabetes mellitus, chronic obstructive pulmonary disease, high body mass index, chronic renal disease, or age-related osteoporosis, there are significant changes in the normal physiology that may influence overall patient outcome following trans-sternal intrathoracic surgery. These changes can create technical difficulties in reconstructing the bisected sternum and adversely affect the biomechanics of the thoracic wall, forcing difficult surgical choices with regard to implant options and increasing the cost of an otherwise routine cardiac surgery. A thorough preoperative surgical and technical planning is essential to avert perioperative complications such as failure of wound healing, non-union of the sternum, and life-threatening mediastinitis. Patient expectations need to be explored and the patients should be well informed so that they can make knowledgeable choices regarding their illness and surgical interventions. They should also be given a probable prognosis to provide psychological support. Within the realm of clinical methodology, the concept of patient-appropriate medicine is introduced to direct attending team to become aware of overall health of its patient. The inclusion of a clinical biomechanical engineer as a surgical team member is recommended to perform patient-specific finite element analysis to select an optimal implant to fix the sternum. To help assess the overall benefit-risk profile objectively, an absolute therapeutic index has been proposed.

In the agriculture domain, wheat is the most important crop across the world. It is a winter cereal crop that provides 14% food production worldwide. Wheat is an essential food for everyone. The motivation behind this work is to enhance the quality of wheat crop images in the agricultural area. Sometimes, the pictures captured in a real-time environment may not be clear for detecting the disease from the crop. So, there is a need to enhance the images. In this paper, histogram features (statistical feature) are extracted for further recognition of wheat rust diseased images. The histogram equalization is a good approach to enhance the pixel intensity of an image. Moreover, various challenges to enhance the quality of an image have also been explored, such as the effect of the histogram, histogram equalization, and Contrast Limited Adaptive Histogram Equalization (CLAHE). Also, it is observed that instead of plotting a simple histogram, histogram equalization is the best way to equalize all pixel values at the same level. In addition to that, various color spaces models such as RGB and HSV have been utilized for analysis. Thereafter, the importance of a 3D plot for color distribution is also discussed. It is concluded that histogram equalization really helps in enhancing the quality of the image and also using 3D plots one can get fine information to estimate the majority of different colors present in the image for performing segmentation and feature extraction.

Introduction: Percutaneous Biliary drainage (PTBD) is required as palliation and optimization for surgery or chemotherapy in carcinoma gallbladder (GBC) but may be associated with complications. We aimed to study the outcomes, complications and changes in quality of life in patients with GBC undergoing PTBD. Methods: A prospective study from July 2018 to December 2019 in patients of GBC presenting with obstructive jaundice was done. Patients planned for PTBD were included in the study. The progression of disease, complications of PTBD, re-interventions, effects on initiation or completion of chemotherapy, surgical resection or intervention, overall survival was recorded. Quality of life (QoL) was assessed using SF–36 questionnaire before and after 4-6 weeks of intervention. Results: Of 160 patients assessed for inclusion, 60 (mean age: 53.7 ± 10.95 years, 27 (45 %) males) were eventually included. Eleven patients (18.3%) had metastatic disease at presentation. Of 60 patients undergoing PTBD, none had immediate procedure related complications, 41(68 %) patients had at-least one and 18 (30%) patients had more than one complication. The most common complication was peri-catheter bile leak (41.6%) followed by catheter dislodgement (30 %), blockage (23.3 %) and bleeding (10 %). Re-intervention was required in 32 (53 %) of patients. There was a significant decrease in QoL after PTBD (PConclusion: The high technical success of PTBD does not translate into the improvement of QoL, survival, and curative surgical treatment.

Oesophageal tuberculosis, an uncommon form of extrapulmonary tuberculosis, has been reported mainly as small case series and the literature is heterogeneous. A systematic review to characterize the clinical presentation, evaluation and management of oesophageal tuberculosis was performed. Electronic databases were searched with keywords: esophagus OR esophageal AND tuberculosis. We included original papers and case series (> 4 patients) with oesophageal tuberculosis. Twenty-two studies reporting 311 patients were included. Mean age in most of the studies was 31–51 years and male gender constituted 50.5% patients. Dysphagia (72.3%), odynophagia (22.4%) and chest pain (31.3%) were predominant symptoms. Mid-oesophagus was the commonest site of involvement (88%). Endoscopic findings included ulcers (59.9%), submucosal bulge (31.7%), extrinsic compression (24.8%) and pseudotumour (5.8%). On endoscopic ultrasound, presence of hypoechoic (69.5%), heteroechoic (47.6%) and matted (86.3%) mediastinal lymph nodes and oesophageal wall involvement (67.3%) were common findings. Computed tomography showed mediastinal lymphadenopathy (76.5%) and oesophageal thickening (52.1%). Diagnosis was confirmed by granuloma (72.3%) and acid fast bacilli positivity (32.5%) in mots patients. Response to antitubercular therapy was excellent; 97.7% patients recovered and 2.3% patients died. Surgery (14.5%) and oesophageal stenting (11.4%) were required infrequently. Oesophageal tuberculosis should be considered in endemic regions as a cause of dysphagia because early treatment is associated with excellent outcomes.

Advent of Functional Magnetic Resonance Imaging (fMRI) has helped researchers to know about the dynamic states of brain. One of the maj or goal of fMRI research is the task classification based on the activity of brain states. Every time, it remains a challenge for such researchers to extract optimum features from brain images due to high dimensional quantity of the data in fMRI Images. In this paper, the authors proposed a novel feature selection technique based on Fast Fourier Transform with Particle Swarm Optimization and Genetic Algorithm (FFT-PSOGA) for extracting the best features in fMRI dataset. The resulted features are trained for machine learning models of GaussianNB, Support Vector Machine, and XGBoost and compared for performance with state-of-art. The achieved results are outperforming the existing works based on the same dataset. The authors believe that the feature selection technique proposed in this paper will be the optimal method for extracting brain images' features in any fMRI dataset which will improve the classification accuracy of the decoding of brain images in a much better way.

A lot of data is getting generated and captured in Internet of Things (IoT) based devices related to healthcare systems. This data is real time and unstructured in nature. However, this real-time medical based data storage and its processing in IoT applications is still a big challenge. In this chapter, the authors are proposing a new Big Data pipeline solution for storing and processing IoT medical data. The proposed Big Data processing platform uses Apache Flume for efficiently collecting and transferring large amounts of IoT data from Cloud-based server into Hadoop Distributed File System for storage of IoT based sensor medical data. Recursive Feature Elimination with Cross Validation (RFECV) is used for eliminating the features of less importance. Apache Spark is to be used for processing this real-time data. Next the authors propose the use of hybrid prediction model of density-based spatial clustering of applications with noise (DBSCAN) to remove sensor data outliers and provide better accuracy in diabetes disease detection by using Random Forest machine learning classification technique. The authors believe that this Big Data pipeline will greatly help in efficient storage of IoT application medical data and will provide a viable solution for effective processing and predicting disease from medical IoT data.

Wheat is one of the essential food crops all over the world. In India, it is the largest growing winter cereal crop that contributes almost 14% to the world’s food production. This crop is usually affected by various types of rust diseases. Rust is one kind of fungal disease, which occurred on wheat crop. The rust is characterized as leaf-rust (brown rust), stem-rust (black rust), and yellow rust (strip rust). Due to these types of diseases, a huge amount of loss may occur in the production of wheat crop. Therefore, it is required to early detect this disease during the growing stage. In the present study, we consider two classes of diseased plants and one for a healthy plant. Due to less amount of image dataset, we performed the image augmentation and generated the synthetic data from the original data. Various experiments are performed on different dataset sample sizes i.e., 100, 500, 1000, 1500, and 2000. The weights for building the model have been considered as the same in ResNet50 and VGG16 transfer learning models. Moreover, to improve the accuracy of the model, we tune the hyper-parameters. The hyper-parameters used to train this model are: batch_size = 32, optimizer = "adam", initial learning rate = 0.01 with decay of 0.0001. After performing the experiments, the model produced appreciable results with the VGG16 model. The proposed approach has obtained the highest classification accuracy rate of 99.07% using the VGG16 model.

Introduction The modification of NOTES (natural orifice transluminal endoscopic surgery) by mucosal safety flap has introduced us to the world of third space endoscopy (TSE). POEM (per-oral endoscopic myotomy) for achalasia cardia being its first vista, the realm expanded so that we can now remove en bloc a subepithelial/intramural tumor by POET (per-oral endoscopic tumor resection), perform G-POEM (gastric per-oral endoscopic myotomy) for refractory gastroparesis, restore esophageal continuity in complete obstruction by performing POETRE (per-oral endoscopic tunneling for the restoration of the esophagus), divide the septum in Zenker diverticulum completely with negligible risk of perforation by Z-POEM (Zenker per-oral endoscopic myotomy) and relieve constipation in Hirschsprung disease by PREM (per-rectal endoscopic myotomy). However, the real potential of TSE became evident with the introduction of POEM with fundoplication. TSE has opened the gates of the peritoneal cavity. Improved expertise and equipment will make the role of endoscopist complimentary to the surgeon with the dawn of a new field in therapeutic endoscopy. Areas covered This review intends to comprehensively discuss the various aspects of POEM for achalasia studied so far followed by a brief discussion about other applications of TSE and the future perspectives in this exciting field.

Functional Magnetic Resonance Imaging (fMRI) researchers are currently using various techniques for analyzing the cognitive states in brain images. Every time, it remains a challenge for such researchers to decode the brain information about stimuli affecting the related Region of Interest (ROI) from voxels of Brain Networks. In this paper, the authors used OpenCV library of Python to analyze various states of brain images. The images of each volume in the dataset are grouped into principal planes of fMRI views. Then operations of Dilation, Erosion, and Gaussian Blur are applied to all images for smoothening purposes. The authors believe that the procedure followed in this paper will be the optimal method for extracting brain images' features, which will improve the classification accuracy of the decoding of brain images in a much better way.