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Pneumonia, a leading cause of mortality in children under five, is usually diagnosed through chest X-ray (CXR) images due to its efficiency and cost-effectiveness. However, the shortage of radiologists in the Least Developed Countries (LDCs) emphasizes the need for automated pneumonia diagnostic systems. This article presents a Deep Learning model, Zero-Order Optimized Convolutional Neural Network (ZooCNN), a Zero-Order Optimization (Zoo)-based CNN model for classifying CXR images into three classes, Normal Lungs (NL), Bacterial Pneumonia (BP), and Viral Pneumonia (VP); this model utilizes the Adaptive Synthetic Sampling (ADASYN) approach to ensure class balance in the Kaggle CXR Images (Pneumonia) dataset. Conventional CNN models, though promising, face challenges such as overfitting and have high computational costs. The use of ZooPlatform (ZooPT), a hyperparameter finetuning strategy, on a baseline CNN model finetunes the hyperparameters and provides a modified architecture, ZooCNN, with a 72% reduction in weights. The model was trained, tested, and validated on the Kaggle CXR Images (Pneumonia) dataset. The ZooCNN achieved an accuracy of 97.27%, a sensitivity of 97.00%, a specificity of 98.60%, and an F1 score of 97.03%. The results were compared with contemporary models to highlight the efficacy of the ZooCNN in pneumonia classification (PC), offering a potential tool to aid physicians in clinical settings.

Background: The symptoms of COVID-19 include fever, myalgia, arthralgia, fatigue, headache, sore throat, dry cough, anosmia, ageusia/dysgeusia, and progression to viral pneumonia. Musculoskeletal symptoms such as fatigue, myalgia, and arthralgia are common COVID-19 symptoms, but their prevalence has not yet been systematically investigated. Hence, our study aims to know the incidence of musculoskeletal symptoms in COVID-19 infection and their relationship between comorbidities like diabetes and hypertension. Methods: In our study, 1053 COVID-19 infected patients confirmed by the RT-PCR method were included. For all the patients in our study, detailed history of musculoskeletal symptoms and comorbidities were collected. Basic investigations were done for all the patients and appropriate treatment was given. The patients were followed up for persistence of musculoskeletal symptoms after discharge from the hospital. Results: During COVID-19 infection, knee joint pain was present among 251 patients (23.8%), generalized myalgia in 147 patients (14%) and 40 patients (3.8%) had both knee joint pain and generalized myalgia. In these patients, during the post-COVID follow-up, 198 patients had persistent knee joint pain, 100 patients had persistence of generalized myalgia and 38 patients had persistence of both knee pain and myalgia, whereas 19 patients developed knee joint pain and one patient developed generalized myalgia after COVID-19 infection. From our study, it is evident that the musculoskeletal symptoms are more during COVID-19 infection than during the pre-COVID period. Compared with pre-COVID status, generalized myalgia is more during the post-COVID follow-up period. This was analyzed with Cochran's Q test and was found to be statistically significant (p < 0.05). Conclusion: Our study showed an increased incidence of musculoskeletal symptoms during and after COVID-19 infection, the most common being generalized myalgia followed by knee joint pain. In patients with comorbidities like diabetes and hypertension, it is evident that musculoskeletal symptoms like knee joint pain and generalized myalgia are increased during COVID-19 infection.

Introduction: In the era of increasing antimicrobial resistance, knowing the mechanism of carbapenem resistance can aid in choosing an apt drug for treatment of patients. There are only few studies estimating the burden of carbapenem resistance and determining the mechanism of resistance among the isolates in our locale. Aim: To determine the prevalence of carbapenemase production by modified Carbapenem Inactivation Method (mCIM) among the Carbapenem Resistant Gram-Negative Bacteria (CRGNB)- Enterobacteriaceae and Pseudomonas aeruginosa isolated in our hospital. Materials and Methods: This was a prospective observational study conducted in Department of Microbiology, KMCH, Coimbatore, Tamil Nadu, India during the period of June 2021 to August 2021. A total of 165 isolates of Enterobacteriaceae family and P. aeruginosa which were resistant to one of the carbapenems (imipenem, meropenem or ertapenem) by Vitek MIC testing were included in the study. All were subjected to mCIM and EDTA-modified CIM (eCIM) test and interpreted as per the CLSI M100 S31 guidelines. Results: Among the 165 isolates, 130 (78.8%) were K. pneumoniae, 27 (16.4%) were other Enterobacteriaceae and eight (4.8%) were P. aeruginosa. Prevalence of mCIM positivity was 51.5% (85 isolates). Approximately, 98% of the mCIM positives (Carbapenemase Producing Gram-Negative Bacteria [CPGNB]) were eCIM positive indicating Metallo-Beta- Lactamase (MBL) production. Conclusion: Performing mCIM in CRGNB is important in routine practice to identify CPGNBs. Due to very high prevalence of MBL among carbapenemase producers, it is advisable to choose ceftazidime avibactam plus aztreonam as the treatment option for CPGNB in our locale.

Introduction: Overzealous application of endodontic irrigants affects the root canal dentin mechanical properties. The effect of volume of endodontic irrigants on the microhardness of root canal dentin has not been studied. Aim: This study assessed the effect of volume of endodontic irrigants used in different final irrigation activation techniques on root canal dentin microhardness (RCDM). Methodology: Sixty human maxillary central incisors were embedded in acrylic resin in Kuttler's endodontic cube to the level of cementoenamel junction. The root samples were randomly divided into 4 experimental groups (n = 15): Group-NI-needle irrigation, Group-PUI–continuous passive ultrasonic irrigation, Group-EndoVac–apical negative pressure system, Group combination– EndoVac + PUI irrigation. Root canals were instrumented up to size 40 (F4). The resin mounted specimens were sectioned longitudinally into two halves and were reassembled in Kuttler's kube to carry out final irrigation activation. A predetermined standardized volume of irrigants was used in each group. The RCDM was measured after root canal instrumentation and after final irrigation using Vicker microhardness tester (coronal, middle, and apical third). The reduction in RCDM values (p < 0.0086) were analyzed using Kruskal Wallis and Mann Whitney-U tests. Results: Reduction in RCDM was observed with all the endodontic irrigating techniques tested. EndoVac and combination irrigation techniques showed maximum reduction in RCDM in all thirds of root canal. Conclusion: It is concluded that the volume of irrigants and agitation plays a role in reducing RCDM. The overall volume of irrigants to cause maximum reduction was 25 ml, beyond which neither volume nor agitation affects RCDM.

Background: Coronavirus Disease-2019 (COVID-19) vaccination has been associated with the development of carditis, especially in children and adolescent males. However, the rates of these events in the global setting have not been explored in a systematic manner. The aim of this systematic review and meta-analysis is to investigate the rates of carditis in children and adolescents receiving COVID-19 vaccines., Methods: PubMed, Embase and several Latin American databases were searched for studies. The number of events, and where available, at-risk populations were extracted. Rate ratios were calculated and expressed as a rate per million doses received. Subgroup analysis based on the dose administered was performed. Subjects ≤ 19 years old who developed pericarditis or myocarditis following COVID-19 vaccination were included., Results: A total of 369 entries were retrieved. After screening, 39 articles were included. Our meta-analysis found that 343 patients developed carditis after the administration of 12,602,625 COVID-19 vaccination doses (pooled rate per million: 37.76; 95% confidence interval [CI] 23.57, 59.19). The rate of carditis was higher amongst male patients (pooled rate ratio: 5.04; 95% CI 1.40, 18.19) and after the second vaccination dose (pooled rate ratio: 5.60; 95% CI 1.97, 15.89). In 301 cases of carditis (281 male; mean age: 15.90 (standard deviation [SD] 1.52) years old) reported amongst the case series/reports, 261 patients were reported to have received treatment. 97.34% of the patients presented with chest pain. The common findings include ST elevation and T wave abnormalities on electrocardiography. Oedema and late gadolinium enhancement in the myocardium were frequently observed in cardiac magnetic resonance imaging (CMR). The mean length of hospital stay was 3.91 days (SD 1.75). In 298 out of 299 patients (99.67%) the carditis resolved with or without treatment., Conclusions: Carditis is a rare complication after COVID-19 vaccination across the globe, but the vast majority of episodes are self-limiting with rapid resolution of symptoms within days. Central illustration. Balancing the benefits of vaccines on COVID-19-caused carditis and post-vaccination carditis., (© 2022. The Author(s).)