Efficacy of deep learning-based artificial intelligence models in screening and referring patients with diabetic retinopathy and glaucoma

Purpose: To analyze the efficacy of a deep learning (DL)?based artificial intelligence (AI)?based algorithm in detecting the presence of diabetic retinopathy (DR) and glaucoma suspect as compared to the diagnosis by specialists secondarily to explore whether the use of this algorithm can reduce the cross?referral in three clinical settings: a diabetologist clinic, retina clinic, and glaucoma clinic. Methods: This is a prospective observational study. Patients between 35 and 65 years of age were recruited from glaucoma and retina clinics at a tertiary eye care hospital and a physician’s clinic. Non?mydriatic fundus photography was performed according to the disease?specific protocols. These images were graded by the AI system and specialist graders and comparatively analyzed. Results: Out of 1085 patients, 362 were seen at glaucoma clinics, 341 were seen at retina clinics, and 382 were seen at physician clinics. The kappa agreement between AI and the glaucoma grader was 85% [95% confidence interval (CI): 77.55–92.45%], and retina grading had 91.90% (95% CI: 87.78–96.02%). The retina grader from the glaucoma clinic had 85% agreement, and the glaucoma grader from the retina clinic had 73% agreement. The sensitivity and specificity of AI glaucoma grading were 79.37% (95% CI: 67.30–88.53%) and 99.45 (95% CI: 98.03–99.93), respectively; DR grading had 83.33% (95 CI: 51.59–97.91) and 98.86 (95% CI: 97.35–99.63). The cross?referral accuracy of DR and glaucoma was 89.57% and 95.43%, respectively. Conclusion: DL?based AI systems showed high sensitivity and specificity in both patients with DR and glaucoma; also, there was a good agreement between the specialist graders and the AI system

Left Main Coronary Artery Aneurysm with Fistula to Superior Vena Cava: A Challenging Case

Coronary artery fistulas (CAFs) are rare congenital coronary artery abnormalities, with direct communication between a coronary artery and a cardiac chamber, great vessel or other structure. We report here, a rare case of a 25?year?old male with CAF from the aneurysmal left main coronary artery to the superior vena cava detected on echocardiography and computerized tomography (CT) coronary angiography

Prioritizing tobacco control & its cessation under sustainable development goals with a focus on India

Sustainable development goals (SDGs) were meant to put each and everywhere ‘at par’. The tobacco epidemic globally is one major deterrent to their achievement. While it gets addressed under SDG 3 through the Framework Convention on Tobacco Control (FCTC) - the World Health Organization (WHO) global treaty (the target 3.a of SDG 3), the progress made globally and by India is slow. As a result, many countries may fall short of achieving the target of reducing tobacco usage (taking 2016 as base year) by 30 per cent by the year 2030. India with its high burden of tobacco use and abysmally low quitting along with soaring economic costs of tobacco related diseases and deaths can do better with the engagement of multisectoral stakeholders to strengthen tobacco control under SDGs. Moreover, there is a need to emphasize that the goal of O - Offer to Quit of WHO MPOWER can be achieved through increasing ‘onus’ on policy makers, and strategists, and opportunities for masses, tobacco users, healthcare professionals (HCPs) and enforcers to have tobacco cessation delivered optimally. By doing so, the United Nations can significantly facilitate a reduction in tobacco use and the resultant economic costs. Furthermore, it will assist the WHO to fulfil the targets set for 2030 under SDG 3.a by the FCTC member countries. In addition, it will fulfil the vision and mission defined in the Chandigarh declaration of the 5th National Conference on Tobacco or Health for India to be tobacco free by 2030.

MAPPING THE SACRED: A GEOGRAPHICAL ANALYSIS OF PLACES OF WORSHIP IN VILLAGE LADWI OF HISAR DISTRICT

Religion and geography appear to have little in common at rst glance. The majority of those who are interested in the study of religion are also generally less interested in the study of geography. Religious places have always played a signicant role in societies' social and cultural fabric. This paper explores the function of religious places in the village of Ladwi, focusing on their historical, cultural, and social signicance. Through examining the sacred spaces with an empirical approach, the paper explores how religious places contribute to the spiritual and social well-being of their respective communities. The central focus of this research paper is to understand how a religious place functions in the space, place and location. Hisar is known for its rich cultural history and there are various temples, Geographical study of religion in the concerned area has been neglected, which is why this study aims to investigate the development, spread, and impact of religion on people's lives from a geographical perspective. Geographical factors play a vital role in answering pertinent questions about religion. Places of worship also hold signicant importance as they are integral parts of the cultural landscape. The historical background of worship places is complex and multifaceted, and studying it from a geographical perspective can provide valuable insights. However, there has been a notable absence of such research in the concerned study area. Therefore, investigating the factors that contributed to the origin of worship places is an important goal of this study

Management of airway obstruction following lidocaine nebulization in a case of tracheal stenosis: case report

Abstract Stenting for lower tracheal stenosis is a tricky situation and for the safe conduct of anesthesia, it is imperative to maintain spontaneous respiration. Airway topicalization is routinely recommended for anticipated difficult airway. We report a case of upper airway obstruction following lidocaine nebulization in a patient to be taken for tracheal stenting for lower tracheal stenosis. We would like to highlight that close monitoring of the patient is advisable during airway topicalization to detect any airway obstruction at the earliest and how fiberoptic intubation can play a pivotal role to secure the airway in an emergency scenario.

Prevalence and Correlates of Vitamin D Deficiency Among Children and Adolescents From a Nationally Representative Survey in India

Objective: To evaluate the prevalence of vitamin D deficiency (VDD) and its correlates among apparently healthy children and adolescents. Methods: We carried out a secondary analysis of data of Comprehensive National Nutrition Survey 2016-18 to analyze the pre-valence and predictors of VDD among Indian children and adolescents. Results: The over-all prevalence of VDD in preschool children (1-4 years), school age (5-9 years) children, and adolescents (10-19 years) was 13.7%, 18.2%, and 23.9%, respectively. Age, living in urban area, and winter season were significantly associated with VDD. Vegetarian diet and high-income households were the main risk factors observed in 5-19 years age category. Female sex and less than three hour of physical activity/week were independent risk factors among adolescents. Conclusion: The prevalence and determinants of VDD across different age-groups are reported, and these should be interpreted and addressed to decrease the burden of VDD in India.

Management of Diabetic Macular Edema Through Ayurveda: A Single Case Study

Diabetic macular edema is one of the leading causes of visual acuity loss in people with diabetes. It produces blurry vision, particularly in the centre of the vision field, floaters and black spots in front of the eyes etc. The treatment recommended by modern science is laser photocoagulation and anti-VEGF injection, which is pricey and does not ensure visual reversal in the patient. In Ayurveda text, diabetic retinopathy and diabetic macular edema are not directly described but etiopathogenesis of eye diseases and Prameha gives an idea of possible correlation between these two diseases. So, DME resembles Timira (Pramehajanya). In Ayurveda, Timira has been explained in detail by our Acharyas. Clinical manifestations of Timira are Vihwal Drishti (blurred vision), Makshika Mashaka Kesha Jaala Pashyati (floaters), Tamasa Darshanam (Scotoma- black spots in front of eyes) and Nasa Akshi Yuktani Vipritani Vikshate (Metamorphopsia or distorted vision) which has similarity with features of DME. Material & Methods: In the present study, a female patient aged 51 years, visited the Shalakya Tantra OPD of National Institute of Ayurveda, Jaipur, with complaining of Blurriness of vision since 6 months and uncontrolled blood sugar level. Result: Blood sugar level was controlled and saw reduction in subjective and objective parameters. Discussion: Following an Ayurvedic drugs and routine will assist to slow the advancement of the condition, prevent further diabetes complications, and improve quality of life.

Drug-drug Interaction between Psychotropic Medications and Medications Used in COVID-19: Comparison of Online Databases

Objective@#COVID-19 has gravely affected patients with psychiatric conditions. Potential interactions may occur between psychotropic medications and medications used in treatment of COVID-19. This study aimed to compare the online databases in terms of the quality of drug-drug interaction related information available on them. @*Methods@#216 drug interactions which included fifty-four psychotropic medication interactions with four COVID-19 drugs across six databases were analyzed by four authors independently. The overall grading of the databases was done on Likert scale independently by the authors using the parameters of ease of understanding for consumers and professionals, level of completeness, discussion on level of evidence and the number of available drugs, congruity with other databases and the mean score was tabulated. @*Results@#Drugbank and Lexicomp had maximum discrepancy. The safety profile of Hydroxychloroquine was the best (eighteen moderate/severe psychotropic medication reactions) while Ritonavir has worst profile with thirty-nine medications. Drugbank had the highest SCOPE score (1.00) for completeness and covid19druginteractions.com had least (0.81). Overall, Liverpool© Drug Interaction Group and Lexicomp scored the highest (23/30 each) and were the best interaction checker software closely followed by Drugs.com (22/30). Medscape and WebMD were the poorest interaction checker databases. @*Conclusion@#There is significant variability in the available online databases. Liverpool © Drug Interaction Group and Lexicomp were the most reliable sources for healthcare workers whereas for patients, Drugs.com was the easiest to understand (as it segregates the needs of general consumers and professionals distinctly to explain the interaction).

Functional Anatomy of the Hamstring Muscle and Its Correlation with the Various Yogic Postures: A Narrative Review

Yoga is believed to be a safe practice; nonetheless, as the number of yoga practitioners has grown, so has the incidence of yoga-related injuries. Overall, lower extremity injuries comprised 64% of total injuries; specifically, the hip, hamstring, knee, ankle, feet and toe. Although a few research studies have quantified the hamstring muscle activities in various yoga asanas, evidence correlating it to functional anatomy is scarce. Therefore, the objective of this narrative review is to examine the literature and analyse hamstrings activity and its relationship to yogic postures, as well as yoga-related injuries, to establish which poses provide the most risk of damage, and to suggest injury-prevention techniques. The following electronic databases were used to conduct the literature search: Cochrane Library, PubMed, Google Scholar, EMBASE, and Web of Science. hamstring muscle injuries OR yoga and rehabilitation OR intervention AND electromyography was among the search phrases utilized. Such information is important for yoga teachers, yoga therapists to help selecting yoga posture for hamstring muscle imbalance condition and avoiding posture to prevent hamstring muscle injury.

Conformance of the Food Vendor Carts Design to the Prescribed Standards as per Food Safety and Standards Regulations: Assessment from an Urban Area of North India

Background: Food Safety and Standards Authority of India, established under the Food Safety and Standards Act, 2006, is mandated with disseminating evidence-based standards, regulating the manufacture, storage, distribution, sale, and import of street food, for ensuring the availability of safe and wholesome food for human consumption and matters connected in addition to that or incidental to that. Hence, this study was conducted to ascertain the conformance of the design of street food vendor’s carts to the prescribed standards. Methods: We conducted a cross?sectional study in Chandigarh between July 2017 and March 2018 among 400 street food vendors. The primary dependent variable of the study was conformance. The carts were evaluated for their conformance to the standard recommended design based upon a checklist designed using the guidelines of Food Safety and Standards Regulations, 2011. Results: Almost half of the respondents had an experience of 6–15 years (48.5%) and were earning between Rs. 500 and 1000/day (56.3%). The majority of them (95%) were migrants from other states. Only 26.3% were using mobile vending sites. On regression analysis, better cart score was predicted by age, education, increasing experience, higher income, when food was prepared at home only, and with assistance in the form of helpers. Conclusions: This study indicates that although the policy was formulated 8 years back, the standards of street food carts were still below par in Chandigarh. The government should give technical specifications and ensure uniformity at the national level.

Supraglottic device for circumventing bag-mask ventilation in giant lip hemangioma

Congenital hemangiomas are benign tumors of endothelium most often occurring as a solitary lesion with a predilection for the head-and-neck. This report presents a case of a giant friable hemangioma of the lower lip in a 1-month-old male child posted for excision of the lesion. Airway management was challenging as the size, site, and history of repeated local site bleeding made mask ventilation impossible. Bypassing mask ventilation, a supraglottic device (SGD) was directly inserted and adequate lung ventilation was ensured followed by C-MAC� video laryngoscope-guided intubation. Challenging extubation was also overcome by the use of a SGD. This case demonstrates how an airway with impossible bag and mask ventilation can be managed by securing the airway with SGD before intubation.

Histopathological finding of vesiculobullous lesions of skin in relation to their clinical presentation: Prospective study from a tertiary care center

Background: Vesiculobullous disorders (VBDs) are extant with diverse clinical manifestations. Vesicles and bullae are fluid-filled cavities present within or beneath the epidermis. They are autoimmune blistering disorders in which autoantibodies are directed against target antigens present in the epidermis and dermo-epidermal junction. Objective: Evaluation of the various clinicodemographic profile of patients with a pattern of distribution (subtypes) of VBDs of the skin and assess the association between clinical aspects and histological changes in vesiculobullous lesions of the skin. Materials and Methods: The study material constituted 93 cases of VBDs out of 936 skin biopsies reported over two and a half years (January 2016 to June 2018) from the tertiary care center. A detailed history of the patients was taken, and a complete physical and dermatological examination with findings including clinical diagnosis was recorded. Histopathological examination (incisional/excisional/punch biopsy) was done in each case. The clinico-demographic evaluation was done and the results were correlated with histopathological findings. Results: Vesiculobullous lesions constituted 10.06% of all skin biopsies. The majority of cases were of pemphigus vulgaris (PV) 30 (32.25%) followed by 16 (17.2%) of bullous pemphigoid. In 83 cases (89.24%) histopathology findings were consistent with clinical diagnosis. Out of 34 cases that were diagnosed clinically as PV , the histopathological study proved 30 cases (88.23%) as PV. Conclusion: Vesiculobullous lesions of the skin are a heterogeneous group of disorders. It is essential to differentiate each pattern of subtype based on clinical examination and histopathological findings. Histopathological diagnosis with clinical correlation plays a major role in arriving at the diagnosis.

Impact of B.1.617 and RBD SARS-CoV-2 variants on vaccine efficacy: An in-silico approach

Purpose: The existing panels of COVID-19 vaccines are based on the spike protein of an earlier SARS-CoV-2 strain that emerged in Wuhan, China. However, the evolving nature of SARS-CoV-2 has resulted in the emergence of new variants, thereby posing a greater challenge in the management of the disease. India faced a deadlier second wave of infections very recently, and genomic surveillance revealed that the B.1.617 variant and its sublineages are responsible for the majority of the cases. Hence, it's crucial to determine if the current vaccines available can be effective against these variants. Methods: To address this, we performed molecular dynamics (MD) simulation on B.1.617 along with K417G variants and other RBD variants. We studied structural alteration of the spike protein and factors affecting antibody neutralization and immune escape via In silico docking. Results: We found that in seven of the 12 variants studied, there was a structural alteration in the RBD region, further affecting its stability and function. Docking analysis of RBD variants and wild-type strains revealed that these variants have a higher affinity for the ACE2 (angiotensin 2 altered enzymes) receptor. Molecular interaction with CR3022 antibody revealed that binding affinity was less in comparison to wild type, with B.1.617 showing the least binding affinity. Conclusions: The results of the extensive simulations provide novel mechanistic insights into the conformational dynamics and improve our understanding of the enhanced properties of these variants in terms of infectivity, transmissibility, neutralization potential, virulence, and host-viral replication fitness.

Case report of prune belly syndrome: An airway challenge too?

Prune belly syndrome (PBS) is a rare congenital disease presenting a characteristic triad of abdominal muscle deficiency, urinary tract abnormality, and cryptorchidism with associated anomalies of various systems. We report the anesthetic management of an infant with PBS with no obvious facial deformity in whom we encountered an unanticipated difficult airway. Multiple attempts to secure the airway with different supraglottic airway devices were unsuccessful and the trachea could be intubated only on the second attemp

Laparohysterotomy for Managing Dystocia due to Uterine Inertia in a Sow: A Case Report

A nondescript sow with the history of delivering eight piglets and one remain in uterus since three days but unable to deliver was reported. The case was diagnosed as dystocia due to uterine inertia and laparohysterotomy was performed under general anesthesia, one male dead piglet was recovered successfully. The animal showed uneventful recovery.

A case of isolated multiple hydatid cysts of spleen

Isolated splenic hydatid disease is an extremely rare entity accounting for less than 3% of the total incidence of Echinococcosis. We present a case of 26yr female presenting with pain in the left hypochondrium and low-grade fever. CECT abdomen showed three loculated lesions in spleen features suggestive of hydatid cysts. She underwent splenectomy with a specimen that showed multiple splenic hydatid cysts. This case report highlights the rare presentation of isolated multiple hydatid cysts of the spleen and its successful diagnosis and treatment.

Founder BRCA1 mutations in Nepalese population

Background@#Founder mutation is a heritable genetic alteration observed with high frequency in a geographically and culturally isolated population where one or more ancestors becomes the forebearer of the altered gene. The current study reports two founder mutations in the BRCA1 gene in the Nepalese people. @*Methods@#Germline BRCA testing in all surface epithelial ovarian cancers and the selected case of breast, prostate, and pancreatic cancers has been the standard practice from 2016 to 2021. One thousand one hundred thirtythree probands were screened for germline BRCA variants by next generation sequencing. The variants were classified as per the American Society of Medical Genetics and Genomics recommendations. Pathogenic (class V) and likely pathogenic (class IV) were considered clinically relevant and utilized for cascade screening. @*Results@#Nepalese population made up a subcohort of 5.12% (58/1,133) of probands tested for germline BRCA1/2 variants. Twenty-seven of these 58 tested harbored pathogenic genetic alterations in BRCA1/2 genes, with 23 being BRCA1 mutant. Sixteen of 23 BRCA1 mutant cases shared one common pathogenic mutation c.2214_2215insT (p.Lys739Ter) (NM_007294.4). Additionally, a second highly recurrent mutation in BRCA1 gene c.5068A>T (p.Lys1690Ter) (NM_007294.4) was noted in six patients from this population. @*Conclusions@#The overwhelming abundance of the above two variants in a geographically confined population confers these two genetic alterations a status of founder mutations amongst the people of Nepal. A more extensive population-based study to reaffirm these findings will help establish a dual site-specific germline testing similar to the “Multisite-3-assay” in Ashkenazi Jews as the primary screening tool, especially in a resource-constrained environment.

Epidemiological Insights from 1,652 Patients with Spinal Tuberculosis Managed at a Single Center: A Retrospective Review of 5-Year Data

Methods@#Hospital records of spinal tuberculosis patients treated at a single center over a period of 5 years were retrospectively reviewed. A diagnosis of spinal tuberculosis was based on standard clinical, radiological, microbiological, and histopathological evidence. Patients were treated in accordance with the “middle-path” regimen; surgery was reserved for selective indications. @*Results@#A total of 1,652 patients were included. Their median age was 32.4 years, with 53% being male. Axial pain (98%) was the most common presenting symptom; 19% of patients had neurological deficit. Lumbar spine (37%) was the most common site of involvement, with a paradiscal pattern (82%) of involvement predominating. Multi-level involvement was seen in 19% of patients; skip lesions were noted in 2.8%. Transpedicular biopsy was performed in 667 patients; at least one tissue test was diagnostic of tuberculosis in 65% of patients. Forty-four patients had drug resistance to rifampicin. Surgery was required in 10.5% of patients. The “middle-path” regimen was associated with high compliance and significant improvements in pain (Visual Analog Scale score) and function (36-Item Short Form Health Survey). @*Conclusions@#Our findings confirm the widespread prevalence of spinal tuberculosis and describe various epidemiological characteristics of a large sample of spinal tuberculosis patients. Adoption of the “middle-path” regimen is associated with high compliance and favorable outcomes in spinal tuberculosis.

Analgesic efficacy of ultrasound-guided transversus abdominis plane block for laparoscopic gynecological surgery: a randomized controlled trial

Background@#This study aimed to determine whether ultrasound-guided transversus abdominis plane (TAP) block is more effective in reducing postoperative pain and analgesic consumption than local anesthetic infiltration (LAI) at the port site for elective laparoscopic gynecological surgeries. @*Methods@#Eighty patients with the American Society of Anesthesiologists status I/II undergoing laparoscopic gynecology surgery were enrolled for this randomized control trial. After general anesthesia was administered, patients in group C received LAI at each port site, and patients in group T received bilateral ultrasound-guided TAP. Postoperative pain was assessed at time intervals of 1/2, 2, 4, 6, 8, and 24 h using the numeric pain scale (NPS). Clinical metrics such as postoperative analgesic diclofenac consumption, need for rescue fentanyl, nausea-vomiting scores, and antiemetic requirements were also recorded. @*Results@#Seventy-four patients were included in the final analysis. Postoperatively, patients in group T had significantly lower NPS than those in group C (P < 0.05). The highest difference in the postoperative NPS was observed at 2 h (median [1Q, 3Q]; group C = 3 [2, 4]; group T = 1 [0, 2]; P < 0.001). A statistically significant difference was observed in the frequency of diclofenac (75 mg intravenous) requirement between the groups (P = 0.010). No significant difference was observed between the groups in need of rescue fentanyl or antiemetic and the nausea-vomiting scores. @*Conclusions@#In patients undergoing laparoscopic gynecological surgery, ultrasound-guided TAP block provided greater postoperative analgesic benefits in terms of lower NPS and reduced analgesic requirements than port site LAI.

Comparison of healing assessments of periapical endodontic surgery using conventional radiography and cone-beam computed tomography: A systematic review

Purpose@#This systematic review aimed to compare assessments of the healing of periapical endodontic surgery using conventional radiography and cone-beam computed tomography (CBCT). @*Materials and Methods@#This review of clinical studies was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. All articles published from 1990 to March 2020 pertaining to clinical and radiographic healing assessments after endodontic surgery using conventional radiography and CBCT were included. The question was “healing assessment of endodontic surgery using cone-beam computed tomography.” The review was conducted by manual searching, as well as undertaking a review of electronic literature databases, including PubMed and Scopus. The studies included compared radiographic and CBCT assessments of periapical healing after periapical endodontic surgery. @*Results@#The initial search retrieved 372 articles. The titles and abstracts of these articles were read, leading to the selection of 73 articles for full-text analysis. After the eligibility criteria were applied, 11 articles were selected for data extraction and qualitative analysis. The majority of studies found that CBCT enabled better assessments of healing than conventional radiography, suggesting higher efficacy of CBCT for correct diagnosis and treatment planning. A risk of bias assessment was done for 10 studies, which fell into the low to moderate risk categories. @*Conclusion@#Three-dimensional radiography provides an overall better assessment of healing, which is imperative for correct diagnosis and treatment planning.