Proposed Convolution Architecture for Monkeypox Detection using Dermoscopy Images

Monkeypox is a skin disease that spreadsfrom animals to people and then people to people, the class of the monkeypox is zoonotic and its genus are othopoxvirus. There is no special treatment for monkeypox but the monkeypox and smallpox symptoms are almost similar, so the antiviral drug developed for prevent from smallpox virus may be used for monkeypox Infected person, the Prevention of monkeypox is just like COVID-19 proper hand wash, Smallpox vaccine, keep away from infected person, used PPE kits. In this paper Deep learning is use for detection of monkeypox with the help of CNN model, The Original Images contains a total number of 228 images, 102 belongs to the Monkeypox class and the remaining 126 represents the normal. But in deep learning greater amount of data required, data augmentation is also applied on it after this the total number of images are 3192. A variety of optimizers have been used to find out the best result in this paper, a comparison is usedbased on Loss, Accuracy, AUC, F1 score, Validation loss, Validation accuracy, validation AUC, Validation F1 score of each optimizer. after comparing alloptimizer, the Adam optimizer gives the best result its total testing accuracy is 92.21%, total number of epochs used for testing is 100. With the help of deep learning model Doctors are easily detect the monkeypox virus with the single image of infected person. © 2023 IEEE.

Intravenous BCAA infusion does not lead to a sustained recovery from overt HE in ACLF – An open label randomized clinical trial

Background –Hepatic encephalopathy(HE) in acute-on-chronic liver failure(ACLF) is associated with significant morbidity and mortality. We conducted a prospective, randomized controlled clinical trial to study efficacy of intravenous branched chain amino acids(IV-BCAA) with lactulose versus lactulose alone for improvement in HE at 24h, day 3 & day 7. Primary outcome was improvement in encephalopathy by ≥ 1 grade at 72 hours. Patients and Methods –EASL defined ACLF patients with overt HE were assessed and randomized into experimental arm (IV-BCAA - 500mL/day for 3 days + Lactulose;n=39) and comparator arm (Lactulose alone;n=37). Six patients developed COVID-19 after randomization & were excluded (4-experimental arm & 2-comparator arm). Results –Of 222 screened patients, 70 (35 in each arm) were included in analysis. Baseline characteristics including HE grade (2.9 ± 0.7 vs 2.8 ± 0.7;P = 0.86) and CLIF-C ACLF score (54.2 ± 5.6 vs 54.8 ± 5.7;P = 0.65) were similar. Overall survival was 40% at 28 days (48.5% vs 31.4%;P=0.14). Improvement in HESA by ≥1 grade at 24h occurred in 14 patients (40%) in BCAA arm and 6 patients (17.1%) in control group (P=0.03) which translated to shorter ICU stay. Median change in HESA at 24h was more in BCAA arm than control arm(P=0.006) which was not sustained at day 3 or 7. Ammonia levels did not correlate with grade of HE (Spearman's correlation coefficient(ρ) = - 0.0843;P=0.29). Conclusion Intravenous BCAA does not lead to a sustained improvement in HE grade in ACLF. Trial registration no NCT04238416 (clinicaltrials.gov)

Learning Behavior and Perspective of Medical Students in India on COVID-19 Pandemic

Introduction: Medical colleges in India are opening gradually for resumption of medical education. Assessment of learning behavior and perspectives of students toward COVID-19 pandemic is essential for effective medical education as well as to assess their role in pandemic if need arises. Hence, the present study aims to assess learning behavior and perspective of medical students on COVID-19 pandemic. Materials and Methods: A descriptive cross-sectional study was conducted from September to December 2020 among 392 medical students at various medical colleges of the country. An online self-administered questionnaire was designed to assess learning behavior of medical students about infection prevention and control practices in COVID-19 adopted during the course of pandemic. Snowball sampling method was used for data collection. Results: On assessment of 392 medical students about preventive measures during COVID-19 pandemic, more than 80% of medical students were aware of the importance of facemask, social distancing, frequent hand washing, and use of digital tools such as Aarogya Setu app in surveillance. Majority of students were aware of the symptoms, testing, and treatment protocols along with importance of self-reporting. Most of the students were aware of various sources of getting scientific and relevant information about pandemic. While majority of students were aware of rationale of quarantine, appropriate waste management technique, and post-COVID precautions, there was a lack of knowledge about appropriate disinfection measures. Conclusions: Medical students are an asset to health care;learning behaviors adopted by them can certainly help to assist health-care system in COVID times.

Early living donor liver transplantation for alcohol-associated hepatitis.

INTRODUCTION AND OBJECTIVES: Lately, there has been a steady increase in early liver transplantation for alcohol-associated hepatitis (AAH). Although several studies have reported favorable outcomes with cadaveric early liver transplantation, the experiences with early living donor liver transplantation (eLDLT) are limited. The primary objective was to assess one-year survival in patients with AAH who underwent eLDLT. The secondary objectives were to describe the donor characteristics, assess the complications following eLDLT, and the rate of alcohol relapse. MATERIALS AND METHODS: This single-center retrospective study was conducted at AIG Hospitals, Hyderabad, India, between April 1, 2020, and December 31, 2021. RESULTS: Twenty-five patients underwent eLDLT. The mean time from abstinence to eLDLT was 92.4 ± 42.94 days. The mean model for end-stage liver disease and discriminant function score at eLDLT were 28.16 ± 2.89 and 104 ± 34.56, respectively. The mean graft-to-recipient weight ratio was 0.85 ± 0.12. Survival was 72% (95%CI, 50.61-88) after a median follow-up of 551 (23-932) days post-LT. Of the 18 women donors,11 were the wives of the recipient. Six of the nine infected recipients died: three of fungal sepsis, two of bacterial sepsis, and one of COVID-19. One patient developed hepatic artery thrombosis and died of early graft dysfunction. Twenty percent had alcohol relapse. CONCLUSIONS: eLDLT is a reasonable treatment option for patients with AAH, with a survival of 72% in our experience. Infections early on post-LT accounted for mortality, and thus a high index of suspicion of infections and vigorous surveillance, in a condition prone to infections, are needed to improve outcomes.

Primary Norfloxacin Prophylaxis for APASL-Defined Acute-on-Chronic Liver Failure: A Placebo-Controlled Double-Blind Randomized Trial.

INTRODUCTION: This study aimed to evaluate the role of prophylactic norfloxacin in preventing bacterial infections and its effect on transplant-free survival (TFS) in patients with acute-on-chronic liver failure (ACLF) identified by the Asian Pacific Association for the Study of the Liver criteria. METHODS: Patients with ACLF included in the study were randomly assigned to receive oral norfloxacin 400 mg or matched placebo once daily for 30 days. The incidence of bacterial infections at days 30 and 90 was the primary outcome, whereas TFS at days 30 and 90 was the secondary outcome. RESULTS: A total of 143 patients were included (72 in the norfloxacin and 71 in the placebo groups). Baseline demographics, biochemical variables, and severity scores were similar between the 2 groups. On Kaplan-Meier analysis, the incidence of bacterial infections at day 30 was 18.1% (95% confidence interval [CI], 10-28.9) and 33.8% (95% CI, 23-46) (P = 0.03); and the incidence of bacterial infections at day 90 was 46% (95% CI, 34-58) and 62% (95% CI, 49.67-73.23) in the norfloxacin and placebo groups, respectively (P = 0.02). On Kaplan-Meier analysis, TFS at day 30 was 77.8% (95% CI, 66.43-86.73) and 64.8% (95% CI, 52.54-75.75) in the norfloxacin and placebo groups, respectively (P = 0.084). Similarly, TFS at day 90 was 58.3% (95% CI, 46.11-69.84) and 43.7% (95% CI, 31.91-55.95), respectively (P = 0.058). Thirty percent of infections were caused by multidrug-resistant organisms. More patients developed concomitant candiduria in the norfloxacin group (25%) than in the placebo group (2.63%). DISCUSSION: Primary norfloxacin prophylaxis effectively prevents bacterial infections in patients with ACLF.

Impact of quarantine on lifestyle and psychological state of people during the COVID-19 pandemic

Objectives: The objective of the study was to assess impact of quarantine on lifestyle behavior and the psychological state of persons during the COVID-19 pandemic. Study Design: This study was a cross-sectional study. Methods: A questionnaire-based cross-sectional study was conducted among 216 persons quarantined during the COVID-19 pandemic at home or in selected facilities set up by various tertiary care hospitals and administrative authorities in various parts of India. The questionnaire was distributed among participants using electronic media. Psychological state during quarantine was assessed using the DASS 21 questionnaire. Results: Out of 57.4% of responders who gave a history of physical exercise before quarantine, 52.7% reported a reduction in physical activity. 18.5% of study participants brought about dietary changes towards healthy diet during quarantine, while 24.5% took up some new activities or hobbies. 62.9% of respondents reported any degree of psychological stress (depression, stress, or anxiety) during the quarantine. Conclusions: Quarantine impacted psychological state of individuals and brought about changes in lifestyle with both positive attributes such as dietary modification toward healthy diet or negative attributes such as reduction in physical activity. IEC activities have a positive impact in terms of reducing negative attributes and increasing the compliance toward quarantine. © 2022 Medical Journal of Dr. D.Y. Patil Vidyapeeth ;Published by Wolters Kluwer - Medknow.

In-Silico Screening of Plant-Derived Natural Compounds for Their Anti- Covid-19 Potential

The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in Wuhan, China, in December 2019 and quickly spread across the worldwide. It becomes a global pandemic and risk to the healthcare system of almost every nation around the world. In this study thirty natural compounds of 19 Indian herbal plants were used to analyze their binding with eight proteins associated with CO VID-19. Based on the molecular docking as well as ADMET analysis, isovitexin, glycyrrhizin, sitosterol, and piperine were identified as potential herbal medicine candidates. On comparing the binding affinity with Ivermectin, we have found that the inhibition potentials of the Trigonella foenum-graecum (fenugreek), Glycyrrhiza glabra (licorice), Tinospora cordifolia (giloy) and Piper nigrum (black pepper) are very promising with no side-effects.

Poor immune response to coronavirus disease vaccines in decompensated cirrhosis patients and liver transplant recipients.

BACKGROUND AND AIMS: Recent studies have reported poor humoral immune response to mRNA vaccines in patients with chronic liver disease (CLD). However, the immunogenicity of ChAdOx1 (vector-based) and BBV152 (inactivated virus) vaccines in patients with CLD and liver transplant recipients (LTRs) is unknown. Therefore, we aimed to assess the immunogenicity of ChAdOx1 and BBV152 vaccines in patients with CLD (including cirrhosis patients) and LTRs. METHODS: In this single-center prospective study, consecutive completely vaccinated (ChAdOx1 or BBV152) non-cirrhosis CLD patients, those with cirrhosis, and LTRs were compared with matched healthy controls for anti-spike antibody and cellular response. RESULTS: Sixty healthy individuals, 50 NCCLD patients, 63 compensated and 50 decompensated cirrhosis, and 17 LTRs were included. The proportion of non-responders was similar among the healthy control (8 %), non-cirrhosis CLD (16 %), and compensated cirrhosis groups (17.5 %;p = 0.3). However, a higher proportion of patients with decompensated cirrhosis (34 %) and LTRs (59 %) were non-responders than the healthy controls (p = 0.001). Cluster of differentiation (CD) 4-effector cells were lower in patients with non-cirrhosis CLD and compensated cirrhosis. CD4-naïve, CD4-effector, B, and B-memory cells were lower in the decompensated cirrhosis group. Although the central memory cells were higher in the decompensated cirrhosis group, they could not differentiate into effector cells. CD4- and CD8-naïve cells were higher in the marrow in the LTRs, while the CD4-effector memory cells and CD4- and CD8-effector cells were lower in the LTRs. Furthermore, B cells were more deficient in the LTRs, suggesting poor antibody response. CONCLUSION: Patients with decompensated cirrhosis and LTRs demonstrated suboptimal humoral and cellular immune responses against recombinant and inactivated COVID-19 vaccines.

Low-intensity Aerobic Exercises during COVID-19 Pandemic in Children with Duchenne Muscular Dystrophy: A Home based Study

Duchenne muscular dystrophy (DMD) is a rare genetic disorder that affects about 0.8 million Indian children. The incidence rate of 1:3500 male births is the most common form of all muscular dystrophies. Covid-19 pandemic cause profound devastation to the lives of DMD children. The muscles are weaker in DMD, and the children are more prone to lung infections. Coronavirus (COVID-19) is a severe lung infection that disturbs the entire function of the World. DMD already has weakness in major muscles, including the respiratory. So, the study aims to identity the effect of low-intensity aerobic exercises in children with DMD. This is a home-based pilot study with 11 DMD children and wheelchair dependent since, for ten years, they have been on continuous rehabilitation and monitoring. When the pandemic was declared in India in March 2020, all children were given clear notes on the disease and its severity to the parents. Self-created quarantine exercise protocol, which includes Limb exercises, breathing exercises, trunk mobility exercises, and positioning, was taught along with a logbook given to all the children. Video calls, and WhatsApp videos, were used to monitor them regularly. The physiotherapist made a personal visit in June 2020 to review the exercises, and subsequently on Aug 20, Oct 20, Dec 20, Feb 21, and May 21. Observations are detailed here. The infection rate was 3 out of 9, and they got admitted to the hospital for other illnesses. All the children noted Flu infection but recovered within ten days without hospitalization. The parents monitored their SPo2 and temperature and updated them in the logbook. A lung function test was done using a handheld incentive spirometer during the personnel visit by the therapist and found satisfactory. The study concluded a significant improvement in the DMD children following low-intensity and quarantine exercises.

COVID-19 and environment: An ecological study of four metropolitan cities

Aim: The aim of the study was to correlate environmental changes with coronavirus disease 2019 (COVID-19) cases in four metropolitan cities. Methodology: Data on monthly cumulative new cases, monthly average temperatures, humidity, precipitation, and average monthly air quality index (AQI) levels for the four Indian cities - Chennai, New Delhi, Mumbai, and Kolkata, and biomedical waste (BMW) quantity at national level were ed for the period from March 2020 to December 2020. Results: An inverse correlation was observed between temperature and transmission of the disease in New Delhi and Kolkata which was of fair degree for New Delhi (r = 0.299, P = 0.402) and poor for Kolkata (r = 0.200, P value = 0.579). Positive correlation of fair and poor degrees was observed between temperature and transmission of the disease in Mumbai (r = 0.272, P = 0.448) and Chennai (r = 0.196, P = 0.588), respectively. A positive correlation was observed between the transmission of the disease and humidity in New Delhi, Mumbai, and Kolkata, which was of moderate-to-good degree for Mumbai (r = 0.729, P = 0.017) and poor for New Delhi (r = 0.242, P = 0.501) and Kolkata (r = 0.123, P = 0.735). A significant positive correlation was observed between the rise in COVID-19 cases and the quantity of BMW generated (r = 0.88, P = 0.009). Furthermore, significant improvement in air quality AQI in four metros and water quality biological oxygen demand/chemical oxygen demand of Yamuna river was observed. Conclusions: Understanding of the interplay of environmental meteorological factors on COVID-19 disease transmission and vice versa is necessary for better informed policy framing and future research. © Medical Journal of Dr. D.Y. Patil Vidyapeeth 2022.

Tinospora cordifolia induced liver injury during covid-19 pandemic

IDDF2022-ABS-0185 Table 1Clinical characteristics of patients with Giloy-induced liver injuryCharacteristics Number of patients (Total-16 patients) Gender Male 7 (43.75%) Female 9 (56.25%) Age (mean ± SD) 48.3±14 years Presentation type Acute hepatitis 6 (37.5%) ACLF 10 (62.5%) Mean duration for symptom onset after consumption of giloy 84.3±35 days Mean BMI 23.23±3 kg/m2 Comorbidities Type 2 diabetes 9 (56.25%) Interstitial lung disease (on inhalational steroids) 2 (12.5%) Hypertension 1 (6.25%) None 5 (31.25%) NAFLD 2 (6.25%) Symptoms Jaundice 16 (100%) Ascites 8 (50%) Fatigue 12 (75%) Pruritus 4 (25%) Liver function tests Peak total bilirubin (Mean ± SD) 17 ± 9.4 mg/dl Peak ALT (mean ± SD) 365± 219 U/L Peak AST (mean ± SD) 558 ± 475 U/L Peak ALP (mean ± SD) 186 ± 114 U/L Peak serum IgG (mean ± SD) 2400 ± 1213 mg/dl Peak INR (mean ± SD) 2.63 ± 1.05 AIH serology ANA 1(6.25%) ASMA - Anti LKM1 - AMA - Seronegative (biopsy proven) - Liver biopsy 10 (62.5) Drug induced liver injury 5 (31.25%) Features of AIH 5 (31.25%) Treatment N-Acetyl Cysteine infusion+Ademetionine 3 (18.75%) Steroids 10 (62.5%) Plasma Exchange 3 (18.75%) Outcome Alive 16 (100%) One listed for liver transplant Mean duration for recovery 37 ± 16 days IDDF2022-ABS-0185 Figure 1ConclusionsGiloy, a commonly used immunity booster, can produce drug-induced liver injury, which often mimics autoimmune hepatitis and responds to steroids.

Perceived Stress and Quality of Sleep among Health-Care Staff Working in a Dedicated COVID Hospital

Introduction: Right from the onset of the COVID-19 pandemic, health-care workers (HCWs) have been at the forefront in combating this deadly disease. The sudden emergence of COVID-19 and its continued persistence, has led to an unprecedented psychological stress among HCWs. To assess the level of stress and its effects on sleep quality of HCWs caring for COVID-19 patients, the present study was conducted among staff working in a dedicated COVID hospital. Methodology: The cross-sectional study was conducted among HCWs at a dedicated COVID hospital in northern India from September to October 20. To assess the levels of stress and quality of sleep, the participants were administered the Perceived Stress Scale and Pittsburgh Sleep Quality Index (PSQI). Results: One hundred and forty-two HCWs out of 162 responded completely. The mean age of the participants was 31.6 +/- 6 years. Ninety-one (64.1%) were doctors and the rest 51 (35.1%) were paramedical staff. The mean PSQI global score was 6.9 +/- 3.19. More than 50% of participants across all age categories reported moderate-to-high stress and poor sleep quality. Conclusion: This study shows that a high proportion of HCWs working in dedicated COVID hospitals suffer from stress and its varied deleterious effect, especially on sleep. Therefore, it is prudent for all stakeholders and decision-makers to take adequate steps for provision of psychological support for stress mitigation and implement measures for prevention and early identification of stress-related symptoms among HCWs working in COVID hospitals.

Post-Covid-19 Rhino-Cerebral Mucormycosis: an Observational Study During the Second Wave

Mucormycosis is one of the most lethal and rapidly spreading fungal infection which is caused by fungus of the order Mucorales. The swiftness of spreading and high mortality rate that characterize mucormycosis cases added more burden to the enormous challenge brought by the Covid-19 pandemic globally. The aim of this article is to identify and discuss mucormycosis and review the literature related to its diagnosis and management. A total of 15 mucormycosis cases with a history of Covid-19 infection were identified in the Department of Dentistry of Shri B M Patil Medical College Hospital and Research Centre BLDE (Deemed to be University), Vijayapura, India. The duration of the study was between April 1st and mid-September 2021. Nasal swab and tissue samples from oral and maxillofacial region were collected. Blood investigations, RT-PCR and HbA1c tests and radiography revealed changes in the trabecular pattern and bone loss associated with periodontal inflammation. Mucormycosis is a life-threatening infection. Hence, dental and other clinical professionals must be aware of this possible fatal complication, so as to avoid an unfavorable outcome in clinical practice.

Post-COVID-19 Cholestasis: A Case Series and Review of Literature.

Background: Coronavirus disease-2019 (COVID-19) cholangiopathy is a recently known entity. There are very few reports of liver transplantation (LT) for COVID-19-induced cholangiopathy. It is well known that vaccines can prevent severe disease and improve outcomes. However, there are no reports on the impact of COVID-19 vaccines on cholestasis. Therefore, we aimed to compare the course and outcome of patients who developed cholestasis following COVID-19 infection among vaccinated and unvaccinated individuals. Methods: Patients diagnosed with post-COVID cholestasis during the pandemic were included in the study after excluding other causes of cholestasis. Results: Eight unvaccinated and seven vaccinated individuals developed cholestasis following COVID-19 infection. Baseline demographics, presentation, severity, and management of COVID-19 were similar in both groups. However, patients in the unvaccinated group had a protracted course. The peak ALP was 312 (239-517) U/L in the vaccinated group and 571.5 (368-1058) U/L in the unvaccinated group (P = 0.02). Similarly, the peak γ-glutamyl transpeptidase values were lower in the vaccinated (325 [237-600] U/L) than in the unvaccinated group (832 [491-1640] U/L; P = 0.004). However, the peak values of total bilirubin, transaminases, and INR were similar in both groups. Five patients developed ascites gradually in the unvaccinated group whereas none in the vaccinated group developed ascites. Plasma exchange was done in five patients, and two were successfully bridged to living donor LT in the unvaccinated group. Only two patients recovered with conservative management in the unvaccinated group, whereas all recovered with conservative management in the vaccinated group. The other four patients in the unvaccinated group were planned for LT. Conclusion: Post-COVID-19 cholestasis is associated with high morbidity and mortality, meriting early identification and appropriate management. Vaccination can modify the course of severe COVID-19 infection and improve outcomes.

Early Diagnosis and Prevention of Infections in Cirrhosis.

Strategies to prevent infection and improve outcomes in patients with cirrhosis. HAV, hepatitis A virus; HBV, hepatitis B virus; COVID-19, novel coronavirus disease 2019; NSBB, nonselective ß-blocker; PPI, proton pump inhibitors.Cirrhosis is a risk factor for infections. Majority of hospital admissions in patients with cirrhosis are due to infections. Sepsis is an immunological response to an infectious process that leads to end-organ dysfunction and death. Preventing infections may avoid the downstream complications, and early diagnosis of infections may improve the outcomes. In this review, we discuss the pathogenesis, diagnosis, and biomarkers of infection; the incremental preventive strategies for infections and sepsi; and the consequent organ failures in cirrhosis. Strategies for primary prevention include reducing gut translocation by selective intestinal decontamination, avoiding unnecessary proton pump inhibitors' use, appropriate use of ß-blockers, and vaccinations for viral diseases including novel coronavirus disease 2019. Secondary prevention includes early diagnosis and a timely and judicious use of antibiotics to prevent organ dysfunction. Organ failure support constitutes tertiary intervention in cirrhosis. In conclusion, infections in cirrhosis are potentially preventable with appropriate care strategies to then enable improved outcomes.

Knowledge, Awareness And Practice Of Dental Practitioners Regarding COVID-19 Pandemic- A Cross-Sectional Study

Background: The present study was conducted to assess knowledge, awareness and practice of dental practitioners regarding COVID-19 pandemic. Materials & Methods: 240 dental practitioners of both genders were provided with a questionnaire regarding knowledge and practice regarding COVID-19 pandemic. Results: 80% showed that SARS-CoV-2 is the cause of COVID- 19. 85% replied that 2-14 days is the incubation period of Covid- 19, 75% correctly replied that 6.8 % is the incubation period for COVID- 19 and 82% replied that rRT-PCR is the laboratory test available for detection of COVID- 19. 80% replied yes in order to provide treatment to infected patients and 10% replied no. In response to question whether masks, head cap and sanitizer protect against virus, 74% replied yes, 18% replied no and 8% replied don’t know. The difference was significant (P< 0.05). Conclusion: Dental practitioners had sufficient knowledge, awareness and practice regarding COVID-19 pandemic.