Comparison of a portable, pneumotach flow-sensor-based spirometer (Spirofy™) with the vitalograph alpha Touch™ spirometer in evaluating lung function in healthy individuals, asthmatics, and COPD patients-a randomized, crossover study.

BACKGROUND: Spirofy™ is India's first portable, pneumotach flow-sensor-based digital spirometer developed to diagnose asthma and chronic obstructive pulmonary disease (COPD). In this study, we compared the performance of the Spirofy™ device with that of the Vitalograph Alpha Touch™ spirometer in measuring the lung capacities of healthy individuals, asthmatics, and COPD patients. We also assessed the inter-device variability between two Spirofy™ devices. METHODS: In a randomized, three-way crossover, open-label study, we measured the differences in forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) between the Spirofy™ and Vitalograph Alpha Touch™ spirometers. A proportion of the FEV1/FVC ratio distribution of < 0.7 was used to compare the diagnostic accuracies of the Spirofy™ with Vitalograph™ Alpha Touch™ spirometers. RESULTS: Ninety subjects participated in this study. The mean ± SD FVC values obtained from the Spirofy™ 1, Spirofy™ 2, and Vitalograph Alpha Touch™ devices were 2.60 ± 1.05 L, 2.64 ± 1.04 L, and 2.67 ± 1.04 L, respectively. The mean ± SD FEV1 values obtained from the Spirofy™ 1, Spirofy™ 2, and Vitalograph Alpha Touch™ devices were 1.87 ± 0.92 (L), 1.88 ± 0.92 (L), and 1.93 ± 0.93 (L), respectively. A significant positive correlation was found between the FVC and FEV1 values recorded by Vitalograph Alpha Touch™, Spirofy™ 1, and Spirofy™ 2. As compared to Vitalograph Alpha Touch™, the Spirofy™ device showed good sensitivity (97%), specificity (90%), and overall accuracy (93.3%) at an FEV1/FVC ratio < 0.7. No inter-device variability was observed between the two Spirofy™ devices. CONCLUSION: Spirofy™ is a portable and easy-to-use device and is as accurate as the standard Vitalograph Alpha Touch™ spirometer for the diagnosis of COPD and asthma. TRIAL REGISTRATION: CTRI/2021/09/036492 (Clinical Trials Registry - India).

Neural Network Clustering and Swarm Intelligence-Based Routing Protocol for Wireless Sensor Networks: A Machine Learning Perspective.

With no requirement for an established network infrastructure, wireless sensor networks (WSNs) are well suited for applications that call for quick network deployment. Military training and emergency rescue operations are two prominent uses of WSNs. The individual network nodes must carry out routing and intrusion detection because there is no predetermined routing or intrusion detection in a wireless network. WSNs can only manage a certain volume of data, and doing so requires a significant amount of energy to process, transmit, and receive. Since sensors have a modest energy source and a constrained bandwidth, they cannot transmit all of their data to a base station for processing and analysis. Therefore, machine learning (ML) techniques are needed for WSNs to facilitate data transmission. Other current solutions have drawbacks as well, such as being less reliable, more susceptible to environmental changes, converging more slowly, and having shorter network lifetimes. This study addressed problems with wireless sensor networks and devised an efficient clustering and routing algorithm based on machine learning. Results from simulations demonstrate that the proposed system beats previous state-of-the-art models on a variety of metrics, including accuracy, specificity, and sensitivity (0.93, 0.93, and 0.92 respectively).

The use of high pressure processing to compensate for the effects of salt reduction in ready-to-eat meat products.

Sodium chloride is an essential ingredient in meat products, where it is not only used as a flavoring agent but also to achieve desired textural properties and as an antimicrobial to improve its safety and extend shelf-life. Although NaCl plays this multi-functional role in meat products, excessive sodium intake is linked to various negative health consequences such as cardiovascular disease and obesity. Sodium chloride added to ready-to-eat meat products is the largest contributor of sodium. Thus, there is an increased interest in the development of meat products with reduced sodium levels. Strategies to reduce sodium include identification of alternatives to sodium, considering safety and functionality, and including technological innovations and alternative food processing strategies. Several studies have shown that high pressure processing (HPP) can partially compensate for the loss in functional and sensory properties of meat products as a result of NaCl reduction. This review summarizes these studies to date and will highlight the ability of HPP to enhance the safety, shelf-life and quality of sodium-reduced meat products.

Influence of Different Stainless Steel Finishes on Biofilm Formation by Listeria monocytogenes.

ABSTRACT: Biofilm formation of Listeria monocytogenes on stainless steel, a widely used abiotic surface in the food processing industry, was investigated by focusing on the attachment tendency and behavior of L. monocytogenes 08-5578 on eight different stainless steel surfaces: glass bead blasted (rough and fine), deburred (Timesaver), drum deburred, pickled, pickled and drum polished, electrolytic polished, and cold rolled (untreated control). The aim was to see whether there are finishes with significantly lower bacterial attachment. Surface roughness data (measured via four roughness parameters), determined by interferometry, was also compared with the number of adhering cells to detect possible correlations. Cultivation of L. monocytogenes biofilms was carried out using a CDC biofilm reactor with 1% tryptic soy broth set at 20°C for 4, 8, and 24 h. In addition, a cultivation trial was run with continuous nutrient flow (1% tryptic soy broth, 6.2 mL/min) for 24 h. Eight-hour results showed a significant difference (P < 0.05) in biofilm cell counts in biofilms between the glass bead-blasted surfaces (3.23 and 3.26 log CFU/cm2 for the fine and rough, respectively) and deburred (Timesaver) surface (2.57 log CFU/cm2), between drum deburred and deburred (Timesaver) surface (3.41 versus 2.57 log CFU/cm2), and between drum deburred and pickled surface (3.41 versus 2.77 log CFU/cm2). Data gained after 4-h, 24-h, and 24-h plus an additional 24-h continuous flow cultivation showed no significant difference in attachment among surfaces. No correlation between roughness data and attachment was found after all four incubation times, suggesting that roughness values, at these ranges, are insufficient in determining the surfaces' affinity to bacteria. Overall, this study suggests that roughness values cannot be used to predict the degree of L. monocytogenes attachment to a specific stainless steel surface.

Deep learning based fusion model for COVID-19 diagnosis and classification using computed tomography images.

Recently, the COVID-19 pandemic becomes increased in a drastic way, with the availability of a limited quantity of rapid testing kits. Therefore, automated COVID-19 diagnosis models are essential to identify the existence of disease from radiological images. Earlier studies have focused on the development of Artificial Intelligence (AI) techniques using X-ray images on COVID-19 diagnosis. This paper aims to develop a Deep Learning Based MultiModal Fusion technique called DLMMF for COVID-19 diagnosis and classification from Computed Tomography (CT) images. The proposed DLMMF model operates on three main processes namely Weiner Filtering (WF) based pre-processing, feature extraction and classification. The proposed model incorporates the fusion of deep features using VGG16 and Inception v4 models. Finally, Gaussian Naïve Bayes (GNB) based classifier is applied for identifying and classifying the test CT images into distinct class labels. The experimental validation of the DLMMF model takes place using open-source COVID-CT dataset, which comprises a total of 760 CT images. The experimental outcome defined the superior performance with the maximum sensitivity of 96.53%, specificity of 95.81%, accuracy of 96.81% and F-score of 96.73%.

Outcomes of Uveitic Macular Edema in the First-line Antimetabolites as Steroid-Sparing Treatment Uveitis Trial.

PURPOSE: To evaluate the outcomes of uveitic macular edema at 6 and 12 months in patients treated with methotrexate or mycophenolate mofetil. DESIGN: Subanalysis of a block-randomized, observer-masked, multicenter clinical trial. PARTICIPANTS: Patients were enrolled in the First-line Antimetabolites as Steroid-sparing Treatment (FAST) Uveitis Trial between August 2013 and August 2017. METHODS: Patients were randomized to oral methotrexate 25 mg weekly or mycophenolate mofetil 1.5 g twice daily for 12 months, along with a corticosteroid taper. In addition to standardized clinical examination, all patients underwent spectral-domain OCT imaging at each visit. At the 6-month primary end point, patients who achieved treatment success continued the same treatment for a subsequent 6 months, and treatment failures switched to the other treatment group. MAIN OUTCOME MEASURES: Prespecified 6-month primary outcome and 12-month outcomes of central subfield thickness and visual acuity. RESULTS: Of 216 patients in the FAST Trial, 42 eyes (30 patients) in the methotrexate group and 55 eyes (41 patients) in the mycophenolate group had uveitic macular edema. Baseline median central subfield thickness was 359 µm and 342 µm in the methotrexate and mycophenolate groups, respectively. At 12 months, for those who stayed on the same treatment, macular thickness decreased from baseline by 30.5 µm (interquartile range [IQR], -132.3 to 4.0) and 54 µm (IQR, -95.5 to -4.5) in the methotrexate and mycophenolate groups, respectively (P = 0.73). In patients who switched treatment at 6 months, macular thickness decreased from baseline by 12.5 µm (IQR, -32.3 to -0.5) and 50 µm (IQR, -181.0 to -10.0) in the methotrexate and mycophenolate groups, respectively (P = 0.34). At 12 months, 7 of 19 eyes (37%) on methotrexate had resolution of macular edema compared with 15 of 25 eyes (60%) on mycophenolate (P = 0.10). For those who switched treatments, 8 of 17 eyes (47%) on methotrexate and 6 of 11 eyes (55%) on mycophenolate had resolution of macular edema (P = 0.92). CONCLUSIONS: Treatment with methotrexate or mycophenolate mofetil for uveitic macular edema results in similar improvements in macular thickness at 6 and 12 months. At 12 months, approximately half of eyes in each antimetabolite group still had persistent macular edema.

Impact of COVID-19 pandemic on uveitis patients receiving immunomodulatory and biological therapies (COPE STUDY).

PURPOSE: To evaluate the change in the ongoing immunomodulatory (IMT) and biological therapies among patients with non-infectious uveitis (NIU), and determine the number of uveitis relapses during the COVID-19 pandemic. METHODS: In this national multicentric prospective case series, data of subjects with NIU receiving corticosteroids, systemic IMT and/or biological agents were analysed. The data collection was performed from 1 March 2020 to 25 June 2020. Main outcome measures included change in the ongoing treatments with corticosteroids, IMT and biological agents, use of alternate therapies and rates of uveitis relapse. RESULTS: In this study, 176 patients (284 eyes) with NIU (mean age: 33±17.1 years; males: 68) were included. A total of 121 eyes (90 patients) were deemed to have active NIU. Of these, seven subjects (7.8%) did not receive intravenous methylprednisolone despite need felt by the treating uveitis experts. In addition, 35 subjects (57.4%) received a rapid tapering dosage of oral corticosteroids despite active disease. A total of 161 (91.5%) subjects were receiving systemic IMT and 25 (14.2%) were on biological therapies. Overall, IMT was altered in 29/161 (18.0%) subjects. Twenty-two eyes were treated with intravitreal therapies in the study period. Fifty-three eyes (32.5%, 29 subjects) developed relapse of NIU, of which 25 subjects (86.2%) were deemed to have reactivation related to altered systemic IMT. No patient developed COVID-19 during follow-up. CONCLUSIONS: During the ongoing COVID-19 pandemic, uveitis specialists may tend to reduce the ongoing systemic IMT, or prefer less aggressive treatment strategies for NIU. These subjects may be at high risk of relapse of uveitis.

Role of Post-Trial Visual Feedback on Unintentional Force Drift During Isometric Finger Force Production Tasks.

A reduction in fingertip forces during a visually occluded isometric task is called unintentional drift. In this study, unintentional drift was studied for two conditions, with and without "epilogue." We define epilogue as the posttrial visual feedback in which the outcome of the just-concluded trial is shown before the start of the next trial. For this study, 14 healthy participants were recruited and were instructed to produce fingertip forces to match a target line at 15% maximum voluntary contraction. The results showed a significant reduction in unintentional drift in the epilogue condition. This reduction is probably due to the difference in the shift in λ, the threshold of the tonic stretch reflex, the hypothetical control variable that the central controller can set.

Closed-bowel Loop Obstruction-An Unusual and Forgotten Complication of Feeding Jejunostomy: Case Report.

Feeding jejunostomy (FJ) is done as a part of significant upper gastrointestinal surgical procedures for patients who cannot tolerate enteral feeds. This procedure is related to different mechanical, infective, and metabolic inconveniences. However, closed-bowel loop obstruction following FJ is rare. We report an unusual complication of closed-bowel loop obstruction in the postoperative period of FJ done for a locally advanced carcinoma of gastroesophageal (GE) junction for enteral access in a 67-year-old male patient. This patient required an emergency laparotomy, to forestall exacerbating of abdomen distension which could have led to gastric ischemia and perforation following obstruction. A redo FJ was done, and the patient had an uneventful postoperative recovery. Therefore, surgeons should have high clinical suspicion for a rarer complication like a closed-loop obstruction in a patient with upper abdominal pain and distension without vomiting following FJ. How to cite this article: Balamurugan S, Aslam MM, Kadambari D, et al. Closed-bowel Loop Obstruction-An Unusual and Forgotten Complication of Feeding Jejunostomy: Case Report. Euroasian J Hepato-Gastroenterol 2022;12(2):92-94.

Effect of cranberry pomace on the physicochemical properties and inactivation of Salmonella during the manufacture of dry fermented sausages.

The effect of cranberry pomace (CP) incorporation on S. enterica serovars inactivation, starter culture population, and physicochemical properties of sausages during the manufacture of dry fermented sausages (DFS) was studied. Sausages containing a five-strain cocktail of S. enterica serovars at 7-log CFU/g, with different levels of CP (control, 0%; low, 0.55%; medium, 1.70%; high, 2.25% wt/wt), or liquid lactic acid (0.33% vol/wt, LA) were subjected to typical fermentation and drying conditions. A significant (P < 0.05) reduction in initial pH was observed in all CP treatments on day 0 as a result of CP native acidity. All treatments except low CP showed a significantly lower pH than the control throughout the study. Water activity (aw) was not significantly affected by CP level during fermentation. However, sausages containing medium and high CP levels showed a significantly lower final product aw than the control. DFS with CP exhibited a significantly (P < 0.05) faster and greater Salmonella inactivation during the first 5 days; reduction rate and level directly correlated to CP level. In the presence of medium and high levels of CP, Staphylococcus spp. growth was suppressed, while Lactobacillus spp. and Pediococcus spp. exhibited a stimulatory response. All treatments except low CP had no significant effect on product chemical composition, and Moisture Protein ratio (MPr). Low CP level yielded DFS with a slightly higher (P < 0.05) moisture content and MPr. Medium and high CP levels resulted in darker, duller and redder DFS with a softer texture. Findings suggest that low CP levels can be utilized by DFS manufacturers as a natural functional ingredient to further minimize the risk associated with Salmonella during DFS production without altering final product characteristics.

Synthesis, Different Characterizations and Pigment Application of Nanoceramic Zirconate Powder.

In this work, several attempts were made to prepare nanoceramic zirconate (Nd2Zr2O7) powder for pigment applications. The single pyrochlore phase, Nd2Zr2O7 was successfully synthesized with the aid of flux at relatively low temperature (1000 °C) upon milling the reaction mixture made from Nd2O3 and ZrO2 in a tungsten carbide vial. Several characterizations were done on the thermal analysis (TG/DTA), X-ray diffraction (XRD), High-resolution scanning electron microscope (HRSEM), energy dispersive X-ray (EDX) analysis, Fourier-transform infrared (FT-IR) analysis, and near-infrared (NIR spectroscopy). A single-phase nanocrystalline (˜28 nm) pyrochlore structure (Fd3m) was confirmed through XRD analysis. A highly uniform particle in the size of ˜110 nm was observed for the Nd2Zr2O7 phase in the microimages. The vibrational (FT-IR) peaks at 423 cm-1 and 510 cm-1 in FTIR spectroscopic study confirmed the formation of pyrochlore structure. Higher NIR reflectivity recorded for this material in the 750-2500 nm region shows its novel application in color cool pigments for energy-saving paints reminiscent of Bi2-xYxCe²O7, Bi²Ce2-xTbxO7, and Gd²Ti²O7.

Coronaviruses - Potential human threat from foodborne transmission?

The COVID-19 pandemic has worldwide impact in terms of number of illnesses, deaths and long-term sequelae. While the main route for the spread of the SARS-CoV-2 virus is person to person from respiratory droplets, survival of the virus in the air and its ability to infect subsequently have raised concerns. COVID-19 outbreaks in meat and other food processing plants raise concern for potential foodborne spread. We focus on the survival of the virus in the food subjected to various unit operations during processing, storage and distribution and the risk to consumers. While the risk of contamination of food products is possibly due to survival of the virus in the air in food processing operations if preventive measures are not followed, survival of the virus on fresh foods is dependent on the intrinsic and extrinsic properties of the specific foods and antimicrobial interventions used during production. Even if the virus remains infective on contaminated foods, maintenance of infectivity after ingestion of food and subsequent invasion of tissue has not been reported. An alternate route of infection from contaminated foods can be during handling of foods and subsequent spread of the virus to other surfaces such as face, nose, leading to infection. However, due to the extensive treatments foods receive during processing, often inhospitable environs of the food products and further food preparation prior to consumption significantly reduce the risk of transmission of the SARS-CoV-2 virus.

Xanthogranulomatous adrenalitis masquerading as a functioning adrenocortical malignancy: a case report.

INTRODUCTION: Xanthogranulomatous adrenalitis (XA) is a rare chronic inflammatory disease of the adrenal glands and resembles adrenal neoplasm in clinical and radiologic characteristics. There is no report on XA presenting as a functioning adrenal mass in the literature. We present a case of XA mimicking a functioning adrenocortical carcinoma. CASE REPORT: A 52-year-old man presented with right flank pain, fever, vomiting, and loss of appetite for 2 weeks. He had signs of dehydration and elevated blood glucose level. Ultrasonography revealed a right adrenal mass. Contrast-enhanced computed tomography showed lobulated and necrotic mass replacing the right suprarenal gland and encasing the right renal vein, adjacent inferior vena cava, psoas, and diaphragm. There was loss of fat planes with liver and upper pole of the right kidney. Biochemical evaluation indicated increased serum and urine cortisol levels. As a sequel to hypercortisolism-induced hyperglycemia, he developed spontaneous chest wall abscess and bilateral sudden vision loss due to vitreous hemorrhages. Pus and blood culture grew methicillin-sensitive Staphylococcus aureus. Adrenal suppressant ketoconazole was administered for better glycemic control. With a diagnosis of locally advanced adrenocortical malignancy, right radical adreno-nephrectomy was performed, and cut section revealed a pus collection of around 100 mL. Histopathology examination showed xanthogranulomatous inflammation involving adrenal gland, Gerota's fascia, psoas, and lymph nodes. Postoperatively, the patient recovered satisfactorily with favorable glycemic control. CONCLUSION: XA can mimic adrenal neoplasms both clinically and radiologically and is associated with staphylococcal infection. It warrants surgical excision and culture-based antibiotics and is mostly diagnosed on postoperative histopathology.

Interleukins and cytokine biomarkers in uveitis.

Interleukins and cytokines are involved in the pathogenesis of uveitis of heterogeneous origin. Understanding the basics of the ocular immune privilege is a fulcrum to discern their specific role in diverse uveitis to potentially translate as therapeutic targets. This review attempts to cover these elements in uveitis of infectious, noninfectious and masquerade origin. Insights of the molecular targets in novel therapy along with the vision of future research are intriguing.

Scleritis: Differentiating infectious from non-infectious entities.

Scleritis is a rare painful ocular disorder, associated with severe ocular pain and tissue destruction. Although a majority of these cases are immune mediated and at least half of these are associated with systemic immune-mediated diseases, a smaller minority are due to infections of the sclera. The two conditions closely mimic each other, and a thorough knowledge of the subtle differences is necessary in order to reach a timely diagnosis. Diagnostic delay can lead to a poor outcome both due to the destruction caused by the uncontrolled infection and also due to propagation of the infection with the use of corticosteroids which may have been started for presumed immune mediated scleritis. In this review, we present the clinical features, etiological agents, and the differentiating features between immune and infectious scleritis. We also present diagnostic and management guidelines for managing scleral infection.

Examination of the Use of Bacteriophage as an Additive and Determining Its Best Application Method to Control Listeria monocytogenes in a Cooked-Meat Model System.

The study examined the efficacy of using bacteriophage as an additive in a cooked-meat model system to control growth of contaminating Listeria monocytogenes during subsequent storage. Studies were designed where Listeria bacteriophage A511 and L. monocytogenes introduced inside or on the surface of the cooked-meat to simulate different bacteriophage application and pathogen contamination scenarios. These scenarios include: (1) A511 and L. monocytogenes in meat; (2) A511 in meat, L. monocytogenes on surface; (3) L. monocytogenes in meat, A511 on surface; and (4) L. monocytogenes followed by A511 on meat surface. Real world bacteriophage application and pathogen contamination levels of 109 PFU/g and 103-4 CFU/g, respectively, were used. These meats were then vacuum packaged and stored at 4°C and changes in A511 titers and L. monocytogenes numbers were enumerated during the 28-day storage. Under the conditions tested, application of A511 directly on top of L. monocytogenes contaminating the surface of the meat was the only scenario where L. monocytogenes numbers were reduced to below detection limits and remained significantly lower than the controls for up to 20 days. Although A511 titers remained stable when applied as an additive in meat, they were not successful in controlling growth of the contaminating L. monocytogenes (present inside or on surface of meat). Similarly, application of A511 on the surface of the meat could not control growth of L. monocytogenes present inside the meat. L. monocytogenes numbers increased from the initial 3-log CFU/g to 9-log CFU/g similar to the controls by the end of the 28-day storage. These results suggest that bacteriophages are effective in controlling growth of surface contaminating bacteria only when applied directly onto the surface of the contaminated food product, and are ineffective as a biocontrol agent when used as an additive.