Search

Abstract Breast cancer, a prevalent and life-threatening disease, necessitates early detection for the effective intervention and the improved patient health outcomes. This paper focuses on the critical problem of identifying breast cancer using a model called Attention U-Net. The model is utilized on the Breast Ultrasound Image Dataset (BUSI), comprising 780 breast images. The images are categorized into three distinct groups: 437 cases classified as benign, 210 cases classified as malignant, and 133 cases classified as normal. The proposed model leverages the attention-driven U-Net’s encoder blocks to capture hierarchical features effectively. The model comprises four decoder blocks which is a pivotal component in the U-Net architecture, responsible for expanding the encoded feature representation obtained from the encoder block and for reconstructing spatial information. Four attention gates are incorporated strategically to enhance feature localization during decoding, showcasing a sophisticated design that facilitates accurate segmentation of breast tumors in ultrasound images. It displays its efficacy in accurately delineating and segregating tumor borders. The experimental findings demonstrate outstanding performance, achieving an overall accuracy of 0.98, precision of 0.97, recall of 0.90, and a dice score of 0.92. It demonstrates its effectiveness in precisely defining and separating tumor boundaries. This research aims to make automated breast cancer segmentation algorithms by emphasizing the importance of early detection in boosting diagnostic capabilities and enabling prompt and targeted medical interventions.

Abstract Low grade endometrial stromal sarcoma (LGESS) typically presents as a solid intracavitary or intramural uterine mass. On imaging, LGESS is usually seen as an endometrial or myometrial solid mass. Cystic change is unusal and may lead to a differential diagnosis of an ovarian mass as was seen in the present case. Here we present a case of a 38 year old woman who presented with a cystic ovarian mass clinically and radiologically. Per-operatively, it was found to be a multiloculated cystic mass, filled with serosanguinous fluid, in the uterine fundus. Histopathological examination showed a tumor mass composed of mainly spindle cells arranged in fascicular pattern showing marked myxoid degeneration and cystic areas. On immunohistochemistry(IHC), tumor cells showed positivity for CD 10, ER, PR, SMA and desmin while HMB45 was negative. Based on histopathological and IHC, a diagnosis of LGESS was made. Most cases of cystic uterine masses have a benign course but, LGESS exhibits a relatively poorer outcome and a risk of metastasis. Hence, we present this case for its unusual presentation which mimics an ovarian mass but has worse prognosis.

Purpose: To assess outcomes of keratoplasty performed in patients diagnosed with keratitis caused by Pythium insidiosum (PI). Design: Retrospective review. Methods: Preoperative, intra operative and post operative data of patients diagnosed with PI keratitis and who underwent keratoplasty for their condition from January 2020 to December 2021 were collected from the central patient database of a tertiary eye care hospital in India. The data were analyzed for anatomic success, elimination of infection, graft survival, incidence of repeat keratoplasty, final visual acuity and varied complications. Results: In total, 16 eyes underwent penetrating keratoplasty for PI keratitis during the study period. Mean time to keratoplasty from onset of symptoms was 31.3 days and mean graft size was 10.4 mm. Nine out of the 16 cases had recurrence of infection following surgery, seven of which required a repeat keratoplasty for elimination of infection. Mean graft size for repeat keratoplasty performed in recurrent cases was 11.7 mm. Globe was successfully salvaged in 14 out of 16 patients (87.5 %). Three grafts remained clear at 6-month follow up while 11 grafts failed. Mean improvement in uncorrected visual acuity from 2.32 to 2.04 logMAR was observed at last follow up. Endo-exudates, graft infiltration, graft dehiscence, secondary glaucoma and retinal detachment were the various complications noted after keratoplasty. Conclusion: PI keratitis is a tenacious and potentially blinding condition. Keratoplasty remains the choice of treatment in this condition, however recurrence of disease and graft failure are common. Large sized grafts, meticulous per-operative removal of infection, adjuvant cryotherapy, and intraoperative and post operative use of antibiotics can help in improving outcome of keratoplasty in these patients.

Background: Retinal vein occlusion (RVO) is one of the most common causes of retinal vascular disease, second to diabetic retinopathy. We aimed to compare the lamina cribrosa thickness (LCT) of patients with unilateral branch RVO (BRVO) versus healthy individuals. Materials and Methods: This was a hospital-based, prospective, cross-sectional, and comparative study. Participants were newly diagnosed RVO cases (n = 25) and apparently normal age-matched healthy controls (n = 25). All the participants underwent systemic and comprehensive ophthalmic examination, including refraction and enhanced depth imaging optical coherence tomography. Relevant parameters were compared between the groups using the independent t-test. Statistical significance thresholds were set at a P < 0.05. Results: The mean age of cases (66.7% female) and controls (52% female) was 55.9 ± 7.4 and 59.4 ± 7.0 years, respectively, (P = 0.089). The mean LCT of the affected eyes in cases (176.6 ± 28.3 μm) was significantly lower compared to the unaffected eyes of cases (200.6 ± 33.1 μm, P = 0.008) and control eye (230.9 ± 36.9 μm, P = 0.001). Conclusions: A thinner lamina cribrosa (LC) was observed in both eyes of unilateral RVO patients compared with healthy, nonglaucomatous subjects’ eyes. The role of LCT as a local mechanical factor in the pathogenesis of BRVO and their relationship to systemic factors merits further investigation.

Introduction There are no established methods to identify children with atypical diabetes for further study. We aimed to develop strategies to systematically ascertain cases of atypical pediatric diabetes using electronic medical records (EMR).Research design and methods We tested two strategies in a large pediatric hospital in the USA. Strategy 1: we designed a questionnaire to rule out typical diabetes and applied it to the EMR of 100 youth with diabetes. Strategy 2: we built three electronic queries to generate reports of three atypical pediatric diabetes phenotypes: unknown type, type 2 diabetes (T2D) diagnosed

Assessing the blood hematocrit (Hct) and oxygenation (SO2) levels are essential for diagnosing numerous blood-related diseases. This study examines the ability of the photoacoustic (PA) technique for quantitative evaluation of these parameters. We conducted the Monte Carlo and k-Wave simulations to compute PA signals at four different optical wavelengths from test blood samples followed by rigorous in vitro experiments. This method can estimate the Hct and SO2 levels faithfully with ≥95% and ≥93% accuracies, respectively in the physiologically relevant hematocrits utilizing PA signals generated at 700 and 1000 nm optical wavelengths. A 2% decrease in the scattering anisotropy factor demotes SO2 estimation by ≈ 27%. This study provides sufficient insight into how the opto-chemical parameters of blood impact PA emission and may help to develop a PA setup for in vitro characterization of human blood.

Abstract The research focuses on the segmentation and classification of leukocytes, a crucial task in medical image analysis for diagnosing various diseases. The leukocyte dataset comprises four classes of images such as monocytes, lymphocytes, eosinophils, and neutrophils. Leukocyte segmentation is achieved through image processing techniques, including background subtraction, noise removal, and contouring. To get isolated leukocytes, background mask creation, Erythrocytes mask creation, and Leukocytes mask creation are performed on the blood cell images. Isolated leukocytes are then subjected to data augmentation including brightness and contrast adjustment, flipping, and random shearing, to improve the generalizability of the CNN model. A deep Convolutional Neural Network (CNN) model is employed on augmented dataset for effective feature extraction and classification. The deep CNN model consists of four convolutional blocks having eleven convolutional layers, eight batch normalization layers, eight Rectified Linear Unit (ReLU) layers, and four dropout layers to capture increasingly complex patterns. For this research, a publicly available dataset from Kaggle consisting of a total of 12,444 images of four types of leukocytes was used to conduct the experiments. Results showcase the robustness of the proposed framework, achieving impressive performance metrics with an accuracy of 97.98% and precision of 97.97%. These outcomes affirm the efficacy of the devised segmentation and classification approach in accurately identifying and categorizing leukocytes. The combination of advanced CNN architecture and meticulous pre-processing steps establishes a foundation for future developments in the field of medical image analysis.

Background: Detection of outbreaks traditionally relies on passive surveillance, and often misidentify or miss outbreaks. Whole genome sequencing (WGS) surveillance has emerged as a proactive measure, enabling early detection of outbreaks and facilitating rapid intervention strategies. WGS surveillance has not been widely studied due to infrastructure, cost, and evidence barriers regarding its impact on reducing healthcare-associated infections (HAIs). This study represents findings from two years of a real-time WGS surveillance program called the Enhanced Detection System for Healthcare-associated Transmission (EDS-HAT). Methods: The study was conducted at UPMC Presbyterian hospital, a 694-bed tertiary care center. Patient isolates of select bacterial pathogens were collected and underwent WGS weekly from November 2021 to November 2023. Potential transmission was defined using single-nucleotide polymorphism thresholds (≤15 for all organisms except Clostridioides difficile). Genetically related clusters were reviewed weekly for epidemiological linkages (unit, personnel, or procedural commonalities) and appropriate interventions were initiated by the infection prevention and control team. We described the frequency of genetic relatedness and nature of epidemiological linkages. Results: Of 7,051 eligible unique patient organism isolates, 4,723 were deemed healthcare-associated and underwent WGS. EDS-HAT identified 478 (12.2%) isolates genetically related to ≥1 other isolate across 173 clusters. Epidemiological links were found in 278 (58.2%) isolates in 114 clusters, with the majority being unit-based (205 isolates, 71.9%); other epidemiological links included equipment or healthcare workers (32 isolates, 11.5%), external facilities (24 isolates, 8.6%), and shared endoscopes (17 isolates, 6.1%); all endoscope outbreaks were effectively contained at two patients. No epidemiological links could be identified for 200 (41.8%) isolates. Infection prevention initiated 134 interventions in 114 clusters, including 74 (55.2%) general staff notification and education, 25 (18.7%) enhanced cleaning efforts, 23 (17.2%) hand hygiene/personal-protective equipment compliance observations, 9 (6.7%) environmental cultures, and 3 (2.2%) enhanced microbiological surveillance. Following the detection of an epidemiological link and intervention, 94/101 (94.1%) outbreaks were effectively halted on the intervened route (Figure). Conclusion: This study demonstrates the feasibility and efficacy of EDS-HAT as an infection prevention tool. Early detection and intervention of outbreaks significantly enhance the capability of healthcare facilities to control and prevent the spread of HAIs. Investment in infrastructure and implementation costs will result in reducing pathogen transmission and improving patient safety in acute care settings.

Aims This team of simulation fellows at a London teaching hospital created an immersive simulation course for core psychiatry trainees to explore the intersection between physical and mental health and impact on provision of care. The course was fully mapped to the updated Royal College Core Training Curriculum as well as Crisis Resource Management principles, and focusses on the integration of care across mental and physical health provisions. Scenarios are set in a range of inpatient and community environments to allow participants to consider differences in delivery of holistic care, prioritisation, ethical and legal considerations across settings. This would be particularly relevant for participants early in training with limited prior exposure who may be unfamiliar with handling emergencies on psychiatric wards and the nuanced limitations in providing medical care. Methods Scenarios were written in consultation with speciality experts and allied health professionals including mental health nursing, dietetics, and pharmacy. The course is written to enable participants to explore the intersection between physical and mental health, and the practical and social implications of an individual's mental and physical condition on provision of care. Alongside debriefing technical and non-technical learning objectives, participants reflected upon the wider determinants of each patient's current physical and mental state and discussed ethicolegal considerations such as patients’ legal status, capacity to consent, and practicalities of transferring patients between services and facilitating holistic care. Results The pilot course took place on July 4th following consultation with stakeholders including senior simulation and education leads within the Trust, and deanery Training Programme Directors, to ensure the course was formally endorsed to allow participants to apply for study leave to attend. Post-course feedback was collected through use of Likert-scales and white space questions; the response was highly positive and showed the programme met its aims and filled a training need. Feedback showed increased confidence managing integrated physical and mental health issues and balancing conflicting priorities with increased understanding of practical and social implications of mental and physical condition on provision of care. Conclusion Next steps involve collaboration with service users to allow accurate representation of the unique needs of a diverse population, and potential use of actors to sensitively and ethically portray simulated patients. Local psychiatry training schools could be approached to consider formal implementation of the course within academic programmes, in addition to potential reformulation of scenarios for use in established courses at the host site such as Undergraduate or Foundation training days.

Aims This team of simulation fellows and a final-year medical student at a London teaching hospital created an innovative simulation course for fourth-year medical students with the aim to supplement existing undergraduate psychiatry teaching by providing additional opportunity to practice clinical skills. The course allowed students to practice and improve advanced communication skills across a range of inpatient and community settings across GP, A&E, medical and psychiatric environments, with themes exploring psychiatry, heightened emotional states and biopsychosocial influences on mental and physical health in a safe, ethical manner, supplementing the teaching provided on clinical placements. Methods The course was fully mapped to the university curriculum as well as the Health Education England Future Doctor Vision and the Medical Licensing Assessment content map. Scenarios were written by trained simulation faculty in conjunction with specialty experts across all core specialties for fourth year medical students including obstetrics and gynaecology, paediatrics, psychiatry, and healthcare of the elderly. Scenarios were created to reflect local demographics with addition of detailed social history and population health information. This involved creation of simulated patients from multicultural backgrounds, with limited English or other communication needs, and representation of numerous gender expressions, sexual orientations, and a range of mental health and neurodevelopmental needs. Results The pilot course took place on May 2nd with 7 student participants following approval from senior education stakeholders. During debriefs, participants differentiated between psychiatric symptoms and non-pathological human experiences, and reflected on how and why the patient in front of them is presenting the way that they are, with regards to social determinants of physical and mental health. They were also guided to reflect upon the technical and non-technical learning objectives of each scenario including use of Crisis Resource Management principles. Quantitative and qualitative feedback was collected through use of Likert-scales and white space questions; feedback showed heightened confidence and competence in core skills including psychiatric history taking, mental state examination and risk assessment, as well as core communication skills such as explaining a new diagnosis and managing heightened emotion. Conclusion Feedback shows the pilot successfully met its aims and enhanced undergraduate training, filling an educational need. Next steps would include formally approaching the university to discuss implementation of the course into the core curriculum. Additional refinements would include further consultation with service users and people with lived experience and consideration around use of actors to ensure complex subjects such as immigration and neurodivergence are portrayed ethically and accurately.

ABSTRACT The topology of the transcription factor network (TFN) of Escherichia coli is far from uniform, with 22 global regulator (GR) proteins controlling one-third of all genes. So far, their production rates cannot be tracked by comparable fluorescent proteins. We developed a library of fluorescent reporters for 16 GRs for this purpose. Each consists of a single-copy plasmid coding for green fluorescent protein (GFP) fused to the full-length copy of the native promoter. We tracked their activity in exponential and stationary growth, as well as under weak and strong stresses. We show that the reporters have high sensitivity and specificity to all stresses tested and detect single-cell variability in transcription rates. Given the influence of GRs on the TFN, we expect that the new library will contribute to dissecting global transcriptional stress-response programs of E. coli. Moreover, the library can be invaluable in bioindustrial applications that tune those programs to, instead of cell growth, favor productivity while reducing energy consumption.IMPORTANCECells contain thousands of genes. Many genes are involved in the control of cellular activities. Some activities require a few hundred genes to run largely synchronous transcriptional programs. To achieve this, cells have evolved global regulator (GR) proteins that can influence hundreds of genes simultaneously. We have engineered a library of Escherichia coli strains to track the levels over time of these, phenotypically critical, GRs. Each strain has a single-copy plasmid coding for a fast-maturing green fluorescent protein whose transcription is controlled by a copy of the natural GR promoter. By allowing the tracking of GR levels, with sensitivity and specificity, this library should become of wide use in scientific research on bacterial gene expression (from molecular to synthetic biology) and, later, be used in applications in therapeutics and bioindustries.

Eutectic-Magnesium electrolytes are sparsely used electrolytes in Magnesium ion batteries. In this context, readily available less toxic precursors based eutectic electrolytes are attracting increasing interest owing to the focus of sustainable battery development. The unique benefits of magnesium such as high specific capacity, low reduction potential, and remarkable reversibility without dendrimer formation are highly advantages when compare to lithium based batteries. Developing an optimal electrolyte composition is a key area of study in the field of battery technology. With improved cell performance, stability across cycles, and general safety, we hope to reduce unwanted interfacial reactions. In this study, we examined eutectic combination of trimethylamine hydrochloride and aluminium chloride (TMA: AlCl3 = TMA) along with magnesium perchlorate to understand ion-solvation, complexation, thermal stability, ion transport and conduction, and electrochemical stability, certain physico-chemical and electrochemical parameters were evaluated prior to assessing the cell's performance. The salient features being an ionic conductivity (σ) of 6.25×10−3 mS cm−1 at 30 °C, remarkable performance retention with over 90 cycles of operation with the electrolyte and an impressive capacity of 90 mAh/g. The behaviour of ionic conductivity with temperature followed the Vogel-Tammann-Fulcher (VTF) equation. Moreover, the anodic stability around 2.5 V (Mg/Mg2+) when platinum is used as the working electrode endorses the suitability of the electrolyte for use in Rechargeable Magnesium Batteries (RMBs).The promising results of this first investigation open up new possibilities for investigating complementary pairings with the aim of improving the efficiency of magnesium-ion cells.

Background: Pseudoexfoliation (PEX) syndrome, an age related microfibrillopathy having varied prevalence and associated with dense cataract, poorly dilating pupil resulting in challenging cataract surgeries. The present study aimed to evaluate pseudoexfoliation syndrome in eyes undergoing cataract surgery in tertiary care centre of Uttarakhand. Materials and methods: A hospital based prospective study carried out from January 2021 to June 2022 and approved by the Institutional Ethical Committee. A total of 1000 eyes of 1000 patients to be operated underwent complete ophthalmic evaluation including refraction, tonometry, gonioscopy, slit lamp biomicroscopy for presence of pseudoexfoliation, cataract grading, and fundus examination. Patients with PEX were diagnosed and data analysed. Results: A total of 54 PEX cases were diagnosed with 29 (53.7%) males and 25(46.3%) were females having mean age of 67.48 + 9.79 years, mean CCT was 528.46 + 18.49 micron and mean IOP was 19.81 + 5.88 mmHg. Prior to cataract surgery, an IOP of more than 21 mm Hg was noted in 40.7% (n=54) of pseudoexfoliative eyes. PXM on pupillary margin present in 51 (94.4%), on anterior lens capsule in 37 (68.5%), on iris in 31 (57.4%), on cornea in 5 (9.3%), phacodonesis in 6 (11.1%), Iris transillumination defect in 3 (5.6%), PXM on trabecular meshwork in 24 (44.4%) and sampaolesi line in 13 (24.1%). Conclusion: PEX presents challenges that necessitate thorough preoperative planning for a safe surgery and a satisfactory postoperative result. Therefore, dilated anterior segment evaluation should be emphasised in daily practise to avoid early PEX patients from being undiagnosed

In this research paper, we obtained the analytic exact solution of time dependent inhomogeneous onedimensional heat conduction equation by using new homotopy perturbation method. The obtained solution of heat diffusion equation was explained graphically using MATLAB. The numerical values of the solution of Heat equation are shown in a table. The novelty of the procedure is that it does no longer require small parameter in an equation and obtain the analytical solution without converting the problem into homogeneous boundary condition. We concluded that the solution of nonlinear and linear differential equation can be received through using new homotopy perturbation method. Conclusion of this study have super utility in the discipline of engineering, mathematics, biomedical and many others.

Abstract A brain tumor is an unnatural expansion of brain cells that can’t be stopped, making it one of the deadliest diseases of the nervous system. The brain tumor segmentation for its earlier diagnosis is a difficult task in the field of medical image analysis. Earlier, segmenting brain tumors was done manually by radiologists but that requires a lot of time and effort. Inspite of this, in the manual segmentation there was possibility of making mistakes due to human intervention. It has been proved that deep learning models can outperform human experts for the diagnosis of brain tumor in MRI images. These algorithms employ a huge number of MRI scans to learn the difficult patterns of brain tumors to segment them automatically and accurately. Here, an encoder-decoder based architecture with deep convolutional neural network is proposed for semantic segmentation of brain tumor in MRI images. The proposed method focuses on the image downsampling in the encoder part. For this, an intelligent LinkNet-34 model with EfficientNetB7 encoder based semantic segmentation model is proposed. The performance of LinkNet-34 model is compared with other three models namely FPN, U-Net, and PSPNet. Further, the performance of EfficientNetB7 used as encoder in LinkNet-34 model has been compared with three encoders namely ResNet34, MobileNet_V2, and ResNet50. After that, the proposed model is optimized using three different optimizers such as RMSProp, Adamax and Adam. The LinkNet-34 model has outperformed with EfficientNetB7 encoder using Adamax optimizer with the value of jaccard index as 0.89 and dice coefficient as 0.915.

Abstract Background Delamanid and bedaquiline are two of the most recently developed antituberculosis (TB) drugs that have been extensively studied in patients with multidrug-resistant TB. There is currently a need for more potent, less-toxic drugs with novel mechanisms of action that can be used in combination with these newer agents to shorten the duration of treatment as well as prevent the development of drug resistance. Quabodepistat (QBS) is a newly discovered inhibitor of decaprenylphosphoryl-β-D-ribose-2′-oxidase, an essential enzyme for Mycobacterium tuberculosis to synthesize key components of its cell wall. The objective of this study is to evaluate the safety, efficacy, and appropriate dosing of a 4-month regimen of QBS in combination with delamanid and bedaquiline in participants with drug-susceptible pulmonary TB in comparison with the 6-month standard treatment (i.e., rifampicin, isoniazid, ethambutol, and pyrazinamide). Methods This phase 2b/c, open-label, randomized, parallel group, dose-finding trial will enroll approximately 120 participants (including no more than 15% with human immunodeficiency virus [HIV] coinfection) aged ≥ 18 to ≤ 65 years at screening with newly diagnosed pulmonary drug-sensitive TB from ~8 sites in South Africa. Following a screening period of up to 14 days, eligible participants will be randomized in a ratio of 1:2:2:1 to one of four arms. Randomization will be stratified by HIV status and the presence of bilateral cavitation on a screening chest x-ray. After the end of the treatment period, participants will be followed until 12 months post randomization. The primary efficacy endpoint is the proportion of participants achieving sputum culture conversion in Mycobacteria Growth Indicator Tube by the end of the treatment period. The safety endpoints consist of adverse events, clinical laboratory tests, vital signs, physical examination findings, and electrocardiographic changes. Discussion QBS’s potent bactericidal activity and distinct mechanism of action (compared with other TB drugs currently available for human use) may make it an ideal candidate for inclusion in a novel treatment regimen to improve efficacy and potentially prevent resistance to concomitant TB drugs. This trial will assess the effectiveness, safety, and dosing of a new, shorter, QBS-based, combination anti-TB treatment regimen. Trial status ClinicalTrials.gov NCT05221502. Registered on February 3, 2022

Solar energy is considered the major source of clean and ubiquitous renewable energy available on various scales in electric grids. In addition, solar energy is harnessed in various electronic devices to charge the batteries and power electronic equipment. Due to its ubiquitous nature, the corresponding market for solar-charged small-scale batteries is growing fast. The most important part to make the technology feasible is a portable battery charger and the associated controllers to automate battery charging. The charger should consider the case of charging to be convenient for the user and minimize battery degradation. However, the issue of slow charging and premature battery life loss plagues current industry standards or innovative battery technologies. In this paper, a new pulse charging technique is proposed that obviates battery deterioration and minimizes the overall charging loss. The solar-powered battery charger is prototyped and executed as a practical, versatile, and compact photovoltaic charge controller at cut rates. With the aid of sensor fusion, the charge controller is disconnected and reconnects the battery during battery overcharging and deep discharging conditions using sensors with relays. The laboratory model is tested using a less expensive PV panel, battery, and digital signal processor (DSP) controller. The charging behavior of the solar-powered PWM charge controller is studied compared with that of the constant voltage–constant current (CV–CC) method. The proposed method is pertinent for minimizing energy issues in impoverished places at a reasonable price.

Introduction Infertility affects 13% to 15% of the couples worldwide. The problem of infertility can have varying effects, depending on the physical and mental health of the couple, ultimately influencing the environment and the overall growth of society. Analysis of a semen sample may lead to various defects in the semen quality and quantity like azoospermia, which means the absence of spermatozoa in the semen ejaculate. Conversely, in oligospermia, the sperm count in the semen ejaculate is low. Micro-organisms, pus cells etc indicate infection in semen and hence can point towards existing infection causing oligospermia. Hence, this study was done to highlight the importance of semen analysis in hospitals and to present a detailed audit of the semen analysed at the tertiary care centre. Materials and methods This is a cross – sectional study where data of 3 years from 2020-to 2023 was collected and tabulated under the reported headings - volume, appearance, motility, pus cells, and any other relevant findings at School of Medical Science and Research, Sharda University. A total of 299 semen samples were analysed. Results Total number of cases recorded were 299. Out of the total samples, 36.5% of the samples showed reduced motility. 1.7% samples had immotile sperms while reduced motility was seen in 8.4% cases. 24.7% cases showed some degree of abnormal forms (categorised by WHO criteria). 35% cases had pus cells above 5/hpf. Conclusion This study has demonstrated that abnormal semen analysis, especially, in terms of sperm quantity, quality, and bacterial infection is a major factor in infertile male having abnormal semen parameters.

ABSTRACT: Objectives: New Delhi metallo-β-lactamase (NDM) is an emergent mechanism of carbapenem resistance associated with high mortality and limited treatment options. Because the blaNDM resistance gene is often carried on plasmids, traditional infection prevention and control (IP&C) surveillance methods and reactive whole genome sequencing (WGS) may not detect plasmid transfer in multispecies outbreaks. Methods: Initial outbreak detection of NDM-producing Enterobacterales identified at an acute care hospital occurred via traditional IP&C methods and was supplemented by real-time WGS surveillance performed weekly. To resolve NDM-encoding plasmids, we performed long-read sequencing and constructed hybrid assemblies. WGS data for suspected outbreaks was shared with the IP&C team for assessment and intervention. Results: We observed a multispecies outbreak of NDM-5-producing Enterobacterales isolated from 15 patients between February 2021 and February 2023. The 19 clinical and surveillance isolates sequenced included 7 bacterial species encoding the same NDM-5 plasmid. WGS surveillance and epidemiologic investigation characterized 10 horizontal plasmid transfer events and 6 bacterial transmission events between patients in varying hospital units. Conclusions: Our investigation revealed a complex, multispecies outbreak of NDM involving multiple plasmid transfer and bacterial transmission events. We highlight the utility of combining traditional IP&C and prospective genomic methods in identifying and containing plasmid-associated outbreaks.

Diabetic retinopathy is a condition that affects the retina and causes vision loss due to blood vessel destruction. The retina is the layer of the eye responsible for visual processing and nerve signaling. Diabetic retinopathy causes vision loss, floaters, and sometimes blindness; however, it often shows no warning signals in the early stages. Deep learning-based techniques have emerged as viable options for automated illness classification as large-scale medical imaging datasets have become more widely available. To adapt to medical image analysis tasks, transfer learning makes use of pre-trained models to extract high-level characteristics from natural images. In this research, an intelligent recommendation-based fine-tuned EfficientNetB0 model has been proposed for quick and precise assessment for the diagnosis of diabetic retinopathy from fundus images, which will help ophthalmologists in early diagnosis and detection. The proposed EfficientNetB0 model is compared with three transfer learning-based models, namely, ResNet152, VGG16, and DenseNet169. The experimental work is carried out using publicly available datasets from Kaggle consisting of 3,200 fundus images. Out of all the transfer learning models, the EfficientNetB0 model has outperformed with an accuracy of 0.91, followed by DenseNet169 with an accuracy of 0.90. In comparison to other approaches, the proposed intelligent recommendation-based fine-tuned EfficientNetB0 approach delivers state-of-the-art performance on the accuracy, recall, precision, and F1-score criteria. The system aims to assist ophthalmologists in early detection, potentially alleviating the burden on healthcare units.

Sclerosing encapsulating peritonitis also known as cocoon abdomen is a rare chronic inflammatory condition of the peritoneum in which the bowel loops are encircled by a membrane (cocoon formation) within the peritoneal cavity leading to intestinal obstruction. It can be primary (idiopathic) or secondary (chemotherapy, beta-blockers, peritoneal dialysis, shunts, tuberculosis, systemic lupus erythematosus, etc.). The symptomatology report includes recurrent episodes of abdominal pain and vomiting. We present here a case of a 32-year-old male who presented with complaints of being unable to pass stools, vomiting (3–4 times), and abdomen pain for 4 days. This case is considered worth mentioning due to its rarity, lack of identification of secondary causes, and diminutive mention of histopathological aspect.

Multiple myeloma (MM) is associated with the secretion of a unique monoclonal protein (M-protein) due to overproduction of immunoglobulin (Ig) by a clone of abnormally proliferating plasma cells. However, in 4% of the cases more than one M-protein can be found. This category of gammopathies is called “double monoclonal gammopathies.” Here, we present a rare case of MM with double monoclonal gammopathy, where the presence of both M-proteins was observed in the single sharp peak on capillary zone electrophoresis (CZE). Further the interference of Hook effect is also discussed. Double monoclonal gammopathies need to be identified to increase diagnostic accuracy and reliability, and to get a better understanding of the disease pathogenesis and progression.

Objectives: To reclassify glial neoplasms according to the 2021 WHO CNS tumor classification and to study the expression pattern of Isocitrate dehydrogenase 1 (IDH1) mutation by immunohistochemistry(IHC) and to categorize these tumors on the basis of IDH1 mutation. Methods: This retrospective study included patients who were diagnosed as glial tumors on histology (n=60). A detailed clinical history and radiological findings were obtained. Patients above 18 years were taken as adults while age upto 18 years were included in pediatric group. IHC for IDH1 mutation was done using Anti-IDH1 (R132H) antibody. Results: Among all glial tumors, 51.7% (31/60) were assigned IDH1 mutant status and the remaining i.e. 48.3% (29/60) were assigned IDH1 wildtype status. While classifying diffuse gliomas according to age, site and morphology, it was observed that the relative proportion of IDH1 mutant and IDH1 wildtype categories in the adult age group was 56.8% (25/44 cases) and 43.2% (19/44 cases) respectively while in the pediatric age group it was 45.5% (5/11 cases) and 54.5% (6/11 cases) respectively. Among the other glial and glioneuronal tumors majority were IDH1 wildtype (80.0%). Most of the WHO grade 1 tumors were IDH1 wildtype (71.4%, 5/7) whereas Grade 2 and 3 tumors were IDH1 mutant (83.3%, 15/18 and 100.0%, 5/5 respectively). On the other hand in Grade 4 tumors there was a higher proportion of neoplasms exhibiting IDH1 wildtype status (70.0%, 21/30). Conclusion: Identification of IDH status as mutant and wildtype is crucial in glial tumors (especially glioblastoma) because both these groups are clinically, genetically, biologically and prognostically different. IHC provides a standard alternative for molecular studies with high sensitivity and specificity with quick, economical and standard results especially useful in resource-poor countries. Reclassification according to the latest WHO classification appears to confer a overall better prognosis than the previous classifications and this study can also provide a base for future larger research avenues and treatment based on IDH1 mutation.

Introduction: Telemedicine use has increased for the past few years, and data security-related issues have also accompanied this. Barriers such as poor digital literacy, unaffordability, and ethical and legal issues have also affected the uptake of digital health. Telemedicine guidelines can help in promoting a suitable environment for wider uptake of telemedicine services by focusing on training, supervision, and monitoring of service providers. This policy review compares the telemedicine guidelines of countries in World Health Organization (WHO) South-East Asia Region (SEAR) as these countries have similar sociocultural backgrounds. Methodology: Latest telemedicine guidelines of the South Asia Region of the WHO were accessed using the official government websites of the countries. The guidelines that were not in the English language were translated into English using Google Translate. The guidelines were analyzed and presented under the following subheadings: (1) Definitions, Purpose, and Tools of Telemedicine; (2) Clinical Aspects of Telemedicine; and (3) Operational and Technical Aspects of Telemedicine. Results: Investigating the telemedicine guidelines in the SEAR of the WHO revealed that only 5 out of 11 countries, that is, India, Bangladesh, Thailand, Indonesia and Nepal, have guidelines specifically for telemedicine. Besides Thailand, the other four countries either published (India, Nepal, and Bangladesh) or updated (Indonesia) their telemedicine guidelines after the onset of the COVID-19 pandemic. Guidelines from India and Bangladesh are detailed and robust compared with those from Nepal, Indonesia, and Thailand. Conclusion: Telemedicine guidelines need to be more robust to improve the uptake of the service. Further research is needed to explore the effectiveness of implementing these guidelines.

Objective: To study and correlate PDL-1 expression with Tumour budding and Tumour Infiltrating Lymphocytes in Colorectal Carcinoma. Background: Colorectal cancer (CRC) is third most common cancer with a high mortality. Many attempts have been made to raise overall survival of CRC patients. The immune system plays an important role in clearing the unhealthy cancer cells. Programmed death 1 (PD1) is a regulatory molecule which dampens the immune response when bound to one of its complementary ligands (PDL1). Its expression is related to the response of immunotherapy in CRC treatment which has been exploited in recent times. However, its prognostic value is still controversial, and the distribution of PD-L1 on tumour Cells or Immune Cells has not been comprehensively analysed. Method: A total of 30 patients diagnosed with CRCs were included who underwent surgical intervention. Cases who took preoperative neoadjuvant chemotherapy or radiotherapy were excluded. IHC analyses of PDL1 was done and was correlated with tumour budding and Tumour Infiltrating Lymphocytes (TILs) and statistical significance was assessed. Results: 11 cases showed low bud count at the invasive front out of which only 3 cases showed PDL1 positivity. The rest 19 cases had high bud count out of which 18 were PDL 1 positive. This difference was highly significant (p = 0.002). In Low Bud / High TILs, 75% cases showed no PDL1 expression in tumour cells, whereas 62.5% cases showed PDL1 positivity in TILs whereas in High Bud / Low TILs group, all the cases (100%) showed PDL1 expression in tumour cells whereas only 75% cases showed PDL1 positivity in TILs, again being statistically significant (p

Performance in stair-climbing is largely associated with disruptions to mobility and community participation in children with cerebral palsy (CP). It is important to understand the nature of motor impairments responsible for making stairs a challenge in children with bilateral CP to clarify underlying causes of impaired mobility. In pediatric clinical populations, sensitive measurements of movement quality can be captured during the initial step of stair ascent. Thus, the purpose of this study was to quantify the lower limb joint moments of children with bilateral CP during the stance phases of a step-up task. Participants performed multiple stepping trials in a university gait laboratory. Outcome measures included extensor support moments (the sum of hip, knee, and ankle sagittal plane moments), hip abduction moments, and their timing. We recruited seven participants per group. We found that peak support and hip abduction moments were similar in the bilateral CP group compared to the typical development (TD) group. We also found that children with bilateral CP timed their peak moments closer together and increasingly depended on the hip joint to complete the task, especially in their more affected (MA) lower limb. Our investigation highlights some underlying causes that may make stair climbing a challenge for the CP population, including a loss of selective voluntary motor control (SVMC), and provides a possible treatment approach to strengthen lower limb muscles.

Background: Pregnancy is the physiological process in a woman's reproductive life. Though all pregnancies carry a risk, almost all pregnancies go uneventfully. In normal pregnancy, as the gestation advances, there is a physiological rise in triglycerides and cholesterol. Hypertriglyceridemia and hypercholesterolemia are markers of preterm labor, as atherosis of uteroplacental spiral arteries can result in preterm labor. Aims & objectives: To evaluate the correlation of increased levels of fats in uncomplicated gestation with preterm delivery Materials & methods: An observational study was conducted prospectively in the Department of Obstetrics & Gynaecology in Sree Balaji Medical College & Hospital, Chennai from Jan 2021 to July 2022, which included all Antenatal women between 14 to 32 weeks with no complications and who are planning to deliver in SBMCH. Results: Out of 290 Pregnant Women, 90.7% delivered at full term, whereas 9.3% had preterm deliveries. 12% had high serum cholesterol levels & 7.5% of them had hypertriglyceridemia. In this study, women who had preterm deliveries had elevated levels of lipids such as LDL and triglycerides, which is statistically significant. Conclusion: Early births are connected with high neonatal and infant mortality. According to statistical analysis of this study, women with intermediate or higher total, LDL, and triglyceride levels were more likely to deliver before 37 weeks of gestation than those with normal lipid profiles. Pregnancy dyslipidemia was also linked to BMI > 25 kg/m2 and advanced age. Recommendation: Based on these observations, we could recommend routine lipid profile assessment and management of dyslipidemia during pregnancy and in those planning to conceive, especially in relatively older women and those with obesity.

Uric acid is a waste product of the human body where high levels of it or hyperuricemia can lead to gout, kidney disease and other health issues. In this paper, Finite Difference Time Doman (FDTD) simulation method was used to develop a plasmonic optical sensor to detect uric acid with molarity ranging from 0 to 3.0 mM. A hybrid layer of gold-zinc oxide (Au–ZnO) was used in this Kretschmann-based Surface Plasmon Resonance (K-SPR) technique with angular interrogation at 670 nm and 785 nm visible optical wavelengths. The purpose of this study is to observe the ability of the hybrid material as a sensing performance enhancer for differentiating between healthy and unhealthy uric acid levels based on the refractive index values from previous study. Upon exposure to 670 nm wavelength, the average sensitivity of this sensor was found to be 0.028°/mM with a linearity of 98.67 % and Q-factor value of 0.0053 mM−1. While at 785 nm, the average sensitivity is equal to 0.0193°/mM with slightly lower linearity at 94.46 % and Q-factor value of 0.0076 mM−1. The results have proven the ability of hybrid material Au–ZnO as a sensing performance enhancer for detecting uric acid when compared with bare Au and can be further explored in experimental work.

Introduction Idiopathic intracranial hypertension (IIH) is a pathology involving an increase in intracranial pressure leading to symptoms including papilledema, tinnitus, and elevated cerebrospinal fluid opening pressure. Recent research has identified venous sinus stenosis as a cause of IIH, a common treatment of which is venous stenting and angioplasty. An adverse event of this procedure is in‐stent stenosis (ISS), due to either neointimal hyperplasia or hypersensitivity to an element in the stent. There has been speculation regarding whether nickel in intracranial stents is a cause of concern, due to its potential to cause a Type IV hypersensitivity reaction and ISS, which is an indicator of future stroke. The purpose of this case report is to determine if the cobalt‐based alloy Onyx Resolute intracranial stents can safely treat IIH in patients with allergic contact dermatitis to nickel. Methods We present a 38‐year old woman who presented with migraines and IIH with papilledema and severe pulsatile tinnitus. Headaches had been present for 5‐10 years. Ophthalmology consult revealed bilateral papilledema, upon which an MRI and MRV revealed venous stenosis. There was a 17mmHg pressure gradient measured in the patient. Patient could not tolerate acetazolamide, with kidney stones and loss of sheen in hair. Cerebral angiogram indicated right transverse‐sigmoid junction stenosis and atretic left venous sinus. The patient had an Onyx Resolute stent placed in the right transverse sigmoid junction. The Onyx Resolute stent is a Zotarolimus‐eluting stent made up of a cobalt‐based shell and a platinum‐Iridium core and is not recommended for patients with a hypersensitivity to nickel, cobalt, or chromium, but has a lower nickel content than a self‐expanding stent. Results Patient underwent cerebral angiogram, revealing right transverse‐sigmoid junction stenosis with a 17mmHg pressure gradient. Stenting and angioplasty were performed; this reduced the venous sinus pressure in the R transverse sinus (pre‐stenotic segment) from 43 mm Hg to 24 mm Hg with resolution of the R transverse‐sigmoid junction pressure gradient. Patient was treated with prasugrel (Effient) for one month. At the one‐month follow‐up, the patient reported an improvement of symptoms, with near‐resolution of her prior headaches in terms of severity and frequency following her procedure. Visual acuity is at baseline, pending formal follow‐up assessment for papilledema. Follow‐up CT Head Venogram with and without contrast showed a patent R transverse to sigmoid venous stent. The patient was continued on aspirin 81mg daily and prasugrel 5mg daily and is to continue follow‐up with yearly ophthalmologic exams. Conclusion Although there is speculation regarding the use of metal intracranial stents in patients allergic to nickel, our patient has shown that it is safe to use the Onyx Resolute intracranial stent despite a pre‐existing nickel hypersensitivity.

Key Clinical Message This case report highlights the importance of recognizing and accurately diagnosing ganglioneuroblastoma, an uncommon variant of neuroblastic tumors in children. Ganglioneuroblastomas have diverse clinical and morphological presentations, and histopathological examination is paramount in guiding treatment decisions, especially in cases with ambiguous symptoms. Early detection is crucial, as the prognosis varies significantly based on the subtype and the presence of metastatic disease. Clinicians should maintain a high index of suspicion and utilize radiological examinations to promptly identify and treat these tumors. Abstract Children are frequently affected by neuroblastic tumors, which grow from the sympathoadrenal lineage of the neural crest during its development. However, intermixed ganglioneuroblastomas are far less common within the same tumor spectrum, the diagnosis of which could become challenging amidst an unusual presentation. In our case report, we present a 4‐year‐old boy who had complaints of fever and difficulty in walking, with a supra‐renal mass on ultrasound, which was diagnosed as ganglioneuroblastoma‐intermixed type on histopathological examination. This report aims to contribute to the understanding of the diverse clinical and morphological spectrum of ganglioneuroblastomas and the importance of multidisciplinary collaboration and histopathological examination to enhance decision‐making in such ambiguous scenarios.

Introduction: The term “blood component” refers to the separation of Whole Blood (WB) into packed red cells, platelet-rich plasma, Fresh Frozen Plasma (FFP), cryoprecipitate, and leukocytes. The practice of separating donated WB units into different blood components and supplying only those components to patients is now considered a standard practice in all blood banks. Therefore, regular auditing of blood usage and its components is essential to assess blood utilisation patterns. Aim: The aim of this study was to analyse the distribution and appropriateness of blood and blood product transfusions in children aged 1-18 years. Materials and Methods: A cross-sectional study was conducted over an 18-month period from December 1, 2014, to June 30, 2016, involving paediatric patients requiring blood and blood product transfusions, who presented to the Department of Paediatrics, Shri B.M. Patil Medical Hospital, Vijayapura, Karnataka, India. The study population consisted of children aged 1-18 years. Data from blood component requisition forms were collected, and reports of investigations such as pre-transfusion/post-transfusion haematological parameters, coagulogram, and peripheral smear were recorded. Predetermined criteria were used to assess each transfusion episode. The results were then analysed, tabulated, and expressed as a percentage. The appropriateness of Packed Red Blood Cell (PRBC), platelet, and FFP transfusions was estimated using predetermined criteria. Data from blood component requisition forms were collected, coded, tabulated, analysed, and expressed as a percentage. Results: The study included 149 paediatric patients aged 1 to 18 years. Out of a total of 214 episodes of blood and blood component transfusions among the 149 patients, 102 episodes (47.7%) were WB transfusions, 67 episodes (31.3%) were packed red cell transfusions, 26 episodes (12.1%) were platelet transfusions, and 19 episodes (8.9%) were FFP transfusions. Out of the total 214 transfusion episodes, 126 (58.5%) were deemed appropriate, while 88 (41.5%) were deemed inappropriate. The most commonly inappropriately used component was WB, followed by platelets, FFP, and packed red cells. Inappropriateness of WB usage was primarily due to attempts to achieve haemostasis in bleeding patients, while sepsis was the most common indication for inappropriate platelet usage. Conclusion: This audit highlights significant variation in transfusion practice patterns among paediatricians. The most common indications for usage were found to be achieving haemostasis, threshold haemoglobin concentration, and sepsis in children.

Objective: To describe the rationale and design of the SIB trial, an interventional clinical trial testing the hypothesis that subcutaneous (s.c.) once-weekly semaglutide can improve intestinal permeability and reduce systemic inflammation in participants with type 2 diabetes (T2D) and obesity. Methods: SIB (NCT04979130) is an investigator-initiated, single-center randomized, double-blinded, placebo-controlled clinical study being conducted at the University of Colorado Anschutz Medical Campus. The primary objective of this novel trial is to test the hypothesis that subcutaneous (s.c.) once-weekly semaglutide could improve intestinal permeability and reduce systemic inflammation in participants with T2D and obesity. Eligible participants had a diagnosis of type 2 diabetes, elevated body mass index, and evidence of systemic inflammation. Participants were randomized 1:1 to s.c. semaglutide or placebo. Participants were assessed for intestinal permeability and markers of inflammation at baseline, mid-study, and at the end of the study. Efficacy assessments were based on the analysis of the following: lactulose:mannitol ratio test, serum lipopolysaccharide-binding protein (LBP), fecal calprotectin, inflammatory biomarkers (IL-6, TNF, IL-1, IL-8, hs-CRP), and HbA1c. All participants who enrolled in the trial provided written informed consent after having received written and oral information on the trial. The risks of semaglutide use were minimized by administration according to FDA-labeled use and close monitoring for adverse events. Discussion: SIB is the first study to examine the effects of GLP-1 receptor agonists on intestinal permeability in humans and will provide important data on their impact on systemic inflammation and intestinal permeability in the setting of T2D and obesity.

Background: Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a systemic disease. Most patients have mild-to-moderate symptoms; however, severe respiratory symptoms develop in some. Although increased inflammatory markers and abnormal coagulation profile are related to the severity and mortality of COVID-19, no definitive relation has been established. Materials and Methods: The laboratory data of 199 patients with COVID-19 admitted to our dedicated COVID-19 care facility, categorized into mild (36), moderate (76), and severe (87) cases, were analyzed for a statistical association between the inflammatory markers and coagulation profile. IBM SPSS V23 software, Chicago, was used for data analysis. Results: A gradual increase in serum IL-6, ferritin, and D-dimer levels were observed from mild, moderate, and severe categories with statistically significant differences among all three groups. A positive correlation was observed between serum IL-6 and D-dimer (r2 = 0.36, P < 0.01) only in the severe group. Among the three parameters, D-dimer had the best discriminating ability between severe and nonsevere disease with a serum cutoff level of 451 ng/mL. Conclusion: Thrombin has pro-inflammatory action. Similarly, IL-6 induces the release of acute-phase reactants like fibrinogen. Because of this interplay, patients with severe COVID-19 are at a dual risk of inflammatory and thromboembolic complications and must be monitored stringently.

Background: The world witnessed the emergence of a global pandemic. Individuals with chronic illnesses like chronic kidney disease (CKD), already known to be immunologically compromised, have the potential to develop a scenario of an acute-on-chronic condition on coronavirus disease 2019 (COVID-19) contraction. Measurement of serum inflammatory biomarkers like interleukin (IL-6), high-sensitivity C-reactive protein (hsCRP) and ferritin may foresee the prognosis despite the pre-existing low-grade inflammation in these patients. Aims: To determine the utility of serum IL-6, hsCRP and Ferritin levels to determine COVID-19 severity and probable prognosis in CKD patients with COVID-19. Materials and Methods: A cross-sectional study was performed on 100 adult known cases of stage 5 of CKD, recently diagnosed as COVID-19 positive by real-time reverse transcription-polymerase chain reaction. The study population was divided into two groups according to COVID-19 severity: A non-severe and a severe group based on guidelines given in the Clinical Management Protocol: COVID-19. Their clinical and laboratory data obtained on the day of admission were analysed. Results: The severe group (n = 17) had 65% of males and 35% of females. A significant difference was found with respect to the age, body mass index and serum IL-6, hsCRP and ferritin levels between the two groups (P < 0.05). Among the three inflammatory biomarkers, hsCRP was found to have the maximum potential to categorise COVID-19 as severe or non-severe disease. Conclusion: Similar to patients with uncomplicated COVID-19 disease, higher serum levels of inflammatory biomarkers – IL-6, hsCRP and ferritin are seen in patients of CKD with severe COVID-19 illness in comparison to those with non-severe COVID-19, despite having a pre-existing background of low-grade chronic inflammation. The serum levels of IL-6, hsCRP and ferritin can be utilised to determine COVID-19 severity and probable prognosis in CKD patients with COVID-19.

Erythroderma or exfoliative dermatitis is characterized by erythema and scaling affecting more than 90% of the body surface area. Drug-induced erythrodermas are relatively uncommon in children but can be potentially life-threatening. We hereby report an unusual case of erythroderma due to oral intake of Giloy (Tinospora cordifolia) in a 10-year-old child.

Purpose: To analyze the topographic distribution of neovascularization (NV) and capillary nonperfusion (CNP) using ultra-wide field fluorescein angiography (UWFFA) in patients with proliferative diabetic retinopathy (PDR). Methods: This was a prospective, single-center, observational study in which all patients who presented between March 2019 and December 2020 and satisfied the inclusion criteria were recruited. In our study, patients with treatment-naïve PDR without any fibrovascular proliferation underwent UWFFA. The images were analyzed qualitatively for the topographic distribution of NV and the CNP area was quantified. The number of lesions picked by UWFFA was compared with 7 standard field (7SF) image using overlay of 7SF. The main outcome measure was characteristics of neovascularization, such as the number, location, and area of CNP, measured using UWFFA, which was considered with 95% confidence intervals (CI). Results: Two hundred and fifty-three eyes of 187 patients with a mean age of 56.03 ± 8 years were included. Mean neovascularization elsewhere (NVE) was 2.91 ± 3.43. Maximum NVEs were seen in the superotemporal (ST; 0.9 ± 1.13) quadrant, followed by the inferotemporal (IT; 0.7 ± 1.08), inferonasal (IN; 0.66 ± 1.02) and superonasal (SN; 0.66 ± 1.01) quadrants. Maximum CNP area was seen in the SN (13.75 ± 8.83 disc diameter square [DD2]) quadrant, followed by the IN (13.48 ± 8.59 DD2), IT (11.34 ± 8.37 DD2), and ST (11.3 ± 8.34 DD2) quadrants. Mean CNP area was maximum in patients with only neovascularization of disc (NVD; 64.99 ± 41.47 DD2), followed by both NVD and NVE (61.37 ± 35.61 DD2), and was minimum in patients with only NVE (36.44 ± 22.03 DD2). Eighty-one (32%) eyes out of 253 had NVE and 189 (75%) out of 253 had CNP area outside 7SF (overlay) of Early Treatment Diabetic Retinopathy Study (ETDRS). Conclusion: Diabetic NV lesions and CNP areas are distributed asymmetrically throughout the retina and are not restricted to the posterior pole. Compared to conventional 7SF imaging, UWFFA reveals significantly more retinal vascular pathology in patients with PDR.

Serum protein electrophoresis (SPEP) is a method by which proteins present in serum are separated into different fractions based on their molecular weight and electric charge. Presence of M spike, composed of monoclonal protein, on electrophoretogram is a characteristic finding that can be seen in monoclonal gammopathies like multiple myeloma. M spike is most commonly seen in the gamma region however, the M-spike can be observed in fraction other than the Y fraction as well i.e. in the beta region and rarely alpha region. Here we have enumerated few cases where M protein has been seen in fractions other than the gamma region. Thus one needs to be cautious about the variable appearance of M-spike during interpretation of SPEP as some physiological proteins if elevated can also give rise to similar spike sometimes referred as pseudo monoclonal pattern.

Introduction: Preclinical studies have demonstrated the ability of radiation therapy (RT) to augment immune response and tumor control by immune checkpoint inhibitors (ICI). However, numerous clinical trials combining RT and ICI have yielded relatively disappointing results. To improve understanding of optimal use of these therapies, we assessed systemic immune effects of prior RT in patients receiving ICI. Methods and Materials: Pre- and post-ICI blood samples were collected from patients enrolled in a prospective immunotherapy biospecimen protocol. Mutiplex panels of 40 cytokines and 120 autoantibodies (Ab) were analyzed. We identified differences in these parameters according to receipt, timing, and type of prior RT. We calculated P values using the Pearson product-moment correlation coefficient and false discovery rate (FDR) using the Benjamini-Hochberg Procedure. Results: Among 277 total patients, 69 (25%) received RT in the 6 months prior to ICI initiation. Among RT-treated patients, 23 (33%) received stereotactic RT, and 33 (48%) received curative intent RT. There was no significant difference in demographics or type of immunotherapy between patients according to prior RT exposure. Baseline complement C8 Ab and MIP-1d/CCL15 were significantly higher among patients with prior RT. For MIP-1d/CCL15, only prior stereotactic RT was associated with significant differences. Conclusions: Prior RT is associated with few changes in systemic immune parameters in patients receiving ICI. The underlying mechanisms and optimal approach to harnessing the potential synergy of RT and ICI require further prospective clinical investigation.

Summary: Background: Healthcare-associated bacterial pathogens frequently carry plasmids that contribute to antibiotic resistance and virulence. The horizontal transfer of plasmids in healthcare settings has been previously documented, but genomic and epidemiologic methods to study this phenomenon remain underdeveloped. The objectives of this study were to apply whole-genome sequencing to systematically resolve and track plasmids carried by nosocomial pathogens in a single hospital, and to identify epidemiologic links that indicated likely horizontal plasmid transfer. Methods: We performed an observational study of plasmids circulating among bacterial isolates infecting patients at a large hospital. We first examined plasmids carried by isolates sampled from the same patient over time and isolates that caused clonal outbreaks in the same hospital to develop thresholds with which horizontal plasmid transfer within a tertiary hospital could be inferred. We then applied those sequence similarity thresholds to perform a systematic screen of 3074 genomes of nosocomial bacterial isolates from a single hospital for the presence of 89 plasmids. We also collected and reviewed data from electronic health records for evidence of geotemporal links between patients infected with bacteria encoding plasmids of interest. Findings: Our analyses determined that 95% of analyzed genomes maintained roughly 95% of their plasmid genetic content and accumulated fewer than 15 SNPs per 100 kb of plasmid sequence. Applying these similarity thresholds to identify horizontal plasmid transfer identified 45 plasmids that potentially circulated among clinical isolates. Ten highly preserved plasmids met criteria for geotemporal links associated with horizontal transfer. Several plasmids with shared backbones also encoded different additional mobile genetic element content, and these elements were variably present among the sampled clinical isolate genomes. Interpretation: Evidence suggests that the horizontal transfer of plasmids among nosocomial bacterial pathogens appears to be frequent within hospitals and can be monitored with whole genome sequencing and comparative genomics approaches. These approaches should incorporate both nucleotide identity and reference sequence coverage to study the dynamics of plasmid transfer in the hospital. Funding: This research was supported by the US National Institute of Allergy and Infectious Disease (NIAID) and the University of Pittsburgh School of Medicine.

Background: Identifying and interrupting transmission of severe acute respiratory syndrome coronavirus 2 and resulting disease (COVID-19) in acute-care settings can be challenging due to incubation period, asymptomatic infection, and prevalent community disease. To elucidate routes of infection and interrupt COVID-19 outbreaks with uncertain epidemiological chains of transmission, UPMC utilized reactive whole-genome sequencing (WGS) of viral specimens. Methods: UPMC infection prevention teams identified healthcare-associated COVID-19 clusters with uncertain transmission pathways among patients and/or healthcare personnel (HCP) in acute-care hospitals. Nasopharyngeal samples preserved in viral transport media were obtained for genetic analyses. Nucleic acids were extracted and WGS libraries were prepared by targeted enrichment or multiplex PCR methodologies. Resulting sequencing reads were aligned to the Wuhan-1 reference genome, followed by identification of single-nucleotide polymorphisms (SNPs) among the genomes and construction of a phylogenetic tree. Specimens were considered genetically similar if there were ≤2 SNP differences between viral genomes within a cluster. Results: Between May 2020 until August 2022, infection prevention teams requested WGS for 17 healthcare-associated clusters of COVID-19 involving 182 individuals across 8 UPMC facilities (median outbreak size, 9 individuals; range, 2–26). Of the 182 individuals, 36 lacked clinical specimens and 30 did not pass WGS quality-control criteria of ≥95% of the reference genome with a minimum of 10× coverage. Of the 116 sequenced genomes, 94 (81%) had virus genetically similar to ≥1 other specimen, including 87 (83.6%) of 104 patient viruses and 7 (58.3%) of 12 HCP viruses, comprising 22 clusters (Fig. 1). The remaining 22 (20.6%) specimens were genetically unrelated. In total, 16 (94.1%) of the 17 epidemiologically identified clusters had 2 or more individuals with a genetically similar virus. Also, 7 (41.1%) of these clusters had genetically similar viral genomes for every individual within each cluster. Also, 9 (52.9%) clusters contained both genetically related and unrelated specimens: 5 of these had more complex genomic profiles (including 4 clusters containing 2 distinct subclusters of ≥2 genetically related viruses) and 1 cluster contained 3 subclusters of ≥2 genetically related viruses. In the outbreak with 3 clusters, 3 SNPs separated specimens from 2 temporally proximal clusters, suggesting possible propagation between clusters (cluster B-3 in Fig. 1). Conclusions: WGS can complement traditional epidemiological investigations of healthcare-associated COVID-19 outbreaks, revealing complex transmission dynamics. Future investigations will characterize the impact of WGS on determining specific transmission pathways in acute-care facilities.

Background: Detecting healthcare-associated transmission and outbreaks often relies on reactive whole-genome sequencing (WGS), which occurs after the suspected transmission has occurred. Additionally, reactive WGS frequently misidentifies transmission and misses transmission when it has occurred. We initiated weekly real-time WGS to detect bacterial transmission and direct infection prevention interventions. We describe our experience after 1 year of real-time WGS surveillance at the University of Pittsburgh Medical Center–Presbyterian Hospital, a large, tertiary-care facility. Methods: Weekly WGS surveillance was performed from November 1, 2021, to October 31, 2022. Cultured isolates of select bacterial pathogens from patients who were hospitalized for ≥3 days or had a recent healthcare exposure in the prior 30 days were collected and sequenced. Isolates that were ≤15 single-nucleotide polymorphisms (SNPs) were considered genetically related clusters except for Clostridioides difficile (≤2 SNPs). Genetically related clusters were investigated for epidemiological links and interventions to interrupt transmission were implemented at the discretion of the infection prevention team. We analyzed subsequent infections that occurred within an outbreak after an intervention was in place. Results: In total, 1,909 isolates were sequenced. Of 1,633 unique patient isolates clustered by sequence type, 74 clusters were identified comprising 210 (12.9%) patient isolates (Table 1). The median time from culture date to sequencing was 14 days (IQR, 5.25). The median cluster size was 2 (IQR, 1) (Table 2). Overall, 118 patient isolates (56.2%) had an epidemiological link to a prior isolate, indicating potential transmission. Of 74 clusters, 66 (89.2%) received infection prevention interventions after notification based upon epidemiological data. The infection prevention team performed 69 total interventions, which included unit education (n = 28), hand hygiene observations (n = 16), enhanced cleaning (n = 16), environmental cultures or removal of endoscope (n = 7), and enhanced microbiology surveillance (n = 2). The 59 subsequent infections after infection prevention notification included 17 (28.8%) with no clear epidemiological link, and 41 (69.5%) with an epidemiological link either to a new transmission route (n = 37) or the same route prior to infection prevention intervention (n = 4). Only 1 (1.7%) subsequent infection within a cluster occurred after an infection prevention intervention from the same potential route, which was a suspected unit-based transmission of vancomycin-resistant Enterococcus faecium. Conclusions: Real-time WGS was effective at detecting genetically related clusters, finding potential sources, and halting further transmission after interventions by the infection prevention team. Quick turnaround times from patient culture to sequencing and analysis were vital for successful WGS surveillance. Real-time WGS surveillance has the potential to substantially shift the infection prevention paradigm for outbreak detection.

Burkholderia spp. are often resistant to antibiotics, and infections with these organisms are difficult to treat. A potential alternative treatment for Burkholderia spp. infections is bacteriophage (phage) therapy; however, it can be difficult to locate phages that target these bacteria. Prophages incorporated into the bacterial genome have been identified within Burkholderia spp. and may represent a source of useful phages for therapy. Here, we investigate whether prophages within Burkholderia spp. clinical isolates can kill conspecific and heterospecific isolates. Thirty-two Burkholderia spp. isolates were induced for prophage release, and harvested phages were tested for lytic activity against the same 32 isolates. Temperate phages were passaged and their host ranges were determined, resulting in four unique phages of prophage origin that showed different ranges of lytic activity. We also analyzed the prophage content of 35 Burkholderia spp. clinical isolate genomes and identified several prophages present in the genomes of multiple isolates of the same species. Finally, we observed that Burkholdera cenocepacia isolates were more phage-susceptible than Burkholderia multivorans isolates. Overall, our findings suggest that prophages present within Burkholderia spp. genomes are a potentially useful starting point for the isolation and development of novel phages for use in phage therapy.

Ocular decompression retinopathy (ODR) is caused by a sudden lowering of high intraocular pressure. Trabeculectomy is the most common procedure preceding ODR. Various mechanical and vascular etiologies have been proposed to cause ODR, with autoregulation and hemodynamics playing a contributing role. Herein, we report a rare case of ODR occurring after bleb needling in a young child using ultrawide-field fundus photography, fluorescein angiography, and optical coherence tomography.

India gained a new economic orientation in 1991 following the policy of economic liberalization. It offered the opportunities to close the gender gap in various fields including the political field as visualized in the original goal of the Indian constitution. However, there is an acute underrepresentation of women at the national political level and there is a lack of evidence-based research studies to analyze this gap. This study maps the political trajectories of 13 elected women leaders holding offices at the national level since 2019. To better understand the challenges and opportunities at both macro and micro levels they came across during their political journey through factual research, based on the primary data collected by interviews both structured and unstructured. The study is predominantly confined to women leaders of two national political parties: Bharatiya Janata Party (BJP) and Indian National Congress (INC). The paper extends the results and argues that patriarchy remained the stumbling block for the effective participation of women political leaders in the decision-making process at the national political party level; however, other factors include ‘power brokers’/intermediaries/micro agencies and the process that shapes the choices of women political leaders ranging from access to party ticket to contest the election to occupying the position of power within the party and the government.

The microbial enhanced oil recovery (MEOR) method is an eco-friendly and economical alternative technology. The technology involves a variety of uncertainties, and its success depends on controlling microbial growth and metabolism. This study is one of a kind that showed successful tertiary recovery of crude oil through indigenous microbial consortia. In this study, a medium was optimized to allow ideal microbial growth under reservoir conditions through RSM. Once the nutrient recipe was optimized, the microbial metabolites were estimated through gas chromatography. The maximum amount of methane gas (0.468 mM) was produced in the TERIW174 sample. The sequencing data set showed the presence of Methanothermobacter sp. and Petrotoga sp. In addition, these established consortia were analyzed for their toxicity, and they appeared to be safe for the environment. Furthermore, a core flood study showed efficient recovery that was ~25 and 34% in TERIW70 and TERIW174 samples, respectively. Thus, both the isolated consortia appeared to be suitable for the field trials.

Bone marrow (BM) is an essential part of the hematopoietic system, which generates all of the body’s blood cells and maintains the body’s overall health and immune system. The classification of bone marrow cells is pivotal in both clinical and research settings because many hematological diseases, such as leukemia, myelodysplastic syndromes, and anemias, are diagnosed based on specific abnormalities in the number, type, or morphology of bone marrow cells. There is a requirement for developing a robust deep-learning algorithm to diagnose bone marrow cells to keep a close check on them. This study proposes a framework for categorizing bone marrow cells into seven classes. In the proposed framework, five transfer learning models—DenseNet121, EfficientNetB5, ResNet50, Xception, and MobileNetV2—are implemented into the bone marrow dataset to classify them into seven classes. The best-performing DenseNet121 model was fine-tuned by adding one batch-normalization layer, one dropout layer, and two dense layers. The proposed fine-tuned DenseNet121 model was optimized using several optimizers, such as AdaGrad, AdaDelta, Adamax, RMSprop, and SGD, along with different batch sizes of 16, 32, 64, and 128. The fine-tuned DenseNet121 model was integrated with an attention mechanism to improve its performance by allowing the model to focus on the most relevant features or regions of the image, which can be particularly beneficial in medical imaging, where certain regions might have critical diagnostic information. The proposed fine-tuned and integrated DenseNet121 achieved the highest accuracy, with a training success rate of 99.97% and a testing success rate of 97.01%. The key hyperparameters, such as batch size, number of epochs, and different optimizers, were all considered for optimizing these pre-trained models to select the best model. This study will help in medical research to effectively classify the BM cells to prevent diseases like leukemia.

Aim: The aim of this study was to evaluate the role of histopathological and histomorphometric features in oesophageal biopsy of patients presenting with symptoms of Gastroesophageal Reflux Disease (GERD). Material and Methods: Present study included 42 patients and 12 controls. Complete clinical evaluation followed by endoscopic examination of the patients was done and multipleoesophageal biopsies were taken. Biopsies were processed routinely and stained with Hematoxylin and Eosin and examined for any changes related to GERD. Morphometric assessment was done by using Leitz optical micrometer. The histological scoring was done based on the parameters: basal cell hyperplasia, stromal papillae elongation, cells with irregular nuclear contour (CINC), eosinophilic infiltrate, gastric and intestinal metaplasia. A numerical score was assigned to each parameter and sum of these scores represented the total score. Statistics: The statistical analysis was done using graph pad prism, Medcalc software and Windows MS office. P value and mean standard deviation (SD) was calculated. Results: The endoscopic findings of all the controls and 83.33% of patients were normal. Only 16.67% of patients had reflux associated changes of varying grades on endoscopy. Oesophageal biopsy of all patients had changes related to GERD on histology. Immunohistochemistry confirmed that cells with irregular nuclear contour were T- lymphocytes. The mean (SD) histological scoring of control and patients were 1.75 (0.62) and 5.66 (1.31) respectively. The difference was considered to be statistically significant (P < 0.001). Thus, it was suggested that a cut-off of histological score > 3 can be used to indicate GERD. Conclusion: Patients with gastroesophageal reflux symptoms can have normal endoscopic findings but can be diagnosed on the basis of histological changes in the squamous epithelium. Scoring of the histopathological parameters along with the cut-off value can give a definitive diagnosis of GERD.