A comparison of the quality of images of chest X-ray between handheld portable digital X-ray & routinely used digital X-ray machine

Background & objectives: Chest X-ray (CXR) is an important screening tool for pulmonary tuberculosis (TB). Accessibility to CXR facilities in difficult-to-reach and underserved populations is a challenge. This can potentially be overcome by deploying digital X-ray machines that are portable. However, these portable X-ray machines need to be validated before their deployment in the field. Here, we compare the image quality of CXR taken by a newly developed handheld X-ray machine with routinely used reference digital X-ray machine through the conduct of a feasibility study. Methods: A total of 100 participants with suspected pulmonary TB were recruited from the outpatient departments of a medical college and a community health centre in Agra. Each participant underwent CXR twice, once with each machine. Both sets of de-identified images were independently read by two radiologists, who were blinded to the type of X-ray machine used. The primary outcome was agreement between image qualities produced by these two machines. Results: The intra-observer (radiologist) agreements regarding the status of the 15 CXR parameters ranged between 74 per cent and 100 per cent, with an unweighted mean of 87.2 per cent (95% confidence interval: 71.5-100). The median Cohen’s kappa values for intra-observer agreement were 0.62 and 0.67 for radiologists 1 and 2, respectively. In addition, on comparison of the overall median score of quality of the image, the handheld machine images had a higher score for image quality. Interpretation & conclusions: The current study shows that a handheld X-ray machine, which is easy to use and can potentially be carried to any area, produces X-ray images with quality that is comparable to digital X-ray machines routinely used in health facilities.

DIELECTRIC AND ELECTRICAL BEHAVIOUR OF ZNO AND CDO SEMICONDUCTING MATERIALS WITH AND WITHOUT MN DOPING

ZnO and CdO pellets with and without Mn doping were prepared by using Hydraulic pressure machine at room temperature. The effect of Mn content (1,3,5 wt % ) on the electrical properties have been carried out by Keithley meter. The result shows that the resistivity decreases as increasing Mn content. Impedance analyzer are used for dielectric behavior and results shows that decrement of dielectric constant as well as dielectric loss with the increment of frequency

Development of the India COVID-19 vaccine tracker

COVID-19 was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Since then, efforts were initiated to develop safe and effective vaccines. Till date, 11 vaccines have been included in the WHO’s emergency use list. The emergence and spread of variant strains of SARS-CoV-2 has altered the disease transmission dynamics, thus creating a need for continuously monitoring the real-world effectiveness of various vaccines and assessing their overall impact on disease control. To achieve this goal, the Indian Council of Medical Research (ICMR) along with the Ministry of Health and Family Welfare, Government of India, took the lead to develop the India COVID-19 Vaccination Tracker by synergizing three different public health databases: National COVID-19 testing database, CoWIN vaccination database and the COVID-19 India portal. A Vaccine Data Analytics Committee (VDAC) was constituted to advise on various modalities of the proposed tracker. The VDAC reviewed the data related to COVID-19 testing, vaccination and patient outcomes available in the three databases and selected relevant data points for inclusion in the tracker, following which databases were integrated, using common identifiers, wherever feasible. Multiple data filters were applied to retrieve information of all individuals ?18 yr who died after the acquisition of COVID-19 infection with or without vaccination, irrespective of the time between vaccination and test positivity. Vaccine effectiveness (VE) against the reduction of mortality and hospitalizations was initially assessed. As compared to the hospitalization data, mortality reporting was found to be much better in terms of correctness and completeness. Therefore, hospitalization data were not considered for analysis and presentation in the vaccine tracker. The vaccine tracker thus depicts VE against mortality, calculated by a cohort approach using person-time analysis. Incidence of COVID-19 deaths among one- and two-dose vaccine recipients was compared with that among unvaccinated groups, to estimate the rate ratios (RRs). VE was estimated as 96.6 and 97.5 per cent, with one and two doses of the vaccines, respectively, during the period of reporting. The India COVID-19 Vaccination Tracker was officially launched on September 9, 2021. The high VE against mortality, as demonstrated by the tracker, has helped aid in allaying vaccine hesitancy, augmenting and maintaining the momentum of India’s COVID-19 vaccination drive

Characterizing the third wave of COVID-19: An analysis from the National Clinical Registry of COVID-19

Background & objectives: Data from the National Clinical Registry for COVID-19 (NCRC) were analyzed with an aim to describe the clinical characteristics, course and outcomes of patients hospitalized with COVID-19 in the third wave of the pandemic and compare them with patients admitted earlier. Methods: The NCRC, launched in September 2020, is a multicentre observational initiative, which provided the platform for the current investigation. Demographic, clinical, treatment and outcome data of hospitalized COVID-19 patients were captured in an electronic data portal from 38 hospitals across India. Patients enrolled during December 16, 2021 to January 17, 2022 were considered representative of the third wave of COVID-19 and compared with those registered during November 15 to December 15, 2021, representative of the tail end of the second wave. Results: Between November 15, 2021 and January 17, 2022, 3230 patients were recruited in NCRC. Patients admitted in the third wave were significantly younger than those admitted earlier (46.7±20.5 vs. 54.6±18 yr). The patients admitted in the third wave had a lower requirement of drugs including steroids, interleukin (IL)-6 inhibitors and remdesivir as well as lower oxygen supplementation and mechanical ventilation. They had improved hospital outcomes with significantly lower in-hospital mortality (11.2 vs. 15.1%). The outcomes were better among the fully vaccinated when compared to the unvaccinated or partially vaccinated.Interpretation & conclusions: The pattern of illness and outcomes were observed to be different in the third wave compared to the last wave. Hospitalized patients were younger with fewer comorbidities, decreased symptoms and improved outcomes, with fully vaccinated patients faring better than the unvaccinated and partially vaccinated ones.

WIND ENERGY IN INDIA 2022

This article first deal with the current scenario of the wind energy in India. Wind energy is available at no cost and it does not emit no greenhouse gases. Harnessing the energy of wind to obtain some useful work like pumping water, sailing boats and grinding grains has been therefore a very long time. In modern time wind energy is used to generate electricity. Wind energy is a clean sources of energy and India has a huge potential for wind energy (302 GW in the country at 100 m height and 695.50 GW at 120 m above the ground level). This vast potential has remained unexplored which can be achieved through well framed policies initiated by government of India. Wind power has emerged as a biggest source of Renewable energy in the world

Splenic Abscess And Perisplenic Hematoma Complicating Osler

A 52-year-old diabetic gentleman was referred to our center with a 3-week history of fever, left-sided abdominal pain, and progressive breathlessness. He also had history of recurrent epistaxis since childhood. Contrast-enhanced computerized tomography chest and abdomen revealed a splenic abscess, left pulmonary arteriovenous malformation, and left pleural effusion. He was managed conservatively with intravenous antibiotics and an antifungal. A repeat imaging was done after 3 weeks which showed resolution of abscess but an increase in the size of the perisplenic hematoma. An ultrasound guided pigtail catheter was inserted into the peri-splenic hematoma and it was drained. He had also developed an acute cerebellar infarct detected on magnetic resonance imaging of brain, which also showed other chronic infarcts of varying age. A diagnostic nasal endoscopy revealed multiple telangiectasias, and Osler–Weber–Rendu disease (hereditary hemorrhagic telangiectasia [HHT]) was diagnosed according to Curacao criteria. Symptomatic splenic involvement may be a rare manifestation of HHT

Fractured retained Double-J stents presenting as urethral foreign body

Background: In few studies, Dexmedetomidine was used an adjuvant to local anesthetics in peripheral nerve blocks Aim: This study was aimed to examine the effect of adding Dexmedetomidine to Bupivacaine 05% during the femoral sciatic nerve blocks and to evaluate its effect in prolonging post-operative analgesia Materials and methods: This was a prospective, double blinded, randomized study which consisted of 80 patients, Patients were randomly allocated into two groups (40patients each): In group BD, (Bupivacaine-Dexmedetomidine hydrochloride), one mL, containing 100 μg, was added to 39 mL of Bupivacaine 05% In group B; 1 mL of normal saline was added to the same volume of Bupivacaine 05% Results: There were no statistically differences between the two groups in demographic data and surgical characteristics The onset time of sensory block, motor block and surgical anesthesia time were significantly shorter in group BD when compared to group B The durations of sensory block, motor block and analgesia were longer in BD group when compared to group B Systolic arterial pressure (SAP) and heart rate were significantly lower in group BD when compared to group B from 10 to 90minutes after initiation of block (P<005), diastolic arterial pressure was similarly lower in group BD at 45, 60, and 90 minutes following initiation of block Conclusion: This study showed that a prolonged duration of analgesia was associated with addition of Dexmedetomidine 100μg to bupivacaine 05% during US-guided combined femoral and sciatic block for below knee surgery and is also associated with significant bradycardia requiring treatment

Prevalence of Femoral Hernia in Bundelkhand Region of India.

Background: Present study is aimed to note the prevalence of femoral hernia and trend of disease in two genders and different age groups in patients from Bundelkhand region. Methods: This observational study was carried out on 42 patients of femoral hernia belonging from Bundelkhand region of India. Patients were classified into groups based on their genders, age, laterality and types of femoral hernia. All the findings were tabulated and inferences were drawn followed by statistical comparison using chi-square test with p value <0.05 considered as significant. Results: Highest prevalence of femoral hernia was noted in >60 years age group. Females show a higher preponderance for femoral hernia as compared to males. Prevalence of hernia was higher on right side as compared to left side. Recurrent femoral hernia showed very small preponderance.Conclusion: Such studies are needed to be conducted in all geographical regions with as much possible number of observations. Results of present study might be helpful for future studies in estimating femoral hernia prevalence in population as a whole.

Correlation between Age of Subjects and Length of the Appendix in Bundelkhand Region of India.

Background: The aim of present study is to note the correlation of appendix length with age in both genders in patients of acute appendicitis from Bundelkhand region. Methods: This observational study was carried out on 100 patients belonging from Bundelkhand region of India, suffering from Acute Appendicitis. The patients were divided into groups based on their genders and ages. Measurement of length of the appendix was taken from base to tip. All the findings were tabulated and inferences were drawn followed by statistical comparison using t-test and ANOVA with p value <0.05 considered as significant. Regression analysis was done to note the correlation between age of the subject and length of appendix in both genders. Results: A highly significant positive correlation was noted between ages of patient with the length of the appendix. This positive correlation was seen in both genders. Conclusion: The data of the present study may provide a baseline in the standardization of the anthropometric information regarding the length of vermiform appendix of Bundelkhand population.

Prevalence of Inguinal Hernia in Bundelkhand Region of India.

Background: The aim of present study is to note prevalence of inguinal hernia in two genders and different age groups in patients from Bundelkhand region. Methods: This observational study was carried out on 130 patients of inguinal hernia belonging from Bundelkhand region of India. Patients were classified into groups based on their genders, age, laterality and type of inguinal hernia. All the findings were tabulated and inferences were drawn followed by statistical comparison using chi-square test with p value <0.05 considered as significant. Results: Highest prevalence of inguinal hernia was noted in 41-50 years age group. Males show a higher preponderance for inguinal hernia as compared to females. Prevalence of hernia was higher on right side as compared to left side, though 6.9% cases were found to be bilateral. Although the recurrence of inguinal hernia was noted in both direct and indirect hernia, but recurrent hernia showed higher preponderance. Conclusion: Such studies are needed to be conducted in all geographical regions with as much possible number of observations. Results of present study might be helpful for future studies in estimating inguinal hernia prevalence in population as a whole.

Incidence, microbiological profile of nosocomial infections, and their antibiotic resistance patterns in a high volume Cardiac Surgical Intensive Care Unit.

Background: Nosocomial infections (NIs) in the postoperative period not only increase morbidity and mortality, but also impose a significant economic burden on the health care infrastructure. This retrospective study was undertaken to (a) evaluate the incidence, characteristics, risk factors and outcomes of NIs and (b) identify common microorganisms responsible for infection and their antibiotic resistance profile in our Cardiac Surgical Intensive Care Unit (CSICU). Patients and Methods: After ethics committee approval, the CSICU records of all patients who underwent cardiovascular surgery between January 2013 and December 2014 were reviewed retrospectively. The incidence of NI, distribution of NI sites, types of microorganisms and their antibiotic resistance, length of CSICU stay, and patient‑outcome were determined. Results: Three hundred and nineteen of 6864 patients (4.6%) developed NI after cardiac surgery. Lower respiratory tract infections (LRTIs) accounted for most of the infections (44.2%) followed by surgical‑site infection (SSI, 11.6%), bloodstream infection (BSI, 7.5%), urinary tract infection (UTI, 6.9%) and infections from combined sources (29.8%). Acinetobacter, Klebsiella, Escherichia coli, and Staphylococcus were the most frequent pathogens isolated in patients with LRTI, BSI, UTI, and SSI, respectively. The Gram‑negative bacteria isolated from different sources were found to be highly resistant to commonly used antibiotics. Conclusion: The incidence of NI and sepsis‑related mortality, in our CSICU, was 4.6% and 1.9%, respectively. Lower respiratory tract was the most common site of infection and Gram‑negative bacilli, the most common pathogens after cardiac surgery. Antibiotic resistance was maximum with Acinetobacter spp.

Feasibility study of a novel intraosseous device in adult human cadavers.

Background & objectives: Intraosseous (IO) access is an alternative to difficult intravenous (iv) access during emergency clinical situations. Existing IO solutions are expensive, require power supply and trained manpower; limiting their use in resource constrained settings. To address these limitations, a novel IO device has been developed. The objectives of this study were to evaluate functionality and safety of this device in adult human cadavers. Methods: The ability of the IO device to penetrate the proximal and/or distal tibia was evaluated in three adult cadavers. Subjective parameters of loss of resistance, stable needle hold, easy needle withdrawal and any damage to the device were evaluated during the study. The insertion time was the objective parameter measured. Four sets of radiographs per insertion confirmed the position of the needle and identified complications. Results: A single physician performed 12 IO access procedures using the same device. Penetration of proximal and/or distal tibia was achieved in all instances. It was successful in the first attempt in eight (66.7%) and during second attempt in the remaining. The mean time to insertion was 4.1 ± 3.1 sec. Appropriate insertion of needle in the intra-medullary space of bone was confirmed with radiological examination in 10 (83.3%) insertions. In two occasions after penetrating the cortical layer of bone, the device overshot the intra-medullary space, as detected by radiological examination. Device got bent during insertion in one instance. There was no evidence of needle breakage or bone fracture. The needle could be withdrawn effortlessly in all instances. Interpretation & conclusions: The novel IO device could successfully penetrate the adult cadaver bones in most cases. Further studies are needed to confirm these results on a large sample.

Hair & skin derived progenitor cells: In search of a candidate cell for regenerative medicine.

Background & objectives: Skin is an established tissue source for cell based therapy. The hair follicle has been introduced later as a tissue source for cell based therapy. The ease of tissue harvest and multipotent nature of the resident stem cells in skin and hair follicle has promoted basic and clinical research in this area. This study was conducted to evaluate skin stem cells (SSCs) and hair follicle stem cells (HFSCs) as candidate cells appropriate for neuronal and melanocyte lineage differentiation. Methods: In this study, SSCs and hair follicle stem cells (HFSCs) were expanded in vitro by explant culture method and were compared in terms of proliferative potential and stemness; differentiation potential into melanocytes and neuronal lineage. Results: SSCs were found to be more proliferative in comparison to HFSCs, however, telomerase activity was more in HFSCs in comparison to SSCs. Capacity to differentiate into two lineages of ectoderm origin (neuronal and melanocyte) was found to be different. HFSCs cells showed more propensities towards melanocyte lineage, whereas SSCs were more inclined towards neuronal lineage. Interpretation & conclusions: The study showed that SSCs had differential advantage over the HFSCs for neuronal cell differentiation, whereas, the HFSCs were better source for melanocytic differentiation.

Variation in Appendix Position in Bundelkhand Region of India.

Background: The aim of present study is to note the prevalence of various positions of appendix along with its length and extent of meso-appendix in two genders and different age groups in patients of acute appendicitis from Bundelkhand region. Method: This observational study was carried out on 100 patients belonging from Bundelkhand region of India, suffering from Acute Appendicitis. Position of appendix and extent of meso-appendix observed carefully followed by measurement of length of appendix from base to tip. All the findings were tabulated and inferences were drawn followed by statistical comparison using chi-square test and t-test with p value <0.05 considered as significant. Result: Highest prevalence of acute appendicitis was found in the age group of 11-19 years age group. Highest prevalent position amongst all appendix position was retrocaecal in both genders and in all age groups followed by pelvic position. The length of appendix ranged from 37 mm to 120 mm in males with an average of 78.9 ± 18.1 mm, while its length ranged from 38 mm to 96 mm in females with an average of 65.5 ± 17.5 mm. Average length of the appendix was found 13.4 mm higher in males as compared to females. In 90% of cases in this study, mesoappendix extended to its full extent, whereas in 10% cases it failed to reach its tip. Conclusion: Findings in this study show subtle differences in length, position and extent of mesoappendix from other studies from other regions. Such studies are needed to be conducted in all geographical regions with as much possible number of observations.

Culture & differentiation of mesenchymal stem cell into osteoblast on degradable biomedical composite scaffold: In vitro study.

Background & objectives: There is a significant bone tissue loss in patients from diseases and traumatic injury. The current autograft transplantation gold standard treatment has drawbacks, namely donor site morbidity and limited supply. The field of tissue engineering has emerged with a goal to provide alternative sources for transplantations to bridge this gap between the need and lack of bone graft. The aim of this study was to prepare biocomposite scaffolds based on chitosan (CHT), polycaprolactone (PCL) and hydroxyapatite (HAP) by freeze drying method and to assess the role of scaffolds in spatial organization, proliferation, and osteogenic differentiation of human mesenchymal stem cells (hMSCs) in vitro, in order to achieve bone graft substitutes with improved physical-chemical and biological properties. Methods: Pure chitosan (100CHT) and composites (40CHT/HAP, 30CHT/HAP/PCL and 25CHT/HAP/PCL scaffolds containing 40, 30, 25 parts per hundred resin (phr) filler, respectively) in acetic acid were freeze dried and the porous foams were studied for physicochemical and in vitro biological properties. Results: Scanning electron microscope (SEM) images of the scaffolds showed porous microstructure (20-300 μm) with uniform pore distribution in all compositions. Materials were tested under compressive load in wet condition (using phosphate buffered saline at pH 7.4). The in vitro studies showed that all the scaffold compositions supported mesenchymal stem cell attachment, proliferation and differentiation as visible from SEM images, [3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyltetrazolium bromide] (MTT) assay, alkaline phosphatase (ALP) assay and quantitative reverse transcription (qRT)-PCR. Interpretation & conclusions: Scaffold composition 25CHT/HAP/PCL showed better biomechanical and osteoinductive properties as evident by mechanical test and alkaline phosphatase activity and osteoblast specific gene expression studies. This study suggests that this novel degradable 3D composite may have great potential to be used as scaffold in bone tissue engineering.

Efficacy of stem cell in improvement of left ventricular function in acute myocardial infarction - MI3 Trial.

Background & objectives: Acute myocardial infarction (AMI) is characterized by irreparable and irreversible loss of cardiac myocytes. Despite major advances in the management of AMI, a large number of patients are left with reduced left ventricular ejection fraction (LVEF), which is a major determinant of short and long term morbidity and mortality. A review of 33 randomized control trials has shown varying improvement in left ventricular (LV) function in patients receiving stem cells compared to standard medical therapy. Most trials had small sample size and were underpowered. This phase III prospective, open labelled, randomized multicenteric trial was undertaken to evaluate the efficacy in improving the LVEF over a period of six months, after injecting a predefined dose of 5-10 × 108 autologous mononuclear cells (MNC) by intra-coronary route, in patients, one to three weeks post ST elevation AMI, in addition to the standard medical therapy. Methods: In this phase III prospective, multicentric trial 250 patients with AMI were included and randomized into stem cell therapy (SCT) and non SCT groups. All patients were followed up for six months. Patients with AMI having left ventricular ejection fraction (LVEF) of 20-50 per cent were included and were randomized to receive intracoronary stem cell infusion after successfully completing percutaneous coronary intervention (PCI). Results: On intention-to-treat analysis the infusion of MNCs had no positive impact on LVEF improvement of ≥ 5 per cent. The improvement in LVEF after six months was 5.17 ± 8.90 per cent in non SCT group and 4.82 ± 10.32 per cent in SCT group. The adverse effects were comparable in both the groups. On post hoc analysis it was noted that the cell dose had a positive impact when infused in the dose of ≥ 5 X 108 (n=71). This benefit was noted upto three weeks post AMI. There were 38 trial deviates in the SCT group which was a limitation of the study. Interpretation & conclusions: Infusion of stem cells was found to have no benefit in ST elevation AMI. However, the procedure was safe. A possible benefit was seen when the predefined cell dose was administered which was noted upto three weeks post AMI, but this was not significant and needs confirmation by larger trials.

Double aortic arch as a source of airway obstruction in a child.

Double aortic arch (DAA) is a congenital vascular anomaly. The diagnosis was difficult till the child was symptomatic, and other causes were ruled out. We present the interesting images of a child of respiratory distress because of tracheal compression from DAA.

Assessment of the American Joint Committee on Cancer 7th edition staging for localised prostate cancer in Asia treated with external beam radiotherapy

<p><b>INTRODUCTION</b>Most international clinical practice guidelines for prostate cancer (PCa) are driven by data derived in a Western setting. However, tumour biology and clinical disease progression are likely to differ in the Asian population. We compare the performance of the revised American Joint Committee on Cancer (AJCC) prognostic groups with the commonly used D'Amico Risk Classification and conventional predictors for PCa, in a large cohort of Asian patients.</p><p><b>MATERIALS AND METHODS</b>We retrospectively reviewed data for 404 consecutive Singaporean patients receiving definitive radiotherapy at our centre between December 1996 and October 2006. The primary outcome was biochemical relapse-free survival (BRFS), defined using the Phoenix definition. The secondary outcome was overall survival (OS). Prognostic risk groups were defined using AJCC 7th edition (AJCC7) and 6th edition (AJCC6). Univariate analysis (UVA) and multivariate analysis (MVA) were performed for the following putative risk factors: age, Gleason score, prognostic grouping, tumour classification, radiation delivery technique, radiotherapy dose, hormonal therapy and initial PSA value.</p><p><b>RESULTS</b>For the cohort, median age was 69 years. Median follow-up was 66.3 months. Five-year BRFS rate was 84.3% with 71 biochemical relapses and 5-year OS rate was 89.1% with 54 deaths. The concordance-indices for BRFS prediction were 0.588, 0.550 and 0.567 for AJCC7, AJCC6 and D'Amico respectively. Initial PSA, T-stage and AJCC7 were prognostic for BRFS on UVA. Comparison of AJCC7 vs. D'Amico showed no statistical additional value of either classification system although D'Amico was superior when compared to AJCC6 in predicting BRFS. T-stage ≥3 and D'Amico were significant prognostic factors for BRFS on MVA.</p><p><b>CONCLUSION</b>In our local, predominantly Chinese population, neither AJCC6 nor AJCC7 demonstrated a high predictive accuracy for BRFS although AJCC7 has a slightly better predictive ability than AJCC6.</p>