Distribution and Association of Lip Print Pattern, Finger Print Pattern and ABO Blood Groups in Relation to Gender and Family Among South Indian Population

Background: Positive identification of living/ deceased using distinct traits is a cornerstone of forensic science. According to Locard’s principle “When two objects come into contact, there is always transfer of material from one to another”. The finger prints, lip prints and blood remains are the evidence for forensic identification. Aim: To study the frequency, distribution and association of ABO blood groups, finger print pattern, lip print pattern among gender and also the inherent nature of patterns among family members. Materials and Methods: A total of 200 Subjects (100 males, 100 females) within the age range of 17- 30 years and 20 families were randomly selected and aggregated as groups. Lip prints and finger prints were collected using dusting technique with fine carbon powder. ABO blood group was determined by slide agglutination method. Results: Ulnar loop - Males - Vertical, Radial loop - Males - Branching, Whorl - Females - Branching, Arch - Males - Intersecting; Females - Vertical. O positive, B positive - Loop - Branching, A positive - Loop - Vertical and Intersecting, AB positive - Whorl - Branching and Intersecting. Among 20 families, 14 families showed 100 percent pattern resemblance. High percentage of similar pattern was observed between father to daughter (70%) in finger prints and mother to son in lip prints (71%). Conclusion: Correlating the uniqueness of these physical evidence helps in personal identification as it can narrow the search & to substantiate the facts where there is little evidence

Development and validation of a mobile application based on a machine learning model to aid in predicting dosage of vitamin K antagonists among Indian patients post mechanical heart valve replacement

Patients who undergo heart valve replacements with mechanical valves need to take Vitamin K Antagonists (VKA) drugs (Warfarin, Nicoumalone) which has got a very narrow therapeutic range and needs very close monitoring using PT-INR. Accessibility to physicians to titrate drugs doses is a major problem in low-middle income countries (LMIC) like India. Our work was aimed at predicting the maintenance dosage of these drugs, using the de-identified medical data collected from patients attending an INR Clinic in South India. We used artificial intelligence (AI) - machine learning to develop the algorithm. A Support Vector Machine (SVM) regression model was built to predict the maintenance dosage of warfarin, who have stable INR values between 2.0 and 4.0. We developed a simple user friendly android mobile application for patients to use the algorithm to predict the doses. The algorithm generated drug doses in 1100 patients were compared to cardiologist prescribed doses and found to have an excellent correlation.

Impact of Early Pulmonary Rehabilitation in Postacute COVID Disease: A Single-Center Experience From India – A Quasi-Experimental Study

Background: It was observed that post?COVID patients reported persistent exertional dyspnea, cough, fatigue, or chest pain. About 10%–20% of patients may progress to pulmonary fibrosis. Pulmonary rehabilitation has been proven to be useful in improving effort tolerance and quality of life in chronic respiratory diseases. Objectives: The objective of this study was to assess the effectiveness of pulmonary rehabilitation in improving 6?min walk distance (6 MWD), peak flow, fatigue, anxiety, and depression in early postacute COVID disease. Materials and Methods: This quasi?experimental study was conducted during January 2021 to March 2021. The patients who recovered from COVID?19 and having persistent exertional dyspnea and fatigue after 3 weeks of recovery were included in the study. Baseline and postintervention assessment of 6 MWD, Visual Analog Scale for Fatigue (VAS?F), peak flow, and Hamilton rating scales (HAM) scales after 4 weeks were done. Compliance was ensured with weakly telemonitoring. Results: Significant improvement in peak flow, 6 MWD, Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), and VAS-F (P < 0.01) after 4 weeks of pulmonary rehabilitation. Conclusion: Early pulmonary rehabilitation in post?COVID syndrome can contribute to statistically significant improvement in functional and psychological parameters as well as post-COVID fatigue.

Heart Failure with Preserved Ejection Fraction: Management Guidelines (From Heart Failure Association of India, Endorsed by Association of Physicians of India)

Heart failure with preserved ejection fraction (HFpEF) accounts for 15–20% of patients with heart failure (HF) in India. Diagnosis is by clinical features supported by biomarkers and echocardiography. Lifestyle modifications, control of risk factors to optimum levels, and treatment of comorbidities are essential in the management of HFpEF. Spironolactone and sacubitril-valsartan [angiotensin receptor neprilysin inhibitor (ARNI)] are beneficial in subsets of HFpEF, especially with lower range of ejection fraction (EF). Sodium-glucose co-transporter-2 inhibitors (SGLT2i)—empagliflozin and dapagliflozin and probably sotagliflozin are the only currently available drugs which have shown benefits in HFpEF, mostly by reducing hospitalizations. The benefit of SGLT2i is evident in both diabetic and nondiabetic subsets. Heart failure with preserved ejection fraction is defined as patients with HF with documented left ventricular ejection fraction (LVEF) equal to or more than 50%.1 Globally, HFpEF accounts for close to 50% of patients presenting with HF. As per the registry data like Trivandrum Heart Failure Registry2 and ASIAN-HF,3 the proportion of HFpEF in our country is approximately 19–25%, which is much lower as compared to that of western population. There is a possibility that many cases go undiagnosed in developing countries like India. The mean age of presentation of patients from India was around 58–68 years, which is about 10 years younger than the data reported from the west. Heart failure with preserved ejection fraction is characterized by elevated left ventricular filling pressures and/or reduced cardiac output either at rest or on exertion. Cardiac output is maintained at the cost of abnormally elevated filling pressure which is responsible for the symptoms and signs. Neurohumoral activation (sympathetic and renin-angiotensin-aldosterone system activation) is present only in a group of HFpEF patients unlike in patients with heart failure with reduced ejection fraction (HfrEF).

Screening for seedling stage salinity tolerance and comparative transcriptome analysis in Rice (Oryza sativa L.)

Soil salinity is one of the major abiotic stresses which affect crop productivity including rice, Oryza sativa L. Developing salt tolerant varieties gained considerable attention accordingly. Here, we studied salinity tolerance in rice crop. We screened ten rice genotypes for saline tolerance at different concentrations of 0 dSm-1, 2 dSm-1, 4 dSm-1, 6 dSm-1, 8 dSm-1,10 dSm-1, 12 dSm-1 and 14 dSm-1, respectively. Among the ten genotypes studied, CARIDhan-7 tolerated salt stress up to 6dSm-1 of irrigated water. Comparative transcriptome analysis was done with the genotypes by treating with saline water at 0dSm-1 and 6 dSm-1. A total of 1013 genes were differentially expressed under simulated stress conditions. Out of which, 551 genes were upregulated and 462 genes were downregulated. Based on the metabolic pathway analysis, the MAPK signaling pathway, along with the other 9 pathways were found to be enriched in the stressed sample. Nine ion transporter genes, 1potassium channel, 1 protein phosphatase gene, IAA homologs OsIAA9, two ROS scavenging-related genes, and 4 stress regulated genes identified were found to be significantly up-regulated along with some functional proteins previously reported under salt stress. An AP2-like ethylene-responsive transcription factor PLETHORA 2 was found to be downregulated. The results suggested that the CARIDhan-7 genotype undergoes various saline tolerant mechanisms and pathways in response to the stress imposed when compared to non-stressed seedlings.

A community-based study on electrocardiographic abnormalities of adult population from South India - Findings from a cross sectional survey

Background: There are no data on electrocardiographic (ECG) findings from general population of Indian subcontinent. We analyzed ECG abnormalities of in adults as part of a community survey of prevalence of coronary artery disease and risk factors from South India. Methods and results: In this cross-sectional study of men and women between the ages 20 to 79 years, ECGs recorded digitally were analyzed using the Minnesota code. Electrocardiograms were analyzed for abnormalities in 4630 participants (women 59.6%). The overall prevalence of ECG abnormalities (39.9%) was higher in men (47.24% vs. 34.9% p <0.0001). QRS axis deviation, first degree AV block, fascicular blocks, incomplete right bundle branch block, sinus bradycardia and ST elevation in the anterior chest leads were markedly higher in men. Sinus tachycardia and low voltage QRS occurred more often in women. The overall prevalence of atrial fibrillation was 0.32% which was markedly lower than the western data. Brugada and early repolarisation patterns occurred in 1.06% and 1.56% respectively, equal in both age groups, but markedly higher in men. Brugada pattern occurred more often than in the west, but much less than the Far East population. Early repolarisation pattern was similar to rest of Asian population, but significantly less than the Caucasian population Conclusion: In this community-based study, prevalence of major electrocardiographic abnormalities was high. Overall, men had significantly higher ECG abnormalities

Parents' and teachers' perceptions of emotional and behavioral problems in school-going adolescents

Introduction: Parents and teachers are the primary consultants to understand the emotional and behavioral problems of school-going adolescents. The current study focuses on parents’ and class teachers’ perspectives of school-going adolescents’ emotional and behavioral problems. Material and Methods: A Cross-sectional questionnaire-based study was conducted among 19 schools from government-private and rural-urban schools across Kollam District, Kerala. Malayalam/English version of the strength and difficulties questionnaire was administered among a sample of 600 parents and 60 class teachers of school-going adolescents. Results: Multiple linear regression analysis showed that parents' reports is significantly predicted by gender (P < 0.01), urban-rural settings (P < 0.001) and socioeconomic status (P < 0.01). Teachers’ reports have significantly been predicted by urban-rural settings (P < 0.01) and socioeconomic status (P < 0.001). Conclusion: More attention is needed for the protection of adolescent’s mental health and fills mental health gaps in services.

Evaluation of retinal nerve fiber layer, ganglion cell layer, and optic nerve head morphological parameters in patients with obstructive sleep apnea and comparison with normal population

Purpose: To compare the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and optic nerve head (ONH) morphological parameters between obstructive sleep apnea (OSA) patients and age?matched controls using spectral domain optical coherence tomography (SD?OCT). Methods: This case control study was conducted in a multi?specialty tertiary care hospital from 2014 to 2016. Patients diagnosed to have OSA by overnight polysomnography were included in the study. Fifty eyes of 25 OSA patients with clinically normal optic disc were compared with 50 eyes of age?matched controls. The study population underwent detailed ophthalmological evaluation including SD?OCT. Results: There was significant thinning of the superior, inferior, and average RNFL in the OSA group when compared to controls. GCL analysis also showed a significant thinning of the six sectors as well as average and minimum ganglion cell layer + inner plexiform layer in OSA patients. The optic nerve head rim area was significantly decreased in OSA patients when compared to controls. Conclusion: OSA patients even with clinically normal optic disc showed significant decrease in the RNFL thickness, GCL thickness, and rim area when compared to age?matched controls. Hence, these patients constitute a high?risk population who need to be regularly screened and followed up for ocular co?morbidities

The Functional Outcome Volar Barton Fracture Treated by Open Reduction and Internal Fixation with T Plate – A Prospective Study

Introduction: Barton's fracture is fracture-dislocation ofradiocarpal joint with the intra-articular fracture involvingthe volar or dorsal lip. These injuries are inherently unstabledemanding open reduction and internal fixation. We presentour experience with buttress plate fixation for volar Barton’sfracture with Ellis T-plate. Aims: To evaluate the functionaloutcome and complications in volar Barton’s fracture treatedby open reduction and internal fixation with T plate.Material and methods: This case series study wasconducted between January 2012 and November 2012 atDepartment of Orthopaedics, Government Medical CollegeThiruvananthapuram. The patients in the age group 18 -75years who were treated by ORIF for volar Barton fractureswere included in the study. During follow up, subjective andobjective assessments were done and the patient’s functionalstatus was evaluated with modified clinical scoring system ofGreen and O’Brien. The 32 patients involved were followedup for eleven months. The descriptive data were analysedusing ‘SPSS’ and conclusions were made based on it.Results: Wrist functions as assessed by Green and O’Brienscore showed 84.4% patients with excellent to good results.Five patients had either fair or poor outcome. None of thesevariables were found to have any significant effect on the finaloutcome.Conclusions: Ellis T plate is a simple and cheap implantwhich provides effective volar distal buttressing in treatmentof volar Barton fractures. Our study shows encouragingresults with good functional results. Also, there is a relativelyshort learning curve and the implant is cost effective.

Early surgical management in pancreatic ascites on a background of chronic pancreatitis

Background: Pancreatic ascites can occur as a complication of acute or chronic pancreatitis. In majority of cases, it is associated with pseudocyst or duct disruption. Management is initially conservative with paracentesis with nutritional support. Early surgery has been recently contemplated as primary management for pancreatic ascites.Methods: A prospective study was done over a duration of three years from November 2017 to October 2019 in patients of chronic pancreatitis presenting with pancreatic ascites. All patients underwent pancreatic protocol contrast enhanced computed tomography abdomen and magnetic resonance cholangiopancreatography, duct diameter and main pancreatic duct (MPD) disruption site.  pseudocyst site was identified. After optimizing patients, early surgery was planned. Surgeries included either lateral pancreatic jejunostomy, if MPD were dilated. Pancreaticogastrostomy, cystogastrostomy or cystojejunostomy, if there was pseudocyst with extraneous impression over stomach or on mesocolon, and distal pancreatectomy (and/or) splenectomy. Results: Out of 20 cases of pancreatic ascites, 6 were of acute pancreatitis and conservatively managed and 14 were subjected to early primary surgery. 8 out of 14 patients underwent LPJ. 2/14 underwent pancreaticogastrostomy. 2/14 underwent cystogastrostomy and 1/14 underwent spleen preserving distal pancreatectomy. 1/14 underwent distal pancreatectomy and splenectomy. None of the patients had postoperative recurrence of pancreatic ascites. One patient developed Postoperative intra-abdominal collection which was drained. Mortality was 2/14 (14.2%), one died immediate postoperatively and another succumb to Pulmonary embolism on post-operative day-4. Pain scores were significantly reduced post-operatively.Conclusions: Primary early surgery directed towards primary pathology, as guided by MPD status, in selected patients with chronic pancreatitis with ascites leads to faster recovery of patient.

Risk factors for non communicable diseases among transport and security personnel of a health sciences university in coastal Karnataka

Background: Non communicable diseases (NCDs) are on the rise among workers in various occupations resulting in morbidity and mortality. This study was conducted to assess the various risk factors and associated socio-demographic factors among the security and transport personnel working in a health sciences university in Mangaluru.Methods: It was a cross-sectional study conducted among all the security and transport personnel. Questionnaire based on WHO-STEPS approach was used. Blood pressure (BP) measurements were recorded.Results: Total 167 study participants were enrolled; 57.5% were security and rest were transport personnel. Physical activity was perceived as light by 63.5% participants. Current smokers constituted to 26% and 33.5% consumed alcohol in past 12 months. Eighteen percent of them top salted their food. Among participants who were apparently healthy, 12.5% and 23.4% had raised systolic and diastolic BP. Associations between the areas of residence (p=0.004) and type of occupation (p<0.001) were found to be significant.Conclusions: Prevalence of risk factors of NCDs was high among study participants. Only few study subjects were physically active and majority of them felt that their routine work provided them with light physical activity. Around one third of the participants consumed tobacco and alcohol. Around 1/4th of the study participants who were not known hypertensive, were found with increased levels of blood pressure.

Psychosocial Perspective Of Nipah Virus Outbreak In Kerala, India

Nipah Virus (NiV) is a biological disaster and zoonotic pathogen which can be transmitted from animal to human beings. TheNiV was first identified in Malaysia in 1998. In India it was traced at Siliguri in 2001, followed by second outbreak in Nadiadistrict of West Bengal in 2007 and the present outbreak consumed more than 17 lives and affected many in Kerala, a southernIndian state which is globally known as “God’s own country”. The “all-time alert care” provided by the Kerala State HealthDepartment have earned applause for early detection of Nipah outbreak. The prompt action ensured containing the spread ofNipah outbreak and halting a major catastrophe, in spite of the best efforts the anxiety and panic was commonly reported amongthe communities. The current review is to explore the psychosocial perspectives of NiV and its impact in Kerala. Studies onNiV were collected from different online search engines, journals and newspapers. The review points out that there is a needto address psychosocial aspects of NiV along with pharmacological intervention to reduce vulnerability by enhancing bettercoping and resilience of individual, family and community.

Achieving 100 percent compliance to perioperative antibiotic administration: a quality improvement initiative

INTRODUCTION@#Timely administration of prophylactic antibiotics within 60 minutes before surgical incision is important for reducing surgical site infections. This quality improvement initiative aimed to work towards achieving 100% compliance with perioperative antibiotic administration.@*METHODS@#We examined the workflow in our Anaesthesia Information Management System (AIMS) and proposed interventions using cause-and-effect analysis of anonymised anaesthetic records from eligible surgical cases extracted from AIMS. This ultimately led to the implementation of an antibiotic pop-up reminder. The overall process was done in a few small plan-do-study-act cycles involving raising awareness, education and reorganisation of AIMS before implementation of the antibiotic pop-up reminder. Data analysis took place from August 2014 to September 2016. Compliance was defined as documented antibiotic administration within 60 minutes before surgical incision, or as documented reason for omission.@*RESULTS@#The median monthly compliance rate, for 33,038 cases before and 28,315 cases after the reminder was implemented, increased from 67.0% at baseline to 94.5%. This increase was consistent and sustained for a year despite frequent personnel turnover. Documentation of antibiotic administration also improved from 81.7% to 99.3%, allowing us to identify and address novel problems that were initially not apparent, and resulting in several department recommendations. These included administering antibiotics later for cases with predicted longer-than-expected preparation times and bringing forward antibiotic administration in lower-segment Caesarean sections.@*CONCLUSION@#The use of information technology and implementation of an antibiotic pop-up reminder on AIMS streamlined our work processes and brought us closer to achieving 100% on-time compliance with perioperative antibiotic administration.

Infective endocarditis due to Streptococci and Enterococci: A 3-year retrospective study

Introduction: Infective endocarditis (IE) is an infection of the heart valves with an aggregation of bacteria in a fibrin plaque called vegetation. Aims and Objectives: This is a retrospective study of all infective endocarditis cases due to alpha haemolytic streptococci and enterococci. Methods: All cases of infective endocarditis cases due to alpha haemolytic streptococci and enterococci in a period of three years from 1st January 2010 to 31st December 2012 were included. Isolation of the same organism from more than one set of blood cultures was taken as a confirmed case of infective endocarditis. Clinical and serological parameters were recorded using a proforma. Results: Native valve endocarditis was more common with only five prosthetic valves being involved. Out of 89 clinically suspected cases of IE in the three years from Jan 2010 to Dec 2012, for which blood was sent for culture, 63(70.78%) samples were positive by culture. Of these, 42/63(66.66%) were due to alpha-lytic Streptococci, enterococci and rare gram positive cocci. The rare ones included Enterococcus gallinarum, abiotropha defective, Vagococcus fluvialis and Nutritionally Variant Streptococci(NVS). High level Aminoglycoside resistance(HLAR) was also encountered. The varied and important features of these isolates are discussed. Complications and treatment are described. Conclusion: From a clinical microbiology point of view, the major challenge faced by the microbiologist in diagnosis of IE is proper aseptic collection of sample before starting antibiotics with a need for multiple samples to detect and also to prove the causative organism. Sensitivity reporting can be a difficult task in the context of NVS, HLAR and gram positives that are slow growing. Congestive failure and embolisation occurs even when the antibiotic treatment is successful.When patients go in for complications, it is very rarely due to wrong antibiotics.

Management protocols for chronic heart failure in India

Heart failure is a common clinical syndrome and a global health priority. The burden of heart failure is increasing at an alarming rate worldwide as well as in India. Heart failure not only increases the risk of mortality, morbidity and worsens the patient’s quality of life, but also puts a huge burden on the overall healthcare system. The management of heart failure has evolved over the years with the advent of new drugs and devices. This document has been developed with an objective to provide standard management guidance and simple heart failure algorithms to aid Indian clinicians in their daily practice. It would also inform the clinicians on the latest evidence in heart failure and provide guidance to recognize and diagnose chronic heart failure early and optimize management.

Evaluation of short-chain-length polyhydroxyalkanoate accumulation in Bacillus aryabhattai

Abstract This study was focused on the polyhydroxybutyrate (PHB) accumulation property of Bacillus aryabhattai isolated from environment. Twenty-four polyhydroxyalkanoate (PHA) producers were screened out from sixty-two environmental bacterial isolates based on Sudan Black B colony staining. Based on their PHA accumulation property, six promising isolates were further screened out. The most productive isolate PHB10 was identified as B. aryabhattai PHB10. The polymer production maxima were 3.264 g/L, 2.181 g/L, 1.47 g/L, 1.742 g/L and 1.786 g/L in glucose, fructose, maltose, starch and glycerol respectively. The bacterial culture reached its stationary and declining phases at 18 h and 21 h respectively and indicated growth-associated PHB production. Nuclear Magnetic Resonance (NMR) spectra confirmed the material as PHB. The material has thermal stability between 30 and 140 °C, melting point at 170 °C and maximum thermal degradation at 287 °C. The molecular weight and poly dispersion index of the polymer were found as 199.7 kDa and 2.67 respectively. The bacterium B. aryabhattai accumulating PHB up to 75% of cell dry mass utilizing various carbon sources is a potential candidate for large scale production of bacterial polyhydroxybutyrate.

Anesthetic considerations for endovascular abdominal aortic aneurysm repair.

Aneurysm is defined as a localized and permanent dilatation with an increase in normal diameter by more than 50%. It is more common in males and can affect up to 8% of elderly men. Smoking is the greatest risk factor for abdominal aortic aneurysm (AAA) and other risk factors include hypertension, hyperlipidemia, family history of aneurysms, inflammatory vasculitis, and trauma. Endovascular Aneurysm Repair [EVAR] is a common procedure performed for AAA, because of its minimal invasiveness as compared with open surgical repair. Patients undergoing EVAR have a greater incidence of major co‑morbidities and should undergo comprehensive preoperative assessment and optimization within the multidisciplinary settings. In majority of cases, EVAR is extremely well‑tolerated. The aim of this article is to outline the Anesthetic considerations related to EVAR.

Comparison of the clinical performance of i-gel, LMA Supreme and LMA ProSeal in elective surgery

<p><b>INTRODUCTION</b>The LMA Supreme™, i-gel® and LMA ProSeal™ are second-generation supraglottic airway devices. We tested the hypothesis that these devices differ in performance when used for spontaneous ventilation during anaesthesia.</p><p><b>METHODS</b>150 patients who underwent general anaesthesia for elective surgery were randomly allocated into three groups. Data was collected on oropharyngeal leak pressures, ease and duration of device insertion, ease of gastric tube insertion, and airway safety.</p><p><b>RESULTS</b>Leak pressure, our primary outcome measure, was found to be higher for the i-gel than the Supreme and ProSeal (mean ± standard error of the mean: 27.31 ± 0.92 cmH2O, 23.60 ± 0.70 cmH2O and 24.44 ± 0.70 cmH2O, respectively; p = 0.003). Devices were inserted on the first attempt for 90%, 82% and 72% of patients in the i-gel, Supreme and ProSeal groups, respectively (p = 0.105); mean device placement times were 23.58 seconds, 25.10 seconds and 26.34 seconds, respectively (p = 0.477). Gastric tubes were inserted on the first attempt in 100% of patients in the Supreme group, and 94% of patients in the i-gel and ProSeal groups (p = 0.100). There was blood staining on removal in 9 (18%) patients in each of the Supreme and ProSeal groups, with none in the i-gel group (p = 0.007). The incidence of postoperative sore throat, dysphagia and hoarseness was lowest for the i-gel.</p><p><b>CONCLUSION</b>The three devices were comparable in terms of ease and duration of placement, but the i-gel had higher initial oropharyngeal leak pressure and lower airway morbidity compared with the ProSeal and Supreme.</p>