Benchmarking performance of an automatic polysomnography scoring system in a population with suspected sleep disorders.

Aim: The current gold standard for measuring sleep disorders is polysomnography (PSG), which is manually scored by a sleep technologist. Scoring a PSG is time-consuming and tedious, with substantial inter-rater variability. A deep-learning-based sleep analysis software module can perform autoscoring of PSG. The primary objective of the study is to validate the accuracy and reliability of the autoscoring software. The secondary objective is to measure workflow improvements in terms of time and cost via a time motion study. Methodology: The performance of an automatic PSG scoring software was benchmarked against the performance of two independent sleep technologists on PSG data collected from patients with suspected sleep disorders. The technologists at the hospital clinic and a third-party scoring company scored the PSG records independently. The scores were then compared between the technologists and the automatic scoring system. An observational study was also performed where the time taken for sleep technologists at the hospital clinic to manually score PSGs was tracked, along with the time taken by the automatic scoring software to assess for potential time savings. Results: Pearson's correlation between the manually scored apnea-hypopnea index (AHI) and the automatically scored AHI was 0.962, demonstrating a near-perfect agreement. The autoscoring system demonstrated similar results in sleep staging. The agreement between automatic staging and manual scoring was higher in terms of accuracy and Cohen's kappa than the agreement between experts. The autoscoring system took an average of 42.7 s to score each record compared with 4,243 s for manual scoring. Following a manual review of the auto scores, an average time savings of 38.6 min per PSG was observed, amounting to 0.25 full-time equivalent (FTE) savings per year. Conclusion: The findings indicate a potential for a reduction in the burden of manual scoring of PSGs by sleep technologists and may be of operational significance for sleep laboratories in the healthcare setting.

Prevalence and Risk Factors of Asthma and Allergy-Related Diseases among Adolescents (PERFORMANCE) study: rationale and methods.

Despite a considerable number of international reports on allergic diseases among children, information about the prevalence and risk factors of asthma and allergy-related diseases among Indian adolescents is relatively sparse. The Prevalence and Risk Factors of Asthma and Allergy-Related Diseases among Adolescents (PERFORMANCE) study has been conceived to study the aetiology of asthma and allergic diseases including rhinoconjunctivitis, atopic eczema and food allergies among adolescents in West Bengal, India, using standardised methods and collaborations. The aims of the study are: 1) to estimate the prevalence and risk factors of asthma and allergic diseases among the adolescents residing in rural, suburban and urban areas of West Bengal; 2) to obtain information about the possible role of lifestyle factors (smoking, diet and physical activity) on the disease prevalence; and 3) to create a network for further investigation on social, environmental and genetic factors affecting the diseases. The PERFORMANCE study comprises two phases. The phase I study will investigate the prevalence and possible contributing factors of asthma and allergic diseases in a defined population. The phase II study will be performed as a follow-up of phase I to assess the incidence of asthma and allergic diseases.

A rare case of isolated testicular tuberculosis and review of literature.

Testicular tuberculosis (TB) is a rare form of genitourinary TB. It is usually presented as painful or painless testicular swelling with or without scrotal ulceration or discharging sinus. Infertility may occur. Epididymal involvement is usually seen in testicular TB. In most cases, genital TB is associated with TB involvement of kidneys or lower urinary tract. Ultrasound (USG) and USG-guided fine needle aspiration cytology of testicular swelling confirm the diagnosis. Anti-TB chemotherapy is the mainstay of treatment to ensure the complete resolution of the lesion. However, in very few cases, orchidectomy is required for both diagnosis and treatment. Here, we report a very rare case of left sided isolated testicular TB in a 20-year-old male who was completely cured with 6 months regimen of anti-TB chemotherapy.

Habitual physical activity score as a predictor of the 6-min walk test distance in healthy adults.

BACKGROUND: The 6-min walk test (6MWT) is a simple, inexpensive test of functional exercise capacity. The 6MWT distance (6MWD) in healthy adults varies geographically, emphasizing the need for population-specific reference equations. The purpose of the present study was to investigate the influences of the habitual physical activity (HPA) score and other anthropometric and demographic parameters on the variability of the 6MWD among healthy adults and to propose a reference equation. METHODS: This was a prospective, cross-sectional, observational study. The 6MWT was conducted in a 30-m hospital corridor on 201 healthy volunteers, 125 men and 76 women, aged 20-60 years. The HPA in the previous 6 months was assessed using Baecke's questionnaire. Univariate analysis followed by multiple regression analysis was performed to analyze the significance levels of different probable predictors. RESULTS: The 6MWD was significantly greater in more active than in less active subjects (663.8±55.4m vs. 599.9±67.8m, p<0.001). The regression analysis showed that the subject's age in years (p=0.017), gender (p=0.006), height in cm (p=0.004), weight in kg (p<0.001), total activity score (TS) (p<0.001), and absolute difference in heart rate before and after exercise (p<0.001) could explain 48.9% of the variability in the 6MWD in healthy adults. CONCLUSIONS: The HPA score is probably the most appropriate variable to include in the reference equation predicting the 6MWD in healthy adults from the Indian subcontinent.

Combinatorial control of gene expression.

The complexity and diversity of eukaryotic organisms are a feat of nature's engineering. Pulling the strings of such an intricate machinery requires an even more masterful and crafty approach. Only the number and type of responses that they generate exceed the staggering proportions of environmental signals perceived and processed by eukaryotes. Hence, at first glance, the cell's sparse stockpile of controlling factors does not seem remotely adequate to carry out this response. The question as to how eukaryotes sense and respond to environmental cues has no single answer. It is an amalgamation, an interplay between several processes, pathways, and factors-a combinatorial control. A short description of some of the most important elements that operate this entire conglomerate is given in this paper.

Unilateral lung hypoplasia: a rare cause of unilateral opaque hemithorax in chest X-ray in a young boy.

Congenital abnormalities of lung are very rare entity, and very often under or misdiagnosed by physicians. The present case, a 12-year boy, who was initially diagnosed as unilateral massive pleural effusion with collapse of lung, and after thorough investigation, including CT scan of thorax, fiber-optic bronchoscopy, and echocardiography, a final diagnosis of unilateral lung hypoplasia was made. So if a teenager present with a unilateral opaque hemithorax in chest X-ray, this entity may be a differential diagnosis.

Identification of orcinol reactive substance in pleural fluid cell lysate--a new parameter for classification of pleural effusion.

BACKGROUND: Cell-free DNA is observed to be more in exudative pleural effusions. Based on this fact development of a clinical chemistry test for classification of pleural effusion will require DNA extraction followed by PCR amplification and electrophoresis. These procedures may not be cost effective for the purpose for classification of pleural effusion as already established parameters are popular for the purpose which can be estimated by comparatively low cost colorimetric procedures. Therefore development of a simple colorimetric test for the classification of pleural fluid based on nucleic acid identification test can be attempted. The aim of this work is to develop such colorimetric test for classification of pleural effusion using only pleural fluid sample. METHODS: Cell pellet is obtained from 5 ml pleural fluid which is lysed and subjected to DNA extraction, followed by identification under UV-transilluminator after electrophoresis and orcinol and diphenylamine reaction. RESULT: Exudates show extractable DNA from 5 ml biofluid (n=52) which are not observed from transudate (n=32). Orcinol reaction is significantly positive in exudates (n=52) compared to the transudates (n=32). Diphenylamine test cannot differentiate exudate from transudate. CONCLUSION: Orcinol reaction of cell lysate obtained from pleural fluid can classify pleural fluid sample into exudate or transudate.

A drop of hydrogen peroxide can differentiate exudative pleural effusion from transudate--development of a bedside screening test.

BACKGROUND: There is no bedside test to classify pleural fluid as exudate or transudate. The aim of the present study is to develop such a test. METHODS: We analyzed the Light's criteria parameters from bloodless pleural fluid and classified the biofluid as exudate or transudate and also estimated some parameters of oxidative stress in the biofluid by established spectrophotometric procedure. Two hundred microliters of sample was taken and added with 10 microl of 30% hydrogen peroxide followed by inspection of the sample for appearance of bubbles. RESULT: All exudative fluids (n=52) have shown appearance of profuse bubbles within 1 min of addition of hydrogen peroxide along with significantly more catalase activity compared to transudate. All transudative fluids (n=32) have not shown bubble formation within 1 min after addition of hydrogen peroxide. The exudate does not show bubble formation if supplemented with catalase inhibitors. Blood mixed transudate have shown profuse bubble formation after addition of hydrogen peroxide. CONCLUSION: In the case of blood uncontaminated pleural fluid, this newly developed protocol's sensitivity and specificity will be equivalent to Light's criteria probably with more advantage as by this procedure transport of the sample to the clinical laboratory is not required due to its inherent simplicity.