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Abstract The article explores the significance of biomarkers in clinical research and the advantages of utilizing artificial intelligence (AI) and machine learning (ML) in the discovery process. Biomarkers provide a more comprehensive understanding of disease progression and response to therapy compared to traditional indicators. AI and ML offer a new approach to biomarker discovery, leveraging large amounts of data to identify patterns and optimize existing biomarkers. Additionally, the article touches on the emergence of digital biomarkers, which use technology to assess an individual's physiological and behavioural states, and the importance of properly processing omics and multi-omics data for efficient handling by computer systems. However, the article acknowledges the challenges posed by AI/ML in the identification of biomarkers, including potential biases in the data and the need for diversity in data representation. To address these challenges, the article suggests the importance of regulation and diversity in the development of AI/ML algorithms.
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Intelligence artificielle/classification , Marqueurs biologiques/analyse , Apprentissage machine/classification , Algorithmes , Multi-omique/instrumentationRÉSUMÉ
Imparting concepts in ?ow dynamics of cardiovascular and respiratory physiology can be intimidating to the beginners in medical schools. We have tried to simplify the approach in effective transfer of these concepts using biophysical concepts and principles pertaining to functioning of these systems which help in easy understanding of the two vital systems in human body. Beginners in medical education ?nd it easy to relate to these concepts.
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Bibliometric analysis is of paramount importance in assessing the research impact wherein studies are ranked on the basis of citations received. It also brings out the excellent contribution of authors and journals in adding evidence for future research. This study aimed at evaluating the top 100 most cited articles on anterior communicating artery (ACoA) Aneurysms. Scopus database was searched using title specific search for the aneurysm of ACoA and top 100 most cited articles along with their authors, author IDs, affiliated institutions, countries and funding bodies were identified. Search yielded 841 articles and top 100 articles were identified to include in this analysis which secured 5615 citations. Citations per year was also calculated to minimize the risk of bias. Maximum citations by any article were 242. The United States was the major contributor to the number of articles while Kessler Institute for Rehabilitation became the highest contributing institution. DeLuca J proved to be a pioneer in this specialized area as he penned 6 studies being first author in 4 of them, making him the most frequent author. National Institutes of Health and the U.S. Department of Health and Human Services were the main funding bodies. Subcategory analysis revealed, 50% studies provided evidence for the treatment and the surgical outcome of the aneurysm. Studies like these can aid in better neurological and neurosurgical management in decision making of ACoA aneurysm.
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Objective: Work related musculo skeletal disorders (WMSD) are very common among dental practitioners who use precise hand-wrist motions and prolonged static postures. The aim of this study was to develop an educative ergonomic plan and test its effectiveness in reducing symptoms of musculo-skeletal disorders among dental practitioners. Material and Methods: This study was conducted on a random sample of 50 dental practitioners of both genders (25 male, 25 female) practising for more than 4 years in urban Bengaluru, India and showing symptoms of neck pain, back pain or wrist pain. In the first round of the questionnaire data was collected from all 50 dentists. Next an educative ergonomic plan was developed which included simple exercises and recommendations in the form of do's and don'ts. The study population were asked to follow the guidelines given and perform the exercises given in the poster daily for a period of 3 months. Then, the questions were again asked. The differences in responses during the first stage and second stage were analyzed. Results: The use of the ergonomic plan led to a statistically significant improvement in certain ergonomic practises such as practise of changing their positions during clinical practice, keeping shoulders and arm at correct level while working and keeping instruments within hand reach. There was a statistically significant reduction in pain levels after the use of the ergonomic plan. Conclusion: The ergonomic plan in the form of recommendations and exercises were an effective tool in improving ergonomic practises and reducing the symptoms of musculoskeletal disorders among dental practitioners. (AU)
Objetivo: Distúrbios osteomusculares relacionados ao trabalho (DORT) são muito comuns entre os dentistas que usam movimentos precisos de mão e punho e posturas estáticas prolongadas. O objetivo deste estudo foi desenvolver um plano ergonômico educativo e testar sua eficácia na redução de sintomas de distúrbios osteomusculares em dentistas. Material e Métodos: Este estudo foi realizado em uma amostra aleatória de 50 dentistas de ambos os sexos (25 homens, 25 mulheres) trabalhando há mais de 4 anos na área urbana de Bengaluru, Índia e apresentando sintomas de dor no pescoço, dor nas costas ou dor no punho. Na primeira etapa do questionário foram coletados dados de todos os 50 dentistas. Em seguida, foi desenvolvido um plano ergonômico educativo que incluía exercícios simples e recomendações na forma de fazer e não fazer. Os participantes foram solicitados a seguir as orientações dadas e realizar os exercícios indicados no pôster diariamente por um período de 3 meses. Em seguida, as perguntas foram feitas novamente. Foram analisadas as diferenças nas respostas durante a primeira etapa e a segunda etapa. Resultados: A utilização do plano ergonômico levou a uma melhora estatisticamente significativa em algumas práticas ergonômicas, como a prática de mudar de posição durante o atendimento clínico, manter ombros e braços no nível correto durante o trabalho e manter os instrumentos ao alcance das mãos. Houve redução estatisticamente significativa dos níveis de dor após a utilização do plano ergonômico. Conclusão: O plano ergonômico na forma de recomendações e exercícios foi uma ferramenta eficaz na melhoria das práticas ergonômicas e na redução dos sintomas de distúrbios osteomusculares entre os cirurgiões-dentistas. (AU)
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Humains , Mâle , Femelle , Lésions par microtraumatismes répétés , Dorsalgie , Cervicalgie , Douleur musculosquelettique , Ingénierie humaineRÉSUMÉ
In this paper,we reviewed the various advanced technologies and methods that could help patients for measuring adherence of patients.There exist intelligent technologies that are available for measuring medication adherence,including medication event monitoring system (MEMS(R)),smart blister packs,radio frequency identification(RFID) embedded smart drawers,and wisely aware RFID dosage (WARD) system.Utilization of these advanced technologies and systems have aided in enhancing the adherence to a greater extent.For example,MEMS(R) refers to the electronic cap that counts the number of bottles opened,but it can be employed only with bottles.Smart blisters are pharmaceutical packagings that possess the capability of monitoring when a pill or tablet is taken out of its packing.All those intelligent technologies can help in active monitoring of patients regarding adherence and capable of eradicating various medication errors due to which adherence is affected.
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Background: Breast cancer is the most common cancer in women worldwide. The commonest mode of presentation of diseases of the breast is lump. It is the most common site-specific cancer in women. Triple test score which includes clinical breast examination, mammogram, FNAC score. A simple non-invasive but reliable test can make a huge difference in management between benign and malignant lumps. Aims and objectives of the study were to differentiate between benign and malignant lesions based on TTS and correlated the accuracy of triple test score with histopathology report, and plan the management accordingly.Methods: A prospective study was carried out in which TTS was calculated by summation of individuals’ scores of all three components and compare with histopathology report.Results: In present study of 74 patients (age group of 30 to 65 years), based on TT score 52 benign, 12 malignant, and 10 suspicious (neither benign nor malignant). But the final histopathological result showed 59 as benign and 15 as malignant, which is in concordant with TTS, which shows the accuracy of up to 100%. Out of 10 (suspicious) which were dis-concordant, 7 are benign and 3 are malignant on histopathology.Conclusions: By use of the triple test score and its interpretation, definitive treatment can be initiated, which would reduce the need for unnecessary biopsy and its ability to predict benign lump, can avoid major surgery.
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Background: Depression was seen to be associated with an increased level of inflammatory biomarkers along with the disturbance in the monoamine neurotransmitter system. Current therapies are mostly focussed on the neurotransmitters imbalance but due to increasing cases of treatment failure there is a need to shift our treatment focus to other potential therapies. This study aimed to evaluate the preventive role of aspirin and metformin in stress induced model of depression in wistar rats.Methods: Fifty four wistar rats were randomly divided into nine groups as normal control, experimental control, aspirin (30 mg/kg, 60 mg/kg), metformin (50 mg/kg, 100 mg/kg), two combination groups and imipramine (15 mg/kg). Depression model was created by the induction of chronic unpredictable mild stress (CUMS) for consecutive 28 days. Behavioural assessment was done by evaluating immobility time in forced swim test (FST) and sucrose preference ratio (SPR) in sucrose preference test. The data were analysed by analysis of variance (ANOVA) test using SPSS software. P<0.05 was considered to be statistically significant.Results: The CUMS led to an increase in immobility time and decrease in SPR. Aspirin and Metformin alone and their combinations showed statistically significant response in preventing the immobility time to increase (p<0.001) and SPR to decrease (p<0.001). However the response of Aspirin was comparable with Imipramine but the response of Metformin was not as significant as of Imipramine (p>0.05).Conclusions: Aspirin and metformin might have a potential role in the prevention of depression.
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An open label, randomized, comparative, interventional pilot study was done to assess the effect of Lekhana Basti (medicated enema) and Rechana Nasya Karma (Errhine therapy) in the management of Sthoulya with special reference to obesity. In the study 30 clinically diagnosed patient of either sex were randomly divided into two groups. In Basti group, Lekhana Basti in Karma Basti manner was given for 30 days. Anuvasana Basti (enema with Triphaladi Taila) in the dose of 120 mL and Asthapana Basti (enema with Triphaladi decoction etc.) in the dose of approximately 960 mL was given. In Nasya group, Rechananasya on alternate days was given with Triphaladi (oil) in the dose of 0.5 mL per nostril for total 28 days. The patients were assessed on objective criteria such as such as weight, chest circumference, mid-arm circumference, mid-thigh circumference, triceps skin fold thickness, sub-scapular skin fold thickness, abdominal skin fold thickness, waist-hip ratio and lipid profile. It was observed that Basti group was a better intervention in providing relief, however there intergroup standard deviation was low on most of the variable expect the lipid profile. The results suggest that the Nasya Karma may be developed as a better practical approach in obesity management.
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Background: To report the incidence and risk factors leading to the development of retinopathy of prematurity (ROP) from a tertiary care center in the western Indian state of Goa, India.Methods: This was a prospective observational study carried out in a level II neonatal intensive care unit (NICU) for a period of 18 months. Babies born at < 34 weeks' gestation and having a birth weight of <1500gm were screened for ROP and laser photocoagulation was done for those who developed threshold ROP. Group differences between any ROP and threshold ROP were analysed using the chi-square test.Results: Out of the 244 preterm neonates screened, 37 developed ROP (15.16%), and 14 out of them (5.73%) developed threshold ROP requiring laser photocoagulation. Very low birth weight, prematurity, apnea, anemia, sepsis, respiratory distress syndrome, bronchopulmonary dysplasia, blood transfusions, exchange transfusions and days taken to reach full enteral feeds and regain birth weight were significantly associated with the development of ROP.Conclusions: This is the first report of ROP from Goa where less than 1 in 5 babies developed ROP. This is similar to that reported across the rest of the country. Judicious oxygen use, ventilation strategies, transfusions guidelines, control of sepsis, early enteral feeds and adequate nutrition may help prevent the development of ROP in the future.
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Background: Intravenous fluid and electrolyte therapy in most of the acutely ill hospitalized children has beenthe cornerstone of medical practice for a well over 50 years.Objective: To determine optimal maintenance fluid therapy by comparing the incidence of hyponatremia orhypernatremia in hospitalised children.Methods: A prospective Randomized study done in PICU in patients admitted to paediatric emergency. The studywas conducted between September 2007 to May 2008. Children of age group 1 month to 16 years were included.The fluid groups were divided into four groups. SPSS version 18 was used for analysis.Results: The mean age in group I is 4.42, in group 2 is 3.84, in group 3 is 3.67 and in group 4 is 4.45. The meanserum sodium levels in fluid group 1 is 137.4 mmol/L, in fluid group II 138.2 mmol/L, in fluid group III is 138.9mmol/L and fluid group IV is 137.8 mmol/L. After initiating maintenance fluid therapy serum sodium levelschanged in each group. As we can see in group 1 mean serum sodium level at the start of the therapy is 137.43mmol/L and after 24 hours of hypotonic fluid infusion it reduced to 135.4 mmol. 69 patients had hyponatremiaand 44 had hypernatremia.Conclusion: Amount of free fluid in the IV maintenance fluid can be factor in causing hypernatremia. Caution iswarranted to guard off a rapid fall of serum sodium level.
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Background: The objective was to study the knowledge level and awareness among patients those attending a multi-speciality about their diseases and medications.Methods: A semi-constructed interview was done on 110 adult patients in the General Medicine Department, SRM Medical College, Hospital and Research Center, Kattankulathur, Kanchipuram.Results: Out of 110 patients. Were 58% was found to be male and 42% was found to be female. The patients' age group ranged from 12-84 years about 29% patients had no education, 30% of the patients were unaware of their diagnosis, 30% were unaware of the causes of their disease, 60% were unaware of the number of medications they were on, 68% did not know the names of their prescribed medication, 70% patients were non-smokers, 90.91% of the patients were aware that smoking was bad for health, 89% of the patients had received enough information from the doctors/nurses regarding their illness and treatment, but 38% of the patients were incapable of understanding their test results.Conclusions: Majority of the patients were aware of their diseases and the number of medications in spite of two third being illiterate. Thirty-two per cent did not know the causes of their illness and could not name their medications. Patients received little information from the health carers regarding their illness, Interpretation of investigations and aims of treatment. This study indicates that education is one of the main factors which are associated with a well understanding of the disease and medication.
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The Six Minute Walk Test (6MWT) was developed in 1963 by Balke to evaluate functional capacity. The test was developed in frail elderly patients 60-90 years of age referred to a geriatric hospital, and it targets community dwelling frail elders. However, the test has been used in a variety of chronic diseases, in adult and pediatric populations as well as in healthy adults and healthy pediatric population. It is a common outcome measurement tool used in physical therapy to determine ones basic exercise endurance and functional fitness. It is simple to perform, and it can help the physical therapist evaluate improvement or decline in one’s overall functional status during his/her rehabilitation program. It is a self paced sub maximal exercise test used to assess functional exercise capacity in patients with chronic diseases. The test has been used as an estimate of physical fitness in severe cardiopulmonary diseases, cystic fibrosis, juvenile idiopathic arthritis, etc in pediatric population. Knowledge about its measurement properties is needed to determine whether it is an appropriate test to use in paediatric population. The purpose of this study will be to systematically review all published clinimetric studies on the 6MWT in various pediatric conditions.
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Background: DPCO (Drugs Prices Control Order) price list is issued by NPPA (National Pharmaceutical Pricing Authority) each year to guide the pharmaceuticals companies for controlling the prices in India. Some drugs cost more than the DPCO list. As antihypertensive drugs are taken lifelong once diagnosis is made, price variation and costing above prescribed price cause a huge economic burden on such patients. This study was undertaken to know the number of antihypertensive drugs brands with price above the recommended DPCO price list 2017.Methods: Authors have collected the data from website medguideindia.com, CIMS (current index of medical specialties), Drug Today, and compared the listed antihypertensive drugs of various available brands in India with DPCO price list 2017. Data was entered in Microsoft excel 2010. Percentage of selling price above the DPCO price list was calculated for each drug.Results: The data of 30 formulations of 16 antihypertensive drugs was analysed. The total number of available brands of all formulations was 1365 out of which only 831 (60.88%) brands were found to have price <DPCO recommended list. 534 (39.12%) brands had price more than the recommended limit. The minimum violation of price limit was found in case of metoprolol 25mg (6.66%) and maximum price violation was observed with spironolactone 25mg and sodium nitroprusside inj 10mg/ml.Conclusions: Reassessment and monitoring for implementation of DPCO price list should be done as still large number of brands are not following the regulations and are violating the limit set by NPPA/DPCO.
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Background: Rheumatoid arthritis (RA) is an immune-mediated arthropathy, so for the treatment disease modifying antirheumatoid drugs are required. In this study we are evaluating the immunomodulatory property of Boswellia serrata extract (BSE) as an alternative medicine.Methods: Complete Freund’s adjuvant (CFA), 0.1ml was injected intradermally in the footpad of left hind paw in 36 Wistar rats to induce RA. Animals were divided into 6 groups. BSE in the doses of 45mg/kg, 90mg/kg and 180mg/kg was administered and cyclophosphamide as standard drug. Various parameters as body weight, paw thickness, ankle diameter, paw volume, arthritis index, TNF- ? and histopathological changes were analyzed.Results: Marked reduction in paw thickness, ankle diameter, paw volume, arthritis index and an improved body weight was found in high dose BSE (180mg/kg) group but the effect was lesser than standard drug Cyclophosphamide.Conclusions: BSE has significant potential as an alternative medicine for treatment of autoimmune diseases like rheumatoid arthritis.
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Background: Glucocorticoids are well known for their analgesic, anti-inflammatory , immune-modulating and antiemetic effects. The present study is done to see the effects of single dose IV administration of dexamethasone for postoperative analgesia in elderly patients on selective population of Bundelkhand region hospitalized for lower limb orthopaedic surgeries under spinal blockade. We found that duration of analgesia was dose dependent and patient receiving dexamethasone had better pain tolerability. Methods: Study was carried out on 120 patients of either sex, more than 60 year of age. The patients were than randomly divided into four groups of 30 patients each. Group I(C): Patients were given 4 ml saline intravenously to serve as control group. Group II (D-8): Patients were given 8 mg dexamethasone diluted to 4ml iv. Group III (D-12): Patients were given 12 mg dexamethasone diluted to 4ml iv. Group IV (D-16): Patients were given 16 mg dexamethasone diluted to 4ml iv. Pt. were observed for the following data: a. Onset of sensory block – tested by appearance of paresthesia, b. Time to reach peak of sensory & motor blockade, c. Recovery of sensory & motor function, d. Duration of anesthesia, e. Duration of complete analgesia- assessed by first demand for analgesic. Results: No significant difference among the study groups, which were slightly earlier than the control group while comparing time of onset of sensory/motor block. Duration of analgesia (time of onset of sensory block to first demand of analgesics): was maximum (545.03±45.25 min.) in group IV followed by group III (305.36±25.35 min.), which was found to be highly significant (p < 0.001) in comparison to group I (155.06±12.27 min) Group IV > Group III > Group II> Group I. Conclusion: Onset of sensory and motor block was comparable in all the four groups. Duration of analgesia was dose dependent with 16 mg dose providing maximum duration of post-operative analgesia at rest in comparison to 12 mg and 8 mg dose.
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Cardiac surgery accounts for the majority of blood transfusions in a hospital. Blood transfusion has been associated with complications and major adverse events after cardiac surgery. Compared to adults it is more difficult to avoid blood transfusion in children after cardiac surgery. This article takes into account the challenges and emphasizes on the various strategies that could be implemented, to conserve blood during pediatric cardiac surgery
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Background and Objectives: Adequate nutritional supplementation in infants with cardiac malformations after surgical repair is a challenge. Critically ill infants in the early postoperative period are in a catabolic stress. The mismatch between estimated energy requirement (EER) and the intake in the postoperative period is multifactorial, predisposing them to complications such as immune deficiency, more infection, and growth failure. This study aimed to assess the feasibility and efficacy of enriched breast milk feed on postoperative recovery and growth of infants after open heart surgery. Methodology: Fifty infants <6 months of age were prospectively randomized in the trial for enteral nutrition (EN) postoperatively from day 1 to 10, after obtaining the Institute Ethics Committee’s approval. They were equally divided into two groups on the basis of the feed they received: Control group was fed with expressed breast milk (EBM; 0.65 kcal/ml) and intervention group was fed with EBM + energy supplementation/fortification with human milk fortifier (7.5 kcal/2 g)/Simyl medium‑chain triglyceride oil (7.8 kcal/ml). Energy need for each infant was calculated as per EER at 90 kcal/kg/day, as the target requirement. The intra‑ and post‑operative variables such as cardiopulmonary bypass and aortic cross‑clamp times, ventilation duration, Intensive Care Unit (ICU), and hospital length of stay and mortality were recorded. Anthropometric and hematological parameters and infection control data were recorded in a predesigned pro forma. Data were analyzed using Stata 14.1 software. Results: The duration of mechanical ventilation, length of ICU stay (LOIS), length of hospital stay (LOHS), infection rate, and mortality rate were lower in the intervention group compared to the control group although none of the differences were statistically significant. Infants in control group needed mechanical ventilation for about a day more (i.e., 153.6 ± 149.0 h vs. 123.2 ± 107.0 h; P = 0.20) than those in the intervention group. Similarly, infants in control group stayed for longer duration in the ICU (13.2 ± 8.9 days) and hospital (16.5 ± 9.8 days) as compared to the intervention group (11.0 ± 6.1 days; 14.1 ± 7.0 days) (P = 0.14 and 0.17, respectively). The LOIS and LOHS were decreased by 2.2 and 2.4 days, respectively, in the intervention group compared to control group. The infection rate (3/25; 5/25) and mortality rate (1/25; 2/25) were lower in the intervention group than those in the control group. The energy intake in the intervention group was 40 kcal more (i.e., 127.2 ± 56.1 kcal vs. 87.1 ± 38.3 kcal) than the control group on the 10th postoperative day. Conclusions: Early enteral/oral feeding after cardiac surgery is feasible and recommended. In addition, enriching the EBM is helpful in achieving the maximum possible calorie intake in the postoperative period. EN therapy might help in providing adequate nutrition, and it decreases ventilation duration, infection rate, LOIS, LOHS, and mortality.