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Biomedical image segmentation (BIS) task is challenging due to the variations in organ types, position, shape, size, scale, orientation, and image contrast. Conventional methods lack accurate and automated designs. Artificial intelligence (AI)-based UNet has recently dominated BIS. This is the first review of its kind that microscopically addressed UNet types by complexity, stratification of UNet by its components, addressing UNet in vascular vs. non-vascular framework, the key to segmentation challenge vs. UNet-based architecture, and finally interfacing the three facets of AI, the pruning, the explainable AI (XAI), and the AI-bias. PRISMA was used to select 267 UNet-based studies. Five classes were identified and labeled as conventional UNet, superior UNet, attention-channel UNet, hybrid UNet, and ensemble UNet. We discovered 81 variations of UNet by considering six kinds of components, namely encoder, decoder, skip connection, bridge network, loss function, and their combination. Vascular vs. non-vascular UNet architecture was compared. AP(ai)Bias 2.0-UNet was identified in these UNet classes based on (i) attributes of UNet architecture and its performance, (ii) explainable AI (XAI), and, (iii) pruning (compression). Five bias methods such as (i) ranking, (ii) radial, (iii) regional area, (iv) PROBAST, and (v) ROBINS-I were applied and compared using a Venn diagram. Vascular and non-vascular UNet systems dominated with sUNet classes with attention. Most of the studies suffered from a low interest in XAI and pruning strategies. None of the UNet models qualified to be bias-free. There is a need to move from paper-to-practice paradigms for clinical evaluation and settings.
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Effective drug delivery to the brain is critical for the treatment of glioblastoma (GBM), an aggressive and invasive primary brain tumor that has a dismal prognosis. Radiation therapy, the mainstay of brain tumor treatment, works by inducing DNA damage. Therefore, inhibiting DNA damage response (DDR) pathways can sensitize tumor cells to radiation and enhance cytotoxicity. AZD1390 is an inhibitor of ataxia-telangiectasia mutated kinase, a critical regulator of DDR. Our in vivo studies in the mouse indicate that delivery of AZD1390 to the central nervous system (CNS) is restricted due to active efflux by P-glycoprotein (P-gp). The free fraction of AZD1390 in brain and spinal cord were found to be low, thereby reducing the partitioning of free drug to these organs. Coadministration of an efflux inhibitor significantly increased CNS exposure of AZD1390. No differences were observed in distribution of AZD1390 within different anatomic regions of CNS, and the functional activity of P-gp and breast cancer resistance protein also remained the same across brain regions. In an intracranial GBM patient-derived xenograft model, AZD1390 accumulation was higher in the tumor core and rim compared with surrounding brain. Despite this heterogenous delivery within tumor-bearing brain, AZD1390 concentrations in normal brain, tumor rim, and tumor core were above in vitro effective radiosensitizing concentrations. These results indicate that despite being a substrate of efflux in the mouse brain, sufficient AZD1390 exposure is anticipated even in regions of normal brain. SIGNIFICANCE STATEMENT Given the invasive nature of glioblastoma (GBM), tumor cells are often protected by an intact blood-brain barrier, requiring the development of brain-penetrant molecules for effective treatment. We show that efflux mediated by P-glycoprotein (P-gp) limits central nervous system (CNS) distribution of AZD1390 and that there are no distributional differences within anatomical regions of CNS. Despite efflux by P-gp, concentrations effective for potent radiosensitization are achieved in GBM tumor-bearing mouse brains, indicating that AZD1390 is an attractive molecule for clinical development of brain tumors.Copyright © 2022 American Society for Pharmacology and Experimental Therapy. All rights reserved.
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Background: Pregnant women experience physiological changes that make them more susceptible to respiratory infections, including COVID-19. Given the potential impact of COVID-19 on pregnancy, it is crucial to continue to investigate the effect of the pandemic on pregnant women and their infants. This information will be important for informing for all the stakeholders including clinical care, and public health policies. Method(s): This study is a retrospective observational analytical study conducted in the Department of Obstetrics and Gynecology at SMGS hospital, Jammu. The study included 180 pregnant females who reported to emergency Obstetrics and Gynecology from 1st April to 30 June 2020. The sample size of 180 patients was divided into two groups: Group 1 included 90 COVID-19 positive pregnant females and Group 2 included 90 COVID-19 negative pregnant females. Result(s): No significant differences were found in age, parity, gestational age, comorbidities, mode of delivery, maternal complications, neonatal Apgar scores, or birth weight. The prevalence of comorbidities and maternal complications was similar in both groups, and most neonates had normal Apgar scores and birth weights. Conclusion(s): Therefore, it is suggested that appropriate management and care should be provided to all pregnant women, regardless of their COVID-19 status, to minimize any potential adverse outcomes.Copyright © 2022, Anka Publishers. All rights reserved.
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Coronavirus infection has become a common cause of sickness and death worldwide. Many drugs have been studied for the treatment of SARS-CoV-2 infections, and vaccines are injected to boost the immune system and safeguard people around the world. Many drug-like compounds are under clinical trials and have the potential to cure respiratory and viral diseases. Natural extracts and herbal products have been extensively used in traditional Chinese medicine and Indian Ayurveda. Natural medicines are more acceptable and are considered cheap and safe for COVID-19 treatment. This comprehensive chapter highlights in silico techniques for drug design and discovery using natural products against coronavirus infection. Especially computational studies of SARS-CoV-2 drugs have been explained. The effects of the mentioned natural metabolites repurposed for coronavirus diseases, especially for SARS-CoV-2, should be evaluated more by clinical investigation so that we may be able to develop potential drugs for most challenging respiratory diseases, especially SARS-CoV-2. © 2023 Elsevier Inc. All rights reserved.
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The article deals with the problem of personal reaction to the danger of COVID-19 virus infection and its influence on social processes. Based on the results, the survey proposes the answers to the central questions of public health services development: what is the correlation between the trust of citizens in a national healthcare system, the government's decision, and the effectiveness of lockdown measures taken to stop the coronavirus spreading with reference of Ukraine and India. This research analyses focus on personal and social attitude towards the immediate danger and the ways how different cultural environments react to the new factors of development and risk in general. It proves that personal and social responsibility is directly connected with a level of trust in the national healthcare system and government decisions. Indian and Ukrainian societies before a face of equal danger and experiencing similar personal emotions show the different social behaviour due to the opposite attitude to national healthcare policy and different social and personal evaluations of the government response. The comparison of the answers of Indian and Ukrainian respondents showed a higher level of passive social reaction and obedience in the Indian group and the lower level of obedience and a higher level of active-controlled and uncontrolled reaction in the Ukrainian group. The research paper proposes some conclusions and recommendations about effective social management of personal and public healthcare challenges. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Suicide is an intentional act of injuring oneself, irrespective of the outcome. However, there are other forms of suicidal behaviour existing among the people. The year 2020 is a hard time due to COVID19 pandemic as it had created difficulty to many people especially the lower economic class people to meet their daily livelihood. The result is many poor victims committing suicide. The method used for committing suicide vary from region to region. However, cutting one's own throat to end their life is very rarely performed by the victims of suicide. A careful interpretation of the injury is required by the forensic pathologist to conclude the manner of the death in such deaths. Here we report one such case, and the manner is concluded after studying the injuries tediously in summation with the police investigation. © 2022, Journal of Indian Academy of Forensic Medicine. All Rights Reserved.
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The article deals with the problem of personal reaction to the danger of COVID-19 virus infection and its influence on social processes. Based on the results, the survey proposes the answers to the central questions of public health services development: what is the correlation between the trust of citizens in a national healthcare system, the government's decision, and the effectiveness of lockdown measures taken to stop the coronavirus spreading with reference of Ukraine and India. This research analyses focus on personal and social attitude towards the immediate danger and the ways how different cultural environments react to the new factors of development and risk in general. It proves that personal and social responsibility is directly connected with a level of trust in the national healthcare system and government decisions. Indian and Ukrainian societies before a face of equal danger and experiencing similar personal emotions show the different social behaviour due to the opposite attitude to national healthcare policy and different social and personal evaluations of the government response. The comparison of the answers of Indian and Ukrainian respondents showed a higher level of passive social reaction and obedience in the Indian group and the lower level of obedience and a higher level of active-controlled and uncontrolled reaction in the Ukrainian group. The research paper proposes some conclusions and recommendations about effective social management of personal and public healthcare challenges. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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The global COVID-19 pandemic has had a tremendous effect on tourism industries and allied businesses, including the hotel industry. Even though in Ukraine this business does not make a major contribution to GDP, the presence of development potential, deferred demand, and performed functions makes it an important component of Ukraine, Therefore, there is a need to assess the impact of COVID-19 on the activities of hospitality entities and justify measures to restore it. The comparison of the main indicators of the functioning of the tourism and hotel business of Ukraine before and during the pandemic period demonstrates significant reductions. However, some businesses and destinations, due to the rapid response to the new reality and the reorientation to domestic tourism, on the contrary, improved pre-epidemic indicators. The unpredictability and scale of the pandemics revealed structural problems in the sector and the need for coordinated activities to address them. The review of measures accepted by the state authorities of Ukraine to minimize the effects of COVID-19 on the tourism and hotel business by 2020 revealed their fragmentation and inconsistency. For the macroeconomic level, there offered a set of institutional and state-legal measures, and there is a partnership of stakeholders at the theme level and the micro level—the systematic operation of various innovative and digital technologies (management, sanitation, technology, and communication). The partnership activities of stakeholders contribute to the innovative recovery of this field, a special place among which is the state and legal support of tourism and business: the introduction of compensation programs for owners and employees, off tax bills, reduction of individual taxes, exemption from liability and/or enforcement contractual relations due to force majeure, and the introduction of state insurance programs to protect against the risks of pandemics. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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In this COVID-19 pandemic situation, health care is on the priority of every human being. The recent development in the miniaturization of intelligent devices has opened many opportunities and played a crucial role in the healthcare industry. The amalgamation of wireless sensor network and Internet of Things is the best example of wireless body area network. These tiny sensor devices have two essential evaluation parameters named as energy efficiency and stability while performing in a group. This paper focuses on various issues of the healthcare system and their solutions. An energy-efficient routing protocol that can provide sensed data to the collection centre or data hub for further processing and treatment of the patients is proposed. Here, we fixed zones for sending data to zone head using distance aware routing, and then zone head send the aggregated data to the data hub. It is better than the low energy adaptive clustering hierarchy (LEACH) by 42% and distance-based residual energy-efficient protocol (DREEP) by 30% in energy efficiency and stability 58% more by LEACH and 39% by DREEP. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Purpose and Background: The purpose of this study is to examine the efficacy of several medications that are administered for the treatment of patients who have mild, moderate and severe case.
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Purpose and Background: The goal of this study is to examine the efficacy of various medications that are recommended for the treatment of patients in India who are suffering from mild-to-severe cases of corona virus disease 2019 (COVID-19). Method(s): In study carried out a retrospective, cross-sectional, observational and descriptive study. Patients diagnosed with COVID-19 ranging from mild, moderate and severe were given as part of this treatment. The primary objectives are to compare the categorical treatment protocols for COVID-19 (as per NIH Treatment Guidelines) infected mild, moderate and severe patients. To evaluate the efficacy of the drugs on the basis of at the time of discharge improvement in SPO2, RR, D-Dimer, PCT, CRP and Ferritin Values. Result(s): A total of 266 patients included in this study mild to severe COVID 19 infection led to significant improvement in SPO2, Respiratory rate (RR), D-Dimer, Procalcitonin (PCT), C-Reactive Protein (CRP) and Ferritin level. Conclusion(s): Adult patients with mild, moderate and severe COVID-19 infection, when treated with different drug combination, were more likely to improve in terms of inflammatory markers and disease severity markers and were more likely to have a better clinical profile at the end of the treatment period. Copyright © 2022, Anka Publishers. All rights reserved.
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Background: The erector spinae plane (ESP) blockade acts as a potent unilateral analgesic technique. The block is performed by injecting local anaesthetic drug in the plane between the erector spinae muscle and the vertebral transverse process, with its effect due to diffusion of the local anaesthetic into the paravertebral space through spaces between the adjacent vertebrae. It is a relatively safe and easy technique as compared to the thoracic epidural because our target in ESP blockade is the transverse process, which is identified easily and is distant from neural or major vascular structures and the pleura. Aim of the study: To assess the analgesic effect of ultrasound guided unilateral erector spinae blockade in open cholecystectomy Material and methods:We present a case series of ESP blockade under ultrasound guidance in nine patients scheduled for open cholecystectomy because surgeons chose to avoid laparoscopic surgery due to the increased risk of COVID-19 infection due to intraperitoneal aerosol generation. Results: All patients with postoperative ESP blockade maintained an NRS pain score of 03/10 for 24 h, except for those requiring emergency analgesia. The pain relief was excellent in all our patients and there were no complaints of nausea, vomiting. Conclusion: ESP blockade is proving to be a successful technique for intraoperative and postoperative analgesia.
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COVID-19, a pandemic caused by severe acute respiratory syndrome (SARS) corona virus-2 has been a worldwide challenge for the entire mankind. However, a safe and efficacious vaccine would be clinically valuable to reduce the risks of COVID-19. In this study, we aimed to assess the seroprevalence of the Neutralizing IgG Antibodies six months after completion of both the doses of Covishield Vaccination (ChAdox1 nCoV-19) and compare it with the IgG titres one month after the first dose and one month after the second dose of the vaccine respectively. The efficacy, safety and comorbidities related to the vaccine were also assessed at different time intervals. The levels of IgG antibodies were estimated in 72 subjects from the Teerthanker Mahaveer Medical College & Research Centre (who turned up after six months of the complete regimen of Covishield Vaccination) using the Enzyme-Linked Immunosorbent Assay (ELISA) Technique. A highly significant increase (p= 0.00) in the neutralizing Antibodies titre was seen in fully vaccinated individuals post six months when compared to the titres of post one month of 1st & 2nddoses. It can therefore be concluded that (ChAdox1 nCoV-19) Covishield Vaccination if administered in full regimen has both acceptable efficacies as well as safety profile. Hence, a complete vaccine regimen may prove as an effective strategy against COVID-19 and consequent minimization of long-term morbid effects. © 2022 International Journal of Health Sciences.
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OBJECTIVE: Mask usage and hand hygiene are the pillars of defense against the novel pathogen causing COVID-19. This study was conducted to compare these practices among healthcare workers (HCWs) and nonhealthcare workers (nonHCWs) and to examine the outlook toward the healthcare sector among the two. METHODS: A cross-sectional online survey (via Google forms) using snowball sampling was conducted. Appropriate ethical clearance was taken from the Institutional Ethical Committee (IEC). HCWs and nonHCWs 18 years of age or older with basic literacy in English and with internet access were included. RESULTS: There were 404 total respondents (M:F ratio: 0.87:1;mean age: 30.16±9.63 years). Among the respondents, 63.3 percent were HCWs while 35.6 percent were nonHCWs. Persons performing hand hygiene more than10 times/ day were found to be almost three times more likely to develop skin dryness (odds ratio [OR]: 2.95, 95% confidence interval [CI]: 1.372, 6.362). Female participants were found to be 2.5 times more likely to develop dryness (odds ratio: 2.594, 95% CI: 1.590, 4.234). Use of gloves was found to be a protective factor against development of dryness (odds ratio: 0.485,95% CI: 0.287, 0.818). A statistically significant correlation was found between mask acne and female respondents (p-value=0.000), HCWs (p-value=0.000), and use of N95 mask in combination with surgical mask (p-value=0.04). LIMITATIONS: Being an online survey, responses could not be captured from people with limited internet access and of lower socioeconomic strata. CONCLUSION: There is a considerable burden of preventive measures on HCWs and nonHCWs alike. Significant dermatological implications are seen with frequent hand hygiene and mask usage.
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Background: ASIA syndrome is an entity that incorporates diverse autoimmune conditions after exposure to various adjuvants in vaccines. There is limited literature available regarding development of thyroid disorders after covid 19 vaccination. Aims and Objectives: Retrospective case series of patients diagnosed with thyroid disease within 2 months of covid-19 vaccination. History, examination, relationship with covid infection and vaccination, onset of symptoms, thyroid function tests, TRAb, Anti-TPO, ESR, CRP, Tc99-thyroid scan were recorded for each of the patient. Results: We observed 9 subjects (females 5, males 4;age range 22-63 yrs) with thyrotoxicosis. The onset of symptoms after vaccination ranged from 2 days to 60 days. Six subjects had Graves' disease (GD) while 3 had subacute thyroiditis (SAT). Two subjects had acute onset of thyroid associated opthalmopathy;one patient needed glucocorticoids (GC). All subjects with GD were treated with antithyroid drugs while subjects with SAT were treated with NSAIDS;none required GC. Conclusions: SAT and GD may develop as a manifestation of ASIA syndrome after covid 19 vaccine. Long-term multicentric observational studies are needed to establish the natural history of ASIA syndrome following covid vaccination.
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This study aims to assess the continuity of medical care, the impact on disease condition and to highlight the major challenges faced by people affected by leprosy during the pandemic. Telephonic questionnaire-based survey was conducted among previously registered patients of leprosy at referral hospitals in India. Leprosy affected people aged >18 years, either on treatment or who had completed treatment with access to phone and willingness to participate were included. The questions were asked pertaining to demographic details, baseline disease characteristics and various problems faced during lockdown relating to livelihood, finances, treatment, and mental status. A total of 196 patients consented to participate in the study. Mean age of study participants was 37.31 (13.86) years, male participants (n=123, 62.7%) were more than females (n=73, 37.2%). Overall, 101 patients (51.5%) experienced exacerbation, 21 patients (10.7%) reported improvement and 74 patients (37.8%) reported no change in disease status during the pandemic. Most common difficulty faced was the procurement of medicines (115 patients, 58.6%) followed by difficulty in diagnostic testing (61 patients, 31.1%). Course of treatment was interrupted in 16 patients. Most of the patients (n=147, 75%), agreed that teleconsultation services would aid in management of their disease. The majority of patients (88.2%) were able to continue some form of treatment. Two patients (1%) tested positive for COVID-19. Nearly all patients (n=189, 96.4%) were informed regarding the risks and preventive measures related to COVID-19. Fifty percent of the patients reported deterioration in mental health due to the pandemic. The present study highlights the gaps in healthcare delivery and social inequalities along with their impact on the health, livelihood and mental status of people affected by leprosy during the current COVID-19 pandemic.
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Introduction: During global Covid-19 pandemic, India fought against the situation by implementing strict lockdown in whole country starting from 25th March 2020. Looking at severity of situation government decided to extend it in 4 phases till 31st May, 2020 which has been applied strictly in all district belonging to "Red Zone". Agra is the worst hit district in Uttar-Pradesh and it remained in the condition of strict Lockdown. Materials and Methods: Record-based comparative cross-sectional study looking for the impact of lockdown on change in pattern and number of medico-legal cases in Agra was done. Data related to name, age, sex, place of residence, type of medico-legal case was collected from records of medicolegal cases admitted in Emergency department of S.N. Medical College, Agra for the period of 25th March to 31 May 2020 (lockdown period) and compared it with data collected from 25th March to 31st May 2019 i.e. data of same corresponding period in last year. Results: On comparison we found out that during lockdown there was a decrease in no. of total admissions by 37.7%, while no. of medico legal cases is decreased by 54.2%. On further analysis of the data maximum decrease is seen in cases of road traffic accident, burns and firearm injuries while there was an increase in number of MLC cases of hanging. On gender wise comparison it was found that during lockdown period male MLC patients are decreased by 62.9% while female MLC patients decreased by 23.5%, which is lesser than decrease in total no. of admission. Interestingly we found out that there is increase in no. of MLC cases of female poisoning and hanging also increased significantly which might be due to increased domestic unrest or financial crisis emerged due to lockdown. Although on comparison of age groups no significant difference is seen during lockdown period. On area-wise comparison there was a decrease from 33% to 18% in total no. of MLC cases coming from districts other than Agra. This may be due to affected referral service or restrictions in inter-district transport. Conclusions: There is overall decrease in medico-legal cases with increased cases of hanging. Cases of female poisoning is also increased probably due to undue raised burden caused due to lockdown. © 2021, Punjab Academy of Forensic Medicine and Toxicology. All rights reserved.
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Background: Tuberculosis (TB) is a communicable disease that is a major cause of illness and one of the leading causes of death. Until the COVID-19 pandemic, TB was the leading cause of death from a single infectious agent, ranking above HIV. Multi drug-resistant TB remains a public health crisis. In this situation, an attempt of using the shorter course Regimen to face the MDR-TB crisis as an alternate method proves to be promising. Therapy of MDR-TB using shorter course regimen is crucial and essential to explore, as it has the potential to increase the success of MDR-TB treatment. Methods: The proposed study was a hospital based, nonrandomized and without control group observational and prospective study, in cohort of 180 DRTB patients conducted at Nodal DRTB Centre, SNMC AGRA. Results: Among 180 patients 54% were male and 46% female. Maximum number of patients 39% in 21-30 years of age group.48% patients were known to their contacts.54% patients developed resistance due to failure of previous regimen.126 patients were reported with adverse effects. Cough was the most common clinical feature.46 completed the treatment.39% patients were declared cured. Conclusion: 70% of the patients faced adverse events during the course. 1.6% patients required change in regimen.61% completed the treatment and 39% were declared cured.