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Allergic bronchopulmonary aspergillosis (ABPA) is a complex allergic disorder caused by immune reactions against Aspergillus fumigatus. ABPA most commonly complicates the course of patients with poorly controlled asthma. Patients commonly present with uncontrolled asthma, fleeting pulmonary opacities, and bronchiectasis. Pathogenetically, ABPA is characterized by the persistence of A. fumigatus in the airways and an exaggerated type-2 immune response. The interest in ABPA stems from the fact that bronchiectasis in ABPA can be prevented if the disorder is diagnosed timely and treated appropriately. Herein, we summarize the current concepts in the epidemiology, pathogenesis, diagnosis, and treatment of ABPA.

The rapid increase in the number of CT acquisitions during the COVID-19 pandemic raised concerns about increased radiation exposure to patients and the resultant radiation-induced health risks. It prompted researchers to explore newer CT techniques like ultra-low dose CT (ULDCT), which could improve patient safety. Our aim was to study the utility of ultra-low dose CT (ULDCT) chest in the evaluation of acute COVID-19 pneumonia with standard-dose CT (SDCT) chest as a reference standard. This was a prospective study approved by the institutional review board. 60 RT-PCR positive COVID-19 patients with valid indication for CT chest underwent SDCT and ULDCT. ULDCT and SDCT were compared in terms of objective (noise and signal-to-noise ratio) and subjective (noise, sharpness, artifacts and diagnostic confidence) image quality, various imaging patterns of COVID-19, CT severity score and effective radiation dose. The sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy of ULDCT for detecting lung lesions were calculated by taking SDCT as a reference standard. The mean age of subjects was 47.2 ± 10.7 years, with 66.67% being men. 90% of ULDCT scans showed no/minimal noise and sharp images, while 93.33% had image quality of high diagnostic confidence. The major imaging findings detected by SDCT were GGOs (90%), consolidation (76.67%), septal thickening (60%), linear opacities (33.33%), crazy-paving pattern (33.33%), nodules (30%), pleural thickening (30%), lymphadenopathy (30%) and pleural effusion (23.33%). Sensitivity, specificity and diagnostic accuracy of ULDCT for detecting most of the imaging patterns were 100% (p < 0.001); except for GGOs (sensitivity: 92.59%, specificity: 100%, diagnostic accuracy: 93.33%), consolidation (sensitivity: 100%, specificity: 71.43%, diagnostic accuracy: 93.33%) and linear opacity (sensitivity: 90.00%, specificity: 100%, diagnostic accuracy: 96.67%). CT severity score (range: 15–25) showed 100% concordance on SDCT and ULDCT, while effective radiation dose was 4.93 ± 1.11 mSv and 0.26 ± 0.024 mSv, respectively. A dose reduction of 94.38 ± 1.7% was achieved with ULDCT. Compared to SDCT, ULDCT chest yielded images of reasonable and comparable diagnostic quality with the advantage of significantly reduced radiation dose; thus, it can be a good alternative to SDCT in the evaluation of COVID-19 pneumonia.

Whether chronic pulmonary aspergillosis (CPA) has different immunophenotypes remains unknown.To identify different CPA immunophenotypes using cluster analysis.We used a subject-centred multivariate clustering approach without prior assumptions to identify CPA phenotypes. We retrospectively included the data of treatment-naïve subjects with CPA and excluded subjects with asthma and allergic bronchopulmonary aspergillosis (ABPA). We performed a scalable two-step cluster analysis using the log-likelihood distance measures to identify CPA phenotypes based on the blood immunological profile (total IgE, eosinophil count and Aspergillus-specific IgE and IgG).We included 351 CPA subjects and found two clusters. Cluster 2 (n = 118) had significantly higher serum total IgE, peripheral blood eosinophil count, and serum A. fumigatus-specific IgE and IgG than cluster 1 (n = 233). Cluster 2 subjects had a lower FEV1:FVC ratio on spirometry and were more likely to have a fungal ball (88 [74.6%] vs. 145 (62.2%), p = .023) on the CT thorax than cluster 1. After treatment discontinuation, cluster 2 had a longer median (interquartile range) time to relapse than cluster 1 (11.5 [7.3-27.4] vs. 4 [1.1-8.9] months, p = .005).We identified two distinct CPA phenotypes, type-2 dominant and non-type-2, with different clinical and radiological findings and treatment outcomes. Future studies should confirm our findings and investigate different treatment strategies based on CPA phenotypes.

Background: Due to the advanced improvement in internet and network technologies, significant number of intrusions and attacks takes place. An intrusion detection system (IDS) is employed to prevent distinct attacks. Several machine learning approaches has been presented for the classification of IDS. But, IDS suffer from the curse of dimensionality that results to increased complexity and decreased resource exploitation. Consequently, it becomes necessary that significant features of data must be investigated by the use of IDS for reducing the dimensionality. Aim: In this article, a new feature selection (FS) based classification system is presented which carries out the FS and classification processes. Methods: Here, the binary variants of the Grasshopper Optimization Algorithm called BGOA is applied as a FS model. The significant features are integrated using an effective model to extract the useful ones and discard the useless features. The chosen features are given to the feed forward neural network (FFNN) model to train and test the KDD99 dataset. Results: The validation of the presented model takes place using a benchmark KDD Cup 1999 dataset. By the inclusion of FS process, the classifier results gets increased by attaining FPR of 0.43, FNR of 0.45, sensitivity of 99.55, specificity of 99.57, accuracy of 99.56, Fscore of 99.59 and kappa value of 99.11. Conclusion: The experimental outcome ensured the superior performance of the presented model compared to diverse models under several aspects and is found to be an appropriate tool for detecting intrusions.

Non-invasive oxygen therapy (NIT) consists of high-flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP). NIT is routinely being used for the management of acute respiratory failure secondary to coronavirus disease-2019 (COVID-19) with variable outcomes. However, previously published studies show that NIT failure might delay endotracheal intubation and invasive mechanical ventilation and results in worse outcomes in patients with hypoxemic respiratory failure. Early prediction of failure of NIT, will help in early decision-making in initiating invasive mechanical ventilation. We retrospectively studied the predictors for NIT failure in patients with moderate to severe COVID-19.Adult patients (18 years) admitted to the intensive care unit (ICU) with moderate to severe COVID-19 ARDS and received NIT [HFNO and CPAP non-invasive ventilation (NIV)] were included in this study. Baseline clinical and laboratory data were collected retrospectively from the electronic hospital information system. NIT failure was defined as the need for invasive mechanical ventilation after the initiation of NIT in the ICU. Univariate and multivariate logistic regression analyses were used to find out the possible predictors of NIT failure.Out of 254 patients admitted to ICU, 127 patients were initiated NIT at admission to ICU. During the course of the ICU stay, 33 (26%) patients subsequently required invasive mechanical ventilation (NIT failure). Respiratory rate-oxygenation index (ROX index) of2.97 at two hours and3.63 at six hours of ICU admission predicted NIT failure in our cohort of patients with a high positive predictive value.Patient selection is crucial for successful NIT in COVID-19. Application of ROX index measured in the first six hours of ICU admission helps in the identification of patients at risk of NIT failure with moderate to severe COVID-19 ARDS.

BACKGROUND AND PURPOSE: A basilar artery intraluminal septation is an exceedingly rarely reported, presumed congenital abnormality. In our clinical practice, we have occasionally noticed an intraluminal band within the inferior aspect of the basilar artery on CTA. Furthermore, we have noticed, at times, the presence of a punctate calcification associated with this finding. We hypothesized that what previous studies have called “basilar septations” in fact represent miniature and thus aberrant basilar fenestrations. MATERIALS AND METHODS: We retrospectively reviewed CTA studies obtained between January 1, 2017, and August 31, 2019. Identified intraluminal basilar abnormalities were classified as either basilar septations or basilar fenestrations. Association with other posterior circulation abnormalities was documented. RESULTS: A total of 3509 studies were examined. A basilar intraluminal abnormality was evident in 80 patients (2.3%). Of these 80 patients, 59 were classified as having a basilar fenestration (1.7%) and 21 were classified as having basilar septations (0.6%). Associated calcification was evident in 3 of the basilar fenestration cases and 13 of the basilar septation cases. CONCLUSIONS: Basilar septations most likely represent and should be referred to as aberrant basilar fenestrations. They should be interpreted as benign congenital incidental findings and should not be misinterpreted as focal dissections or arterial webs. Important variations in the morphology of aberrant basilar fenestrations exist, including areas of thinning, varying thickness, and nodularity. Therefore, when associated with calcification or nodularity, aberrant basilar fenestrations should not be confused with focal intraluminal thrombi or calcified or noncalcified emboli.

Muthu V, Sehgal IS, Dhooria S, Prasad KT, Aggarwal AN, Agarwal R. Corticosteroids for Non-severe COVID-19: Primum Non Nocere. Indian J Crit Care Med 2022;26(3):403-404.

The erosion wear due to raindrop plays a vital role in the service life of wind turbine components, especially blades. Furthermore, the rain impact angle and the environmental conditions have a major impact on erosion wear. In the present work, the rain erosion performance of glass fiber reinforced polyester (GFRP) blade material in offshore and onshore environmental conditions has been studied. A whirling arm test rig was created and used to conduct the erosion tests on both offshore and onshore conditions. To simulate the offshore and onshore environmental conditions, experiments were carried out using both fresh and saltwater. The trail runs were carried out for time duration (30–90 min) at different impact angles (0—90 deg) by running the whirling arm tester at different impact velocities (30–70 m/s). During the experimentation, the impact velocity varied from 30 to 70 m/s. The impact angle was taken as 0 deg, 30 deg, 45 deg, 60 deg, and 90 deg, respectively. The results showed that erosion wear in the offshore conditions was more in all the cases as compared to onshore conditions. Furthermore, the maximum mass loss was at 45-deg impact angles for both conditions, which was further endorsed by Scanning Electron Microscope (SEM) analysis. Very little work has been reported on the optimization of erosion wear response of Offshore and Onshore wind turbines by using different design of experiment techniques. The erosion testing reveals that the GFRP blades exhibit a ductile erosion mechanism, which was further explained by using three-dimensional surface plots with the help of Image J software.

Background: Machining and metal coating of plastics are essential requirements as plastics are overtaking other engineering materials nowadays. Metallization improves product life as well as enhances its surface and mechanical properties. The machining (i.e., cutting, drilling, boring) of plastic parts with conventional processes is difficult as the dimensional accuracy and surface finish cannot be obtained from existing methods or/and needs multiple operations to acquire the surface finish needed. The coating of plastic materials is also a complex method using chemicals and electricity. An innovative method of coating and machining on plastic components has been demonstrated, which would be beneficial for potential researchers. A detailed analysis of previous patents and techniques has been performed based on which an advanced apparatus has been proposed. Objective: The objective of this study was to develop an apparatus based on non-conventional machining techniques. Moreover, the apparatus would be capable of plating metal layer on polymers using chemicals and fine metal particles. An in-depth analysis of previous patents used for the same application has been performed and based on the limitations of already existing techniques. Methods: An apparatus for machining and metal coating of polymers utilizes compressed air at high pressure mixed with chemical vapors. Before compression, the air is filtered to remove the impurities and moisture. Afterwards, heated chemical vapors are mixed with air in a specific proportion for machining of plastic parts. A jet of air and chemical vapours impinges on work material, which would perform machining in two steps. Initially, the chemical vapours would dissolve plastic material, which would instantly melt and starts flowing. Afterwards, the air jet would remove the excess plastic material due to high pressure. On the other hand, metallization can also be performed using different chemicals in proper proportion. Results: The apparatus makes it easy for machining and metalizing the ABS or plastic parts as the process is performed on one apparatus simultaneously one after the other. The high speed jet of acetone vapors has a greater tendency to perform various machining operations like cutting, drilling, boring of ABS parts. These vapours, when mixed with pressurized air, enhance the capability of machining the workpieces. And the metallization of plastic parts provides luster and surface finish to the workpiece. Conclusion: The present invention is to provide an apparatus for effectively plating or coating the machined workpieces. Moreover, the present work provides detailing of an apparatus for improving the mechanical strength, hardness and surface finish of the machined workpiece. In addition to this, the proposed apparatus is enabled to make strong bonding between metal particles and plastics.

Statins are a class of drugs widely used worldwide to manage hypercholesterolemia and the prevention of secondary heart attacks. Currently, available statins vary in terms of their pharmacokinetic and pharmacodynamic profiles. Although the primary target of statins is the inhibition of HMG-CoA reductase (HMGR), the rate-limiting enzyme in cholesterol biosynthesis, statins exhibit many pleiotropic effects downstream of the mevalonate pathway. These pleiotropic effects include the ability to reduce myocardial fibrosis, pathologic cardiac disease states, hypertension, promote bone differentiation, anti-inflammatory, and antitumor effects through multiple mechanisms. Although these pleiotropic effects of statins may be a cause for enthusiasm, there are many adverse effects that, for the most part, are unappreciated and need to be highlighted. These adverse effects include myopathy, new-onset type 2 diabetes, renal and hepatic dysfunction. Although these adverse effects may be relatively uncommon, considering the number of people worldwide who use statins daily, the actual number of people affected becomes quite large. Also, co-administration of statins with several other medications, herbal agents, and foods, which interact through common enzymatic pathways, can have untoward clinical consequences. In this review, we address these concerns.

The study to investigate the socio-economic values of different land use systems and their impact on the livelihood of farmers was carried out in different blocks of Jammu district of Jammu and Kashmir during 2019. Out of total 20 blocks of Jammu district, 10 blocks were delineated purposively having maximum rainfed area. Two villages were selected randomly from each selected block with 08 farmers/households randomly selected as respondents making a size of 160 respondents. A prestructured questionnaire was used for collecting the data from respondents. Two agroforestry systems namely; agrisilviculture and agro-silvo-pastoral were mainly identified in study area contributing 23% and 77% to the livelihood of the respondents respectively.The findings revealed that the overall economic returns from agri-silviculture system and agro-silvo-pastoral in study area in Jammu district were `164833 and `181820 respectively. The study further concluded that large part of population in the study area was dependent on agriculture as the main income generating component in existing agroforestry systems.

Chronic pulmonary aspergillosis has a 5-year mortality of 50-80% globally, and the optimal duration of treatment for chronic pulmonary aspergillosis remains unclear. We aimed to compare the effect of 6-months of oral itraconazole with 12-months of oral itraconazole on chronic pulmonary aspergillosis clinical outcomes.In this single-centre, open-label, randomised controlled trial conducted in one chest clinic in Chandigarh, India, we screened consecutive patients with chronic pulmonary aspergillosis who were naive to antifungal treatment and randomised eligible patients, using block randomisation, to receive a starting dose of 400 mg/day of oral itraconazole for either 6 months or 12 months. There was no masking of participants or investigators. We excluded patients who were unable to provide informed consent; had an intake of any antifungal drugs for more than 3 weeks in the preceding 6 months; had active Mycobacterium tuberculosis or non-tuberculous mycobacterial pulmonary disease; and had allergic, subacute, or invasive forms of aspergillosis. The primary outcome was the proportion of patients having relapse 2 years after treatment initiation. We performed an intention-to-treat analysis for all outcomes. The study is registered with ClinicalTrials.gov, NCT03920527.We recruited participants between July 1, 2019, and Aug 31, 2021. We screened 250 patients, of which 164 were included in the trial. 81 patients were randomised to the 6-month group and 83 patients were randomised to the 12-month group. The study population was 78 (48%) women and 86 (52%) men, and the mean age of participants was 44·3 (SD 13·3) years. The proportion of patients experiencing relapse was significantly lower in the 12-month group, 31 (38%) had a relapse in the 6-month group compared with 8 (10%) in the 12-month group, with an absolute risk reduction of 0.29 [95% CI 0·16-0·40]. The mean time to first relapse was 23 months in the 12-month group, which is significantly longer than the mean of 18 months in the 6-month group (p0.0001). There were 16 deaths in total, eight in each group. Ten (12%) of 81 patients in the 6-months group and 18 (22%) of 83 patients in the 12-months group had adverse effects, with none requiring treatment modification. Nausea and anorexia were the most common adverse events in both groups.Treatment of chronic pulmonary aspergillosis with 12 months of oral itraconazole was superior to 6 months of oral itraconazole in reducing relapses at 2 years. Itraconazole should be given for at least 12 months for treating chronic pulmonary aspergillosis.None.For the Hindi translation of the abstract see Supplementary Materials section.

Background Foreign body (FB) ingestion is a common presentation to ear, nose, and throat (ENT) surgeons. Usual culprits include fish or chicken bones, steak, or non-organic items. FBs can be categorised into batteries, hard objects, and soft boluses. Hard objects that have not passed beyond the post-cricoid region require removal to minimise perforation risk. In rare cases FBs are reported to migrate extra-luminally into surrounding tissues of the neck necessitating cross-sectional imaging ahead of neck exploration. Case Report A 70-year-old lady presented to A&E with a sensation of FBs in her throat. She was aphagic without dyspnoea. Home-cooked fish ingestion was the precursor. Panendoscopy was clear. The patient was discharged once tolerating fluids and soft diet. She presented 14 months later to the ENT clinic with a persistent FB sensation in her throat. A computed-tomography scan of neck showed a right sided, radio-opaque, 3 cm foreign body sitting just anterior to the carotid sheath, behind the right superior thyroid lobe. An elective external neck exploration revealed a 3 cm shard of glass which was successfully removed without complications. Conclusions Extra-luminal migration of FBs is extremely rare. They may present with life-threatening suppurative or vascular complications. A literature review revealed that migratory FBs tend to be sharp and long such as needles, wires, or fishbones. To allow prompt diagnosis and management, we propose a low threshold for CT imaging in instances with a clear history and persistent symptoms even when panendoscopy is negative.

This research is an attempt to examine the recent status and development of scientific studies on the use of machine learning algorithms to model air pollution challenges. This study uses the Web of Science database as a primary search engine and covers over 900 highly peer-reviewed articles in the period 1990–2022. Papers published on these topics were evaluated using the VOSViewer and biblioshiny software to identify and visualize significant authors, key trends, nations, research publications, and journals working on these issues. The findings show that research grew exponentially after 2012. Based on the survey, “particulate matter” is the highly occurring keyword, followed by “prediction”. Papers published by Chinese researchers have garnered the most citations (2421), followed by papers published in the United States of America (2256), and England (722). This study assists scholars, professionals, and global policymakers in understanding the current status of the research contribution on “air pollution and machine learning” as well as identifying the relevant areas for future research.