A comparative study of ProRithm and standard monitoring techniques for non-invasive blood pressure measurement using photoplethysmography and electrocardiography signals through artificial intelligence/machine learning methods

Background: Multi-parameter monitoring devices are essential for providing real-time patient data, which is crucial for effective healthcare interventions. This clinical trial evaluated the accuracy of the ProRithm beat-to-beat cuffless device for arterial blood pressure monitoring, comparing it with a standard sphygmomanometer. Methods: This observational study included 30 subjects aged 18 and above. Systolic and diastolic blood pressure measurements from both the ProRithm device and the Philips Monitor were compared using statistical analysis. Results: The analysis revealed no statistically significant differences between the ProRithm device and the manual method. In comparison with manual measurements using a sphygmomanometer, the mean systolic blood pressure was 131.2 mmHg with ProRithm it was 129.3 mmHg. Similarly, with the manual method, while the mean diastolic blood pressure was 76.2 mmHg and with ProRithm it was 75.9 mmHg. Conclusions: This study indicates that portable, small-sized devices like ProRithm, which facilitate remote monitoring, are effective for real-time blood pressure assessment in clinical settings.

Cracking of enigma of Evans: a rare association with Sjogren and systemic lupus erythematosus

Evans syndrome (ES) is characterized by the simultaneous or consecutive occurrence of warm autoimmune hemolytic anemia (AIHA) along with immune thrombocytopenia (ITP), and less commonly, autoimmune neutropenia. It may manifest spontaneously or as a result of autoimmune, malignancy or lymphoproliferative disease. Clinical manifestations may be associated with hemolysis and thrombocytopenia, potentially leading to life-threatening outcomes. ES is a rare diagnosis of exclusion. Due to its infrequency, the treatment is typically empirical, relying largely on intravenous corticosteroids or immunoglobulins. We are presenting case of a 46-year-old- female with bleeding from the mouth and gums and rashes all over the body with no prior diagnosis of rheumatological disorder. This case is pivotal as it highlights a key factor contributing to ES and presents a pragmatic method for addressing the condition.

A micro bacteriological culture assessment of the histopathological alterations in liver and bile in gallstone disease

Background: The present investigation aims to evaluate both the intensity and occurrence of hepatic impairment in patients afflicted with gallstone disease, examining the involvement of bacteria in the progression of these alterations. Methods: This prospective observational investigation was carried out on 189 patients scheduled for open or laparoscopic cholecystectomy at IGIMS in Patna, Bihar, India. In all the patients, laboratory and radiological investigations were performed. A healthy section of the liver border near the gallbladder fossa was chosen and grasped with non-traumatic forceps. Approximately 1 cm of the liver edge was excised using scissors and forwarded for histopathological analysis. Results: An examination of 189 liver biopsy specimens revealed that 87 (46%) patients showed no abnormalities, while 102 patients (54%) exhibited one or more changes. Upon analysing the liver biopsy samples from the control cohort (41 patients) during autopsy, 37% of the cases were identified to display hepatic lipidosis, while 48% of the cases showed lymphocytic invasion. Importantly, no cases of acute inflammatory changes were detected in the control cohort. Microbiological analysis was conducted on 96 patients, of which 33 (34%) showed positive cultures, with one or more microorganisms isolated from either the biliary tract or liver. Among these, 74% (24 cases) originated from the bile or gallbladder, while 26% (9 cases) were isolated from the liver. Conclusions: Gallstone disease induces significant liver histological changes, notably more prevalent in patients with prolonged symptoms. The present study clearly identifies this and underscores the importance of timely diagnosis and intervention for the effective management of this disease.

Smokeless tobacco use: A meta-analysis of risk and attributable mortality estimates for India.

BACKGROUND: Use of smokeless tobacco (SLT) is widely prevalent in India and Indian subcontinent. Cohort and case–control studies in India and elsewhere report excess mortality due to its use. OBJECTIVE: The aim was to estimate the SLT use‑attributable deaths in males and females, aged 35 years and older, in India. MATERIALS AND METHODS: Prevalence of SLT use in persons aged 35 years and older was obtained from the Global Adult Tobacco Survey in India and population size and deaths in the relevant age‑sex groups were obtained from UN estimates (2010 revision) for 2008. A meta‑relative risk (RR) based population attributable fraction was used to estimate attributable deaths in persons aged 35 years and older. A random effects model was used in the meta‑analysis on all‑cause mortality from SLT use in India including four cohort and one case–control study. The studies included in the meta‑analysis were adjusted for smoking, age and education. RESULTS: The prevalence of SLT use in India was 25.2% for men and 24.5% for women aged 35 years and older. RRs for females and males were 1.34 (1.27–1.42) and 1.17 (1.05–1.42), respectively. The number of deaths attributable to SLT use in India is estimated to be 368127 (217,076 women and 151,051 men), with nearly three‑fifth (60%) of these deaths occurring among women. CON CLUSION: SLT use caused over 350,000 deaths in India in 2010, and nearly three‑fifth of SLT use‑attributable deaths were among women in India. This calls for targeted public health intervention focusing on SLT products especially among women.

Antibacterial effects of azadirachta indica leaf and bark extracts in clinical isolates of diabetic patients.

Background: Antibacterial activities of crude Azadirachta indica (neem) bark and leaf extracts were investigated in bacterial species isolated from clinical samples of diabetic individuals. Methods and Material: Nine different dilutions of methanolic bark and leaf extracts were tested for this purpose in agar well diffusion method. Results: Both the extracts were active against Gram positive as well as Gram negative strains. Zones of inhibition produced by different bacteria for different concentrations were summarized by linear regression. Highest activities were exhibited for coagulase negative Staphylococcus (CONS) by both bark and leaf extracts, Y = 16.95 + 0.19X and Y = 18.90 – 0.70X, respectively. Conclusions: Results indicate that exhaustive studies involving identification of specific compounds in neem extracts and testing their activities in diabetic samples would be worthwhile considering steep emergence of multidrug resistant species in diabetic infections and infections in general.

Association of lipid profile and body mass index (bmi) in hypertensive patients of Eastern Nepal.

Dyslipidemia is closely associated with hypertension. Out of different fractions of lipoprotein, definite association of elevated LDL-Cholesterol (LDLc) and other lipid parameters has been well observed in hypertensive patients. The present cross sectional study was undertaken at BP Koirala Institute of Health Sciences with the aim to find out association of different lipid parameters and Body Mass Index (BMI) among newly diagnosed hypertension without any medications in Eastern Nepal. 80 hypertensive patients fulfilling JNC-7 criteria and 80 healthy controls were enrolled in this study. Lipid parameters (TC, TG, LDLc, VLDLc, HDLc) were estimated by Enzymatic Colorimetric test. Quetlet's formula was used to calculate BMI. Results were analyzed with student's 't' test and Pearson correlation analysis. Mean age of patients and controls were 36.30 +/- 7.73 yrs & 32.13 +/- 7.21 yrs respectively. There was significant increase in different lipid parameters namely TC (170.18 22.53 vs 145.23 21.13,P<0.005), TG (146.60 53.87 vs 119.77 35.61, P<0.005), LDLc (100.71 23.74 vs 79.25 20.10,P<0.05) and VLDLc (29.32 1077 vs 23.92 7.12, P<0.05) in patients as compared to the healthy controls. However there was no any significant difference in HDLc value. Pearson correlation analysis shows positive correlation of BMI with all the four lipid parameters even though it was not statistically significant. Thus this study shows direct association of BMI, dyslipidemia in hypertensive patients of the Eastern Nepal.

Effect of metronidazole on spermatogenesis and FSH, LH and testosterone levels of pre-pubertal rats.

Metronidazole, a 5-nitroimidazole drug has been reported to decrease testicular weight, testicular and epididymal spermatid counts and causes abnormal sperm morphology with degeneration of seminiferous tubules with 6 weeks treatment of metronidazole (400 mg/kg, day). In contrast to DNA flow cytometry (FCM), the histological and gravimetric parameters do not allow a rapid, sensitive, objective and multiparameteric evaluation of reproductive toxicants on spermatogenesis. Moreover, the exact mechanisms for such an effect are not entirely clear. The present study was therefore undertaken to assess the effects of intraperitoneal (i.p.) administration of metronidazole 400 mg/kg daily for 30 days on testicular germ cell changes assessed by DNA (FCM) and hormone levels of testosterone, FSH and LH in pre-pubertal rats. A significant reduction in the haploid cell population in metronidazole treated groups as compared to saline treated controls was observed. The mean serum FSH, LH and testosterone value were also lowered in treated animals. Thus, the spermatotoxic effects of metronidazole were probably mediated by decrease in the circulating hormones responsible for spermatogenesis.

An incidental case of breast cysticercosis associated with fibroadenoma.

It is unusual for cysticercosis to occur in the substance of the breast. Only a few cases have been described in the literature. We report a case of cysticercosis perched on fibroadenoma of breast found on surgical excision in a 35 year old Nepali woman. The patient had no discernible evidence of cysticercosis in the other organs.

Endocrinological parameters in experimental unilateral undescended testis.

It is a common clinical practice to estimate FSH, LH and testosterone levels in patients with unilateral undescended testis (U/L UDT) as a prognostic pointer to fertility potential. Is this practice correct? To ascertain this aspect, new born rats were operated to create experimental U/L UDT by gubernaculectomy and anchoring the gubernaculum to anterior abdominal wall. Fertility and hormone levels were evaluated later in adult life. Though fertility of rats with U/L UDT was significantly less (p < 0.01) than the controls, no significant alterations were found in the levels of serum testosterone, FSH and LH. Even though variations in the hormone levels may be responsible, to a certain extent, for the decrease in fertility potential in U/L UDT, estimation of sex hormone levels in U/L UDT is not a sensitive indicator of fertility potential. U/L UDT may additionally be affecting fertility through non-endocrinological mechanisms.

Evaluation of psoralen with solar ultraviolet light (puvasol) and adjunctive topical tar therapy in psoriasis.

Fifty patients having psoriasis were studied with a view to assess the efficacy of 'puvasol' (Oral psoralen with sun-rays exposure) alone and in combination with topical tar therapy and were placed in 2 groups, each group being consisted of 25 patients. At the end of 8 weeks, out of 25 patients (Group 1) receiving 'Puvasol' in combination with topital tar therapy 15 patients (60%) showed complete clearance, marked improvement of lesions were seen in 4 cases (16%) and deterioration in one case (4%). Out of 25 patients (Group I) receiving 'Puvasol' alone 8 cases (32%) showed complete clearance of lesions and 11 patients (44%) showed marked im-provement of lesions. It is found that topical tar therapy when used as an adjunct to 'Puvasol' was more effective than 'Puvasol' alone.

Indeterminate leprosy: a therapeutic evaluation.

Out of 50 cases of indeterminate leprosy, 46 were male and 4 were female. The only clinical finding was a single hypopigmented macule in 38 (76%) cases. Nine (18%) patients had two and three (6%) cases had three hypopigmented macules. All patients were treated with multidrug therapy for one year. At the end of six months, the lesions were still active in 12 (24%) cases. At the end of one year of treatment it was found that 33 (66%) patients became inactive and 3 (6%) cases were still to be active. The study shows that all indeterminate leprosy cases must be treated with multidrug therapy till all signs of activity are subsided.

Clinico-histopathological study of multidrug therapy in indeterminate leprosy.

A study was undertaken in 42 patients with indeterminate leprosy to evaluate the efficacy of multidrug therapy (MDT) in Indeterminate leprosy for 12 months. The main clinical finding was a single hypopigmented macule in 31 (73.8%) of the 42 cases. Histopathologically all cases showed lymphohistiocytic infiltration around skin appendages and dermal nerves. At the end of six months of MDT all the cases were evaluated clinically and 33 (85.5%) showed marked improvement or total inactivation while the lesions were still active clinically in 21.4% cases. Histopathological examination of lesions in 30 patients showed complete histological resolution in 9 cases only. At the end of one year of treatment it was found that 28 cases (66.3%) had become inactive and only 2 (4.7%) were found to be still active.

A clinico-pathological study of multidrug regimen in paucibacillary leprosy.

Preliminary results of a clinical trial in one hundred untreated paucibacillary leprosy cases with multidrug therapy (MDT) as per WHO recommendation are presented. Out of 100 fresh cases studied 18 had indeterminate, 35 tuberculoid and 47 cases had borderline tuberculoid leprosy. All were given MDT consisting of rifampicin 600 mg once a month and dapsone 100 mg daily for six months. At the end of six months all the cases were evaluated clinically and histopathological examination of lesions were studied. The lesions were still active in 35% of patient clinically and 47% histologically. Complete histological resolution have come across only in 4 cases suffering from indeterminate leprosy. Altogether 65% cases receiving MDT have shown marked improvement to total inactivation. Histologically, lymphocytic infiltration still persisted in 90% of slides examined and nerve infiltration were still present in 64% of cases at the end of six months receiving MDT.