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Background: Diabetic retinopathy is a major microvascular complication of diabetes mellitus causing blindness in patients with diabetes mellitus. Lack of knowledge about diabetic retinopathy and its complications is the major cause for increasing blindness in India. The aim of the study is to evaluate the knowledge about diabetic retinopathy and its influence on attitude and practice in diabetic retinopathy among patients coming to a tertiary care centre in karnataka. Materials and Methods: Patients coming to tertiary care centre were interviewed by a single interviewer with questionnaire consisting of knowledge, attitude and practice questions prepared in English and responses noted and analysed. A pilot study was conducted in sample population before starting the study. Results: Out of 300 patients, 173 were males (57.7%) and 127 were females (42.3%). The minimum age of males and females was 31 and 32 years respectively. Among 300 diabetic patients, 163 patients (54.3%) had no knowledge about diabetic retinopathy compared to 137 patients(45.7%) who had knowledge about diabetic retinopathy which is statistically significant with p value (68.6%) compared to females (31.4%) which is statistically significant with p value of educational status and socioeconomic status increased, there was statistically significant increase in knowledge. Patients with longer duration of diabetes had good knowledge which is statistically significant. Patients with more knowledge and longer duration of diabetes were found to follow a good practice in diabetic retinopathy which is statistically significant with a p value of less than 0.05. Conclusion: Lack of knowledge about complications and screening methods is the cause for worsening the attitude and practice in diabetic retinopathy. Patient education at primary health care and community level can provide patients with positive attitude towards treatment and follow good practice patterns to prevent blindness due to diabetic retinopat

Neutrophil responses against pathogens must be balanced between protection and immunopathology. Factors that determine these outcomes are not well-understood. In a mouse model of genital herpes simplex virus-2 (HSV-2) infection, which results in severe genital inflammation, antibody-mediated neutrophil depletion reduced disease. Comparative single-cell RNA-sequencing analysis of vaginal cells against a model of genital HSV-1 infection, which results in mild inflammation, demonstrated sustained expression of interferon-stimulated genes (ISGs) only after HSV-2 infection primarily within the neutrophil population. Both therapeutic blockade of IFNα/β receptor 1 (IFNAR1) and genetic deletion of IFNAR1 in neutrophils concomitantly decreased HSV-2 genital disease severity and vaginal IL-18 levels. Therapeutic neutralization of IL-18 also diminished genital inflammation, indicating an important role for this cytokine in promoting neutrophil-dependent immunopathology. Our study reveals that sustained type I interferon (IFN) signaling is a driver of pathogenic neutrophil responses and identifies IL-18 as a novel component of disease during genital HSV-2 infection., eLife digest Herpes simplex virus (HSV) is a human pathogen that causes genital herpes, an incurable disease that results in recurrent sores and inflammation. Infection with HSV induces a strong antiviral immune response, which results in large numbers of immune cells arriving at these lesions. But while some of these cells help to control viral replication, others might contribute to the inflammation that drives the disease. One of the first immune cells to respond to infection are neutrophils. Although neutrophils are generally protective, especially against bacteria and fungi, they have also been implicated in tissue damage and severe inflammation during viral infections. But what determines whether a neutrophil will help to fight off an infection or increase disease severity is still an open question. To investigate this, Lebratti, Lim et al. studied mice that had been infected with the genital herpes virus HSV-2, which is known to cause significant amounts of inflammation in mice. The experiments revealed that a signaling molecule called type I interferon, which is thought to be antiviral, causes neutrophils at the site of the infection to produce proteins, such as IL-18, which trigger an inflammatory reaction. Lebratti, Lim et al. found that type I interferon and IL-18 had shifting roles during the course of infection. In the early stages, both molecules had a protective effect, confirming results from previous studies. However, as the infection progressed, sustained levels of type I interferon signaling in neutrophils led to excess amounts of IL-18. Lebratti, Lim et al. discovered that blocking interferon signaling or decreasing the levels of IL-18 later during infection unexpectedly reduced the severity of the disease and resulted in less genital tissue damage. Further experiments also showed that mice infected with another genital herpes virus called HSV-1 did not experience sustained levels of type I interferon. This may explain why this virus causes less severe disease in mice. Understanding how the immune system reacts to viruses could reveal new targets for treatments of genital herpes. At the moment, there is little information about IL-18 production during genital herpes in humans. So, the next step is to see whether neutrophils behave in the same way and whether IL-18 can be detected during human disease. It is possible that the same immune components could promote disease in other infections too. If so, this work may help uncover new drug targets for other viral diseases.

The goal of operative treatment of shaft of humerus fractures is to reestablish length, alignment, and rotation with stable fixation that allows early motion and ideally early weight bearing on the fractured extremity. Various methods of treating middle and distal humeral shaft fractures have continued to evolve from closed methods, external fixation, antegrade and retrograde intramedullary nailing, and conventional plating to minimally invasive osteosynthesis. Plate osteosynthesis remains the gold standard of fixation for humeral shaft fractures. biological plate osteosynthesis is important to preserve bone vascularity, also to improve consolidation, to reduce the infection rate, to avoid bone grafting. MIPO techniques avoid direct exposure of the fracture site and transform the implants in an internal extramedullary splint. More flexible fixation should encourage the formation of callus while less precise indirect reduction will reduce operative trauma. This study determines the safety of MIPPO technique and also to evaluate the clinical, radiological, and functional outcomes in the treatment of humeral shaft fractures (middle & distal one third).

INTRODUCTION: Intraarticular fractures of the tibial plateau and periarticular fractures of the proximal tibia, caused by high energy trauma pose a therapeutic dilemma. We present the use of hybrid external fixation system which includes Ilizarov ring fixator and AO rod external fixator connected with indigenously manufactured connecting clamps and short shafts augmented with or without minimal internal fixation1. AIM OF THE STUDY: 1. To assess the performance of the Hybrid External Fixator in the treatment of different types of proximal tibial fractures. 2. To evaluate the functional outcome, soft tissue healing and fracture union and radiological outcome. 3. To evaluate the biomechanical and biological advantage of hybrid external fixator. BIOMECHANICS : The mechanical characteristics of hybrid external fixation system can be called as SOLID ELASTIC. It gives solid enough for stabilization and providing micromotion which enhances good callus formation. MATERIALS: From August 2010 to November 2011, 21 caes of periarticular fractures of the proximal tibia were treated by use of 5/8 th Ilizarov ring, AO tubular external fixator and with indigenously manufactured connecting clamps & short shaft in a hybrid mode. All cases were prospectively followed up and studied. Almost all the cases (99%) had sustained Road traffic Accidents (high velocity injuries) except one case which had sustained injury by fall of cement wall over her leg. Minimum follow up – 1.5 months , maximum follow up – 12 months, mean follow up – 6.42 months .All the patients were in the age group of 26 to 65 years, mean age is 43.09. METHOD: SELECTION OF CASES: Inclusion Criteria: 1. Tibial plateau fractures according to Schatzkar classificafion Type 4, Type 5 and Type 6. 2. Proximal 1/4 extra articular tibial fractures (severely comminuted) 3. Open Proxial tibial fractures according to Gustillo Anderson Classification Gr 2, Gr 3A, 3B, 3C 4. Proximal tibial fracture with compartment syndrome after Fasciotomy. 5. High velocity proximal tibial fracture in impending compartment syndrome. Exclusion Criteria : 1. Schatzkar type 1 , type 2 and type 3. 2. More than 2 weeks old fractures. 3. Proximal tibial fractures with neurological disorder. 4. Proximal tibial fractures with paralytic disorder. SURGICAL TECHNIQUE: Reduce the articular surface initially. Determine the wire position. Minimum of 2 0r 3 wires are needed. Position the wires in the safe zone. Wire should be inserted 14 mm distal to the tibial plateau so that the capsule will not be pierced by wires.Each wire should be placed 30 – 50 degrees wide apart as possible. Olive wires are used to reduce and compress the fragments.place the shanz screws and assemble the frame. RESULTS: After analyzing the above characters we have obtained. Excellent results in 7 patients ( 33. 3% ), Good in 9 (42.35% ), Fair in 4 (19.04% ), Failure in 1(4.76% ) patient. CONCLUSION : The hybrid external fixator method we have applied is safe as regards of soft tissue healing and the limited number of complications associated directly to this method of application. We recommend a mini open reduction with percutaneous cannulated cancellous screw (one or two for securing interfragmentary compression) or olive wires with hybrid external fixator. This is the best method for closed (Schatzkar type 4, 5, 6) as well as open proximal tibial fractures.

Hospital acquired infections are infections that are neither present nor incubating when a patient enters hospital 1 . Despite progress in public health and hospital care, infections continue to develop in hospitalized patients, and may also affect hospital staff. 2 About nine per cent of inpatients have a hospital acquired infection at point of time. (3) Their effects vary from discomfort, functional disability and emotional stress to prolonged or permanent disability . Small proportion of patient deaths each year are primarily attributable to hospital acquired infections (2,3) . The economic costs are considerable. The increased length of stay for infected patients is the greatest contributor to cost. 2 The development of a surveillance process to monitor this rate is an essential first step to identify local problems and priorities, and evaluate the effectiveness of infection control activity. Surveillance, by itself, is an effective process to decrease the frequency of hospital-acquired infections. 2,5 This study was undertaken as a part of surveillance system for MICU to find out incidence of device associated infection rate, causative microorganisms and their antibiotic sensitivity pattern. In this study the attack rate of catheter associated Urinary Tract Infection was 52.63% and incidence of 83.33% per 1000 catheter days. Most common organisms isolated were Klebsiella (63.63%,) E-Coli (31.81% ) and Pseudomonas (4.54%). Eighty one percent of Klebsiella isolates, 76.47% of E. Coli isolates and 87.5% of Pseudomonas isolates were resistant for antibiotics tested. Out of total isolates tested, 58.82% were resistant to Gentamycin, 100% isolates were resistant to Ampicillin and Cefotaxim, 80% were resistant to Ciprofloxacin, 87.5% were resistant to Sulphamethaxazole and 42.10% were resistant to Furantoin. The proportion of days spent in the ICU in which the patient's treatment included invasive devices is increasing, in fact 25-50% of nosocomial infections are due to combined effect of the patient's own flora and invasive devices . Catheter-associated urinary tract infection (UTI), Central line-associated bloodstream infection (BSI), Ventilator-associated pneumonia (VAP) are among leading causes of mortality and morbidity among ICU patients.

Internet of Things is a burgeoning field in the world of technology. It helps ease life for a person by means of internetworking physical devices, automotive, home appliances and other items embedded with electronics, software, sensors and actuators. Smart garage is one such device that helps ease the access of the garage doors in domestic use. Unlike most solutions, smart garage help you to access your doors with the help of a computable device such as smart phones or tablets connected to a network, and access by means of secured pins to authorize the access. We designed one such garage using Arduino web server, and a smartphone. Which we compared with existing methods. We have illustrated the building process of the setup for the prototype of our garage, and various means to improve power consumptions and alternate methods for a secured pin.

IoT is an expanding network of physical devices that are linked with different types of sensors and with the help of connectivity to the internet, they are able to exchange data. Through IoT, internet has now extended its roots to almost every possible thing present around us and is no more limited to our personal computers and mobile phones. Safety, the elementary concern of any project, has not been left untouched by IoT. Gas Leakages in open or closed areas can prove to be dangerous and lethal. The traditional Gas Leakage Detector Systems though have great precision, fail to acknowledge a few factors in the field of alerting the people about the leakage. Therefore we have used the IoT technology to make a Gas Leakage Detector having Smart Alerting techniques involving calling, sending text message and an e-mail to the concerned authority and an ability to predict hazardous situation so that people could be made aware in advance by performing data analytics on sensor readings.

Levodopa is effective for the motor symptoms of Parkinson's disease (PD), but is associated with motor fluctuations and dyskinesia. Many patients require add-on therapy to improve motor fluctuations without exacerbating dyskinesia. The objective of this Phase III, multicenter, double-blind, placebo-controlled, parallel-group study was to evaluate the efficacy and safety of safinamide, an α-aminoamide with dopaminergic and nondopaminergic mechanisms, as add-on to l-dopa in the treatment of patients with PD and motor fluctuations. Patients were randomized to oral safinamide 100 mg/day (n = 224), 50 mg/day (n = 223), or placebo (n = 222) for 24 weeks. The primary endpoint was total on time with no or nontroublesome dyskinesia (assessed using the Hauser patient diaries). Secondary endpoints included off time, Unified Parkinson's Disease Rating Scale (UPDRS) Part III (motor) scores, and Clinical Global Impression-Change (CGI-C). At week 24, mean ± SD increases in total on time with no or nontroublesome dyskinesia were 1.36 ± 2.625 hours for safinamide 100 mg/day, 1.37 ± 2.745 hours for safinamide 50 mg/day, and 0.97 ± 2.375 hours for placebo. Least squares means differences in both safinamide groups were significantly higher versus placebo. Improvements in off time, UPDRS Part III, and CGI-C were significantly greater in both safinamide groups versus placebo. There were no significant between-group differences for incidences of treatment-emergent adverse events (TEAEs) or TEAEs leading to discontinuation. The addition of safinamide 50 mg/day or 100 mg/day to l-dopa in patients with PD and motor fluctuations significantly increased total on time with no or nontroublesome dyskinesia, decreased off time, and improved parkinsonism, indicating that safinamide improves motor symptoms and parkinsonism without worsening dyskinesia.

In a 6-month double-blind, placebo-controlled study of Parkinson's disease patients with motor fluctuations, safinamide 50 and 100 mg/d significantly increased ON-time without increasing dyskinesia. Further long-term safinamide use in these patients was evaluated over an additional 18 months. Patients continued on their randomized placebo, 50, or 100 mg/d safinamide. The primary endpoint was change in Dyskinesia Rating Scale total score during ON-time over 24 months. Other efficacy endpoints included change in ON-time without troublesome dyskinesia, changes in individual diary categories, depressive symptoms, and quality of life measures. Change in Dyskinesia Rating Scale was not significantly different in safinamide versus placebo groups, despite decreased mean total Dyskinesia Rating Scale with safinamide compared with an almost unchanged score in placebo. Ad hoc subgroup analysis of moderate to severe dyskinetic patients at baseline (36% of patients) showed a decrease with safinamide 100 mg/d compared with placebo (P = 0.0317). Improvements in motor function, activities of daily living, depressive symptoms, clinical status, and quality of life at 6 months remained significant at 24 months. Adverse events and discontinuation rates were similar with safinamide and placebo. This 2-year, controlled study of add-on safinamide in mid-to-late Parkinson's disease with motor fluctuations, although not demonstrating an overall difference in dyskinesias between patients and controls, showed improvement in dyskinesia in patients at least moderately dyskinetic at baseline. The study additionally demonstrated significant clinical benefits in ON-time (without troublesome dyskinesia), OFF-time, activities of daily living, motor symptoms, quality of life, and symptoms of depression.

Background: Although inhibitors of the renin–angiotensin–aldosterone system can slow the progression of diabetic kidney disease, the residual risk is high. Whether nuclear 1 factor (erythroid-derived 2)–related factor 2 activators further reduce this risk is unknown. Methods: We randomly assigned 2185 patients with type 2 diabetes mellitus and stage 4 chronic kidney disease (estimated glomerular filtration rate [GFR], 15 to < 30 ml per minute per 1.73 m2 of body-surface area) to bardoxolone methyl, at a daily dose of 20 mg, or placebo. The primary composite outcome was end-stage renal disease (ESRD) or death from cardiovascular causes. Results: The sponsor and the steering committee terminated the trial on the recommendation of the independent data and safety monitoring committee; the median follow-up was 9 months. A total of 69 of 1088 patients (6%) randomly assigned to bardoxolone methyl and 69 of 1097 (6%) randomly assigned to placebo had a primary composite outcome (hazard ratio in the bardoxolone methyl group vs. the placebo group, 0.98; 95% confidence interval [CI], 0.70 to 1.37; P=0.92). In the bardoxolone methyl group, ESRD developed in 43 patients, and 27 patients died from cardiovascular causes; in the placebo group, ESRD developed in 51 patients, and 19 patients died from cardiovascular causes. A total of 96 patients in the bardoxolone methyl group were hospitalized for heart failure or died from heart failure, as compared with 55 in the placebo group (hazard ratio, 1.83; 95% CI, 1.32 to 2.55; P < 0.001). Estimated GFR, blood pressure, and the urinary albumin-to-creatinine ratio increased significantly and body weight decreased significantly in the bardoxolone methyl group, as compared with the placebo group. Conclusions: Among patients with type 2 diabetes mellitus and stage 4 chronic kidney disease, bardoxolone methyl did not reduce the risk of ESRD or death from cardiovascular causes. A higher rate of cardiovascular events with bardoxolone methyl than with placebo prompted termination of the trial. (Funded by Reata Pharmaceuticals; BEACON ClinicalTrials.gov number, NCT01351675.)

One of the most significant threats faced by enterprise networks today is from Bots. A Bot is a program that operates as an agent for a user and runs automated tasks over the internet, at a much higher rate than would be possible for a human alone. A collection of Bots in a network, used for malicious purposes is referred to as a Botnet. Bot attacks can range from localized attacks like key-logging to network intensive attacks like Distributed Denial of Service (DDoS). In this paper, we suggest a novel approach that can detect and combat Bots. The proposed solution adopts a two pronged strategy which we have classified into the standalone algorithm and the network algorithm. The standalone algorithm runs independently on each node of the network. It monitors the active processes on the node and tries to identify Bot processes using parameters such as response time and output to input traffic ratio. If a suspicious process has been identified the network algorithm is triggered. The network algorithm will then analyze conversations to and from the hosts of the network using the transport layer flow records. It then tries to deduce the Bot pattern as well as Bot signatures which can subsequently be used by the standalone algorithm to thwart Bot processes at their very onset., Comment: 12 pages, 7 figures

Background: Evidence suggests that intradialytic exercise benefits end-stage renal disease (ESRD) patients. We examined the feasibility of intradialytic modified Tai Chi (IMTC) among ESRD undergoing hemodialysis and assessed IMTC’s impact on risk of falls, bone metabolism, oxidative stress damage, and quality of life in ESRD patients. Methods: Forty-five ESRD patients were randomized to either non-exercising control group (CON, n=25) or IMTC group (n=20) who performed IMTC exercise 3/week, 45 min/session while sitting in a recliner with one arm connected to the dialysis machine for 12 weeks. At baseline and 12 weeks, we measured risk-of-falls related parameters (balance, gait, and functioning strength), biomarkers of bone metabolism and oxidative stress damage, and quality of life. Results: Thirty-four participants completed the study. The feedback from participants suggests that IMTC exercise is easy to learn and feasible. After 12 weeks, IMTC tended to lower tartrate- resistant acid phosphatase (bone resorption biomarker) and improved quality of life (role physical and vitality) compared to CON. There was no significant difference in balance, gait, and functional strength, possibly due to a ceiling effect. There was no significant difference in serum bone-specific alkaline phosphatase, calcium, phosphorus and intact parathyroid hormone levels, plasma 8-hydroxy-2’-deoxyguanosine levels, and other domains of quality of life. The CON group experienced a 20% decrease in 25-hydroxy vitamin D at the end of study. Conclusions: IMTC exercise was safe and well accepted by ESRD patients. It improved quality of life, tended to suppress bone resorption, and helped maintain 25-hydroxy vitamin D levels in ESRD patients. These findings need to be confirmed in a larger, more sufficiently powered efficacy study.

Morbidly obese patients with clinical features of obstructive sleep apnoea can present a myriad of challenges to the anaesthesiologists which must be addressed to minimise the perioperative risks. Initiation of continuous positive airway pressure (CPAP) therapy early in the pre- and post-operative period along with appropriate anaesthetic planning is of paramount importance in such patients. This case report emphasises the usefulness of CPAP therapy, even for a short duration, to minimise morbidity, improve recovery and hasten early discharge from the hospital after major surgery.

Thelaziasis is an Arthropod-born disease of the eye and adnexa caused by Thelazia callipaeda, a nematode parasite transmitted by drosophilid flies to carnivores and humans. Because of its distribution mainly confined to South Asian countries and Russia, it is commonly known as Oriental Eye worm. It is often under-reported and not been given its due clinical importance. We report first case of human Thelaziasis from Hassan District, Karnataka. Five creamy-white, translucent worms were removed from the conjunctival sac of a 74-year-old male patient. Based on morphological characters, the worms were identified as nematodes belonging to the genus Thelazia and speciation was confirmed by CDC, Atlanta as callipaeda. Rarity of the disease and its ability to cause both extra and intraocular manifestations leading to ocular morbidity is the reason for presenting this case. From the available data, this is the first case report from Karnataka, India.

A fault in rock strata would invariably disrupt the pattern of the magnetic field contours from which an experienced geophysicist is able to detect a fault, that is, find its location and orientation. In this paper digital signal processing tools, namely, directional filtering and angular spectrum are developed for the detection of a fault from the digital aeromagnetic maps and their performance is compared. Digital filter design tools are used to design a filter with a wedge shaped passband. Both the angle and direction of the axis of the wedge are user specified. The filter is then applied to a model where there are two faulted magnetic layers, each of which is free of any other directionality. It is shown that the filter is able to detect the fault in the deeper layer even in the presence of another faulted layer at a shallow depth. In the second approach the angular spectrum is used to measure the orientation of a known fault. Some care need to be exercised, as a peak in the angular spectrum may also be caused by other factors, such as, the direction of polarization, or by tapered spectral window, etc. We have computed the angular spectrum of the eastern part of the aeromagnetic map over the south Indian shield. It is found that the angular spectrum in the low frequency band shows a peak corresponding to the east-northeast–west-southwest fault suggested in Reddy et al. (1988) [Reddy, A.G.B., Mathew, M.P., Singh, B., Naidu, P.S., 1988. Aeromagnetic evidence of crustal structure in the granitic terrain of Tamilnadu–Kerala. J. Geol. Soc. India 32, 368-381]. Also there are peaks corresponding to the direction of polarization, the tapered window used in the analysis, and a few shallow lineations.

Severe cardiovascular responses in the form of tachycardia and hypertension following nasal speculum insertion occur during sublabial rhinoseptal trans-sphenoid approach for resection of small pituitary tumours. We compare the effects of preoperative administration of clonidine (α-2 agonist) and atenolol (α-blocker) over haemodynamic response, caused by speculum insertion during trans-sphenoid pituitary resection. We enrolled 66 patients in age range 18-65 years, of ASA I-II, and of either sex undergoing elective sublabial rhinoseptal trans-sphenoidal hypophysectomy. Group I (control) received placebo, group II (clonidine) received tablet clonidine 5 μg/kg, and group III (atenolol) received tablet atenolol 0.5 mg/kg. The heart rate increased on speculum insertion and 5 and 10 minutes following speculum insertion as compared to the pre-speculum values in the control group, while no change in the heart rate was observed in other groups (P

It is shown that the use of a coarsely quantized binary digital hologram as a matched filter on an optical computer does not degrade signal-to-noise ratio (SNR) appreciably.

Prequantization has been forwarded as a means to improve the performance of double phase holograms (DPHs). We show here that any improvement (even under the best of conditions) is not large enough to help the DPH to compete favourably with other holograms.

An expression for the spectrum and cross spectrum of an acoustic field measured at two vertically separated sensors in shallow water has been obtained for any correlated noise sources distributed over the surface. Numerical results are presented for the case where the noise sources, white noise and wind-induced colored noise, are contained within a circular disk centered over the sensors. The acoustic field is generally inhomogeneous except when the channel is deep. The coherence function becomes real for a large disk, for a radius greater than 25 times the depth of the channel, decreases with further increase of the size of the disk, and finally tapers off after certain limiting size, approximately given by 1/alpha, where alpha is the attenuation coefficient.

A point source or a dipole source of electric current, placed on a randomly layered semi-infinite medium, produces an inhomogeneous random potential field on the surface. The variance of the random potential, normalized with reference to the normal field (that is, a field due to a point source or a dipole source on a homogeneous medium), falls off inversely as the distance from the source. The conductivity of the layers is assumed to vary randomly about a mean value (unity) such that the variations can be represented by a zero mean homogeneous random function. Further the variations are assumed to be small compared to the mean so that the first order perturbation is adequate. The analysis shows that the dipole field is more sensitive than the single pole field to the conductivity variations.

The signal-to-noise (S/N) ratio in the reconstructed image from a binary hologram has been quantitatively related to the amplitude and phase quantization levels. The S/N ratio increases monotonically with increasing number of quantization levels. This observation is further supported by experimental results.