The Role of Artificial Intelligence-Powered Imaging in Cerebrovascular Accident Detection.

Cerebrovascular accidents (CVAs) often occur suddenly and abruptly, leaving patients with long-lasting disabilities that place a huge emotional and economic burden on everyone involved. CVAs result when emboli or thrombi travel to the brain and impede blood flow; the subsequent lack of oxygen supply leads to ischemia and eventually tissue infarction. The most important factor determining the prognosis of CVA patients is time, specifically the time from the onset of disease to treatment. Artificial intelligence (AI)-assisted neuroimaging alleviates the time constraints of analysis faced using traditional diagnostic imaging modalities, thus shortening the time from diagnosis to treatment. Numerous recent studies support the increased accuracy and processing capabilities of AI-assisted imaging modalities. However, the learning curve is steep, and huge barriers still exist preventing a full-scale implementation of this technology. Thus, the potential for AI to revolutionize medicine and healthcare delivery demands attention. This paper aims to elucidate the progress of AI-powered imaging in CVA diagnosis while considering traditional imaging techniques and suggesting methods to overcome adoption barriers in the hope that AI-assisted neuroimaging will be considered normal practice in the near future. There are multiple modalities for AI neuroimaging, all of which require collecting sufficient data to establish inclusive, accurate, and uniform detection platforms. Future efforts must focus on developing methods for data harmonization and standardization. Furthermore, transparency in the explainability of these technologies needs to be established to facilitate trust between physicians and AI-powered technology. This necessitates considerable resources, both financial and expertise wise which are not available everywhere.

Neutrophil-to-Lymphocyte Ratio as a Potential Biomarker to Managing Type 2 Diabetes Mellitus and Predicting Disease Progression.

Introduction Diabetes is a chronic disease that causes dysregulation of blood glucose. Type 2 diabetes mellitus (T2DM) could result in long-term inflammatory conditions that affect different organs of the body. Despite the availability of diagnostic markers like glycated hemoglobin (HbA1c) for T2DM, it is essential to find an appropriate marker that could predict long-term complications. This study evaluates the potential role of neutrophil-to-lymphocyte ratio (NLR) in predicting disease progression and treatment responses.  Methods This case-control study was carried out among 160 T2DM patients and 132 non-diabetic persons. Blood samples were collected from each participant and were processed for hemoglobin, HbA1c, iron, ferritin, and complete blood picture (NLR).  Results The study showed that there was a significant variation in the serum levels of ferritin (264.8±611.6 ng/ml versus 168.3±364.7 ng/ml, p=0.392), iron (4.095±8.851 mcg/dl versus 55.20±37.62 mcg/dl, p=0.0111), and HbA1c (8.169±1.635% versus 5.668±0.5260% p<0.0001) among T2DM patients compared to non-diabetic persons. The NLR values (4.189±4.154 versus 4.095±8.851, p=0.009) among patients with T2DM significantly varied with that of non-diabetic persons. A significant negative correlation was noticed between the serum levels of iron and NLR (r=-0.17, p=0.014) and a positive correlation was noticed between HbA1c and NLR (r=0.19, p=0.014). The serum levels of iron revealed a significant positive correlation with the serum levels of ferritin (r=0.24, p=0.002) and hemoglobin percentage (r=0.41, p=0.008). HbA1c revealed a significant positive correlation with NLR (r=0.19, p=0.014). Additionally, a significant negative correlation was observed between iron with NLR (r=-0.17, p=0.029) and hemoglobin percentage with NLR (r=-0.30, p=0.005). However, no such correlation was demonstrated among non-diabetic persons. With an accuracy of 89.85% and high sensitivity and specificity, NLR showed diagnostic accuracy like HbA1c.  Conclusions NLR demonstrated equivalent efficacy to HbA1c in predicting glycemic control. Since diabetes affects different organs of the body, evaluating NLR probably predicts inflammation. Therefore, NLR could be useful in the management of T2DM and in predicting long-term complications.

Evaluation of a Rapid Urine Antigen Detection Assay as a Point-of-Care Test in the Diagnosis of Community-Acquired Pneumonia.

Introduction Community-acquired pneumonia (CAP) is among the most common public health problems encountered throughout the world. CAP is a frequent cause of lower respiratory tract infections among children and geriatric-age persons. The etiology of CAP is complex but generally involves infection with bacteria like Streptococcus pneumoniae (S. pneumoniae), which is the most common cause of CAP. The underdiagnosis of CAP due to the limitations of conventional culture methods could be responsible for severe morbidity and mortality, especially among susceptible populations. We evaluated the usefulness of a rapid immunochromatographic test (BinaxNOW™, Abbott, Chicago, IL) that detects S. pneumoniae through a rapid urine antigen test (RUAT) as a point-of-care (POC) diagnostic method in the early detection of CAP. Methods A prospective study was conducted in a university-affiliated teaching hospital between January 2019 and September 2019 (nine months). The study recruited 300 inpatients who revealed signs and symptoms associated with pneumonia. The study was approved by the institutional ethics committee, and all participants provided their voluntary informed consent. Laboratory evaluation included the collection of sputum samples, which were processed for Gram stain and routine culture. Five milliliters of blood were collected from all the subjects for carrying out a blood culture. A urine sample was collected from each participant for the detection of S. pneumoniae through the point-of-care urinary antigen test. Results Of the 300 patients diagnosed with CAP, the S. pneumoniae RUAT was positive in 110 out of 140 cases of pneumococcal pneumoniae (78.57%). The RUAT results were positive for 20 (66.6%) out of 30 bacteremic patients and for 90 (81.8%) out of 110 patients positive for sputum culture. The RUAT was positive in 10 out of 20 cases of pneumonia with an unknown microbial etiology. The overall sensitivity (78.57%), specificity (100%), positive predictive value (100%), negative predictive value (98.88%), and accuracy (90%) of the RUAT were similar to sputum culture results.  Conclusion The RUAT has shown comparable efficacy with sputum culture and therefore can be used as a complementary approach to conventional methods in the early diagnosis of CAP caused by S. pneumoniae. Due to its ease of use and rapid results, it could be incorporated as a POC diagnostic test.

The Prevalence of Low Birth Weight Among Newborn Babies and Its Associated Maternal Risk Factors: A Hospital-Based Cross-Sectional Study.

Background Low birth weight (LBW) is at the forefront of 100 core health issues that are used as indicators to assess the global nutrition monitoring framework as reported by the World Health Organization (WHO). Several factors could contribute to LBW, which essentially include intrauterine growth retardation and premature delivery/birth. Moreover, LBW predisposes neonates to several developmental disturbances including both physical and mental disorders. Given that LBW is more common in poor and developing countries, there is not much reliable data that could be used to formulate strategies for controlling this problem. This study, therefore, attempts to assess the prevalence of LBW among newborn babies and its associated maternal risk factors. Methods This hospital-based cross-sectional study was carried out between June 2016 and May 2017 (one year) and included 327 LBW babies. A predefined and prevalidated questionnaire was used to obtain data for the study. The data collected included age, religion, parity, birth spacing, pre-pregnancy weight, weight gain during pregnancy, height, mother's education, occupation, family income, socioeconomic status, obstetric history, previous history of stillbirths and abortions, and history of any LBW baby. Results The prevalence of LBW was noted to be 36.33%. The occurrence of LBW babies was predominant among mothers who were aged <19 years (62.26%) and >35 years (57.14%). Grand multipara women showed the highest rates (53.70%) of LBW babies. Additionally, LBW was predominantly noticed among newborns (46.66%) with a birth spacing of <18 months, those born to mothers with pre-pregnancy weight of <40 Kg (94.04%), mothers with a height of <145 cm (83.46%), mothers who gained <7 kg during the pregnancy (82.20%), illiterate mothers (43.75%), and mothers who were agricultural workers (63.76%). Other maternal factors that could predispose to LBW included lower monthly income (66.25%), low socioeconomic status (52.90%), less number of antenatal visits (59.65%), low blood hemoglobin (100%), history of strenuous physical activities (48.66%), smoking and/or tobacco chewing habit (91.42%), alcoholism (66.66%), lack of iron and folic acid supplementation during pregnancy (64.58%), history of stillbirths (51.51%), and mothers suffering from chronic hypertension, preeclampsia, and eclampsia (47.61%), and tuberculosis (75%). Religion-wise, Muslim mothers revealed the highest prevalence (48.57%) of LBW, followed by Hindus (37.71%) and Christians (20%). The mother's age, pre-pregnancy weight, weight gain during pregnancy, height of the mother, hemoglobin concentration, weight of the baby, and length of the newborn (p≤0.05) could influence the health of the newborn. However, maternal infections, previous bad obstetrics history, presence of systemic illnesses, and protein and calorie supplementation (p≥0.05) had no significant impact on birth weight. Conclusions The results showed that multiple factors are responsible for LBW. Maternal factors such as weight, height, age, parity, weight gained during pregnancy, and anemia during pregnancy could predispose to delivering LBW babies. Additionally, other risk factors for LBW identified in this study were the literacy level of mothers, occupation, family income, socioeconomic status, antenatal care, strenuous physical activity during pregnancy, smoking/tobacco chewing, alcohol/toddy consumption, and iron and folic acid supplementation during pregnancy.

Dyslipidemia Among Diabetes Mellitus Patients: A Case-Control Study From a Tertiary Care Hospital in South India.

Background Diabetes mellitus (DM) is a chronic endocrine disease characterized by impaired glucose metabolism. Type 2 DM (T2DM) is an age-related disease that usually affects middle and older-aged people who suffer from increased blood glucose activities. Several complications are associated with uncontrolled diabetes that include abnormal lipid levels/dyslipidemia. This may predispose T2DM patients to life-threatening cardiovascular diseases. Therefore, it is essential to evaluate the activities of lipids among T2DM patients. Methodology A case-control study involving 300 participants was conducted in the outpatient department of medicine attached to Mahavir Institute of Medical Sciences, Vikarabad, Telangana, India. The study included 150 T2DM patients and the same number of age-matched controls. In this study, 5 mL of fasting blood sugar (FBS) was collected from each participant for the estimation of lipids (total cholesterol (TC), triacylglyceride (TAG), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and very low-density lipoprotein-cholesterol (VLDL-C)) and glucose. Results The FBS levels among T2DM patients (211.6 ± 60.97 mg/dL) and non-diabetic individuals (87.34 ± 13.06 mg/dL) were significantly (p < 0001) different. Analysis of lipid chemistry that included TC (174.8 ± 38.28 mg/dL vs. 157.22 ± 30.34 mg/dL), TAG (173.14 ± 83.48 mg/dL vs. 133.94 ± 39.69 mg/dL), HDL-C (37.28 ± 7.84 mg/dL vs. 43.4 ± 10.82 mg/dL), LDL-C (113.44 ± 28.79 mg/dL vs. 96.72 ± 21.53 mg/dL), and VLDL-C (34.58 ± 19.02 mg/dL vs. 26.7 ± 8.61 mg/dL) revealed significant variations among T2DM and non-diabetic individuals. There was a 14.10% decrease in the activities of HDL-C among T2DM patients along with an increase in the activities of TC (11.18%), TAG (29.27%), LDL-C (17.29%), and VLDL-C (30%). Conclusions T2DM patients have demonstrated abnormal lipid activities/dyslipidemia compared to non-diabetic patients. Patients with dyslipidemia may be predisposed to cardiovascular diseases. Therefore, regular monitoring of such patients for dyslipidemia is extremely vital to minimize the long-term complications associated with T2DM.

Comparison of Short-Term Versus Long-Term Antibiotic Therapy Among Severe Cases of Pneumonia: A Prospective Observational Study Among Children.

Introduction Pneumonia continues to be the leading cause of morbidity and mortality in children younger than five years. The World Health Organization (WHO) recommends intravenous antibiotics for five days for severe pneumonia. However, the optimum duration of parenteral antibiotic therapy for pneumonia is not practicable and feasible in poor and resource-constrained settings like India. Given the current Indian scenario wherein childhood pneumonia is extremely prevalent, we attempted to undertake this study to compare the duration of antibiotic therapy in severe cases of community-acquired pneumonia (CAP). Methods A prospective observational study was carried out on 225 cases of severe and very severe CAP patients at a tertiary care center. The study group included children between two months to five years of age. The participants were subjected to antibiotic therapy (parenteral) plus supportive care. The selection of antibiotics was empirical and according to the WHO acute respiratory infection control program. Hematological parameters including blood hemoglobin, C-reactive protein, erythrocyte sedimentation rate (ESR), and total leukocyte count, and radiological evaluation were performed on all the participants. Cases were followed up for the duration of clinical response. Results Out of the 225 cases, 25 patients did not respond to antibiotics and were categorized as the treatment failure group. Of the remaining 200 cases, 104 (52%) showed clinical response within three days (3.0±0.016), and 96 showed a response in four to seven days (4.4±0.064). The mean duration of antibiotic therapy among short-course versus long-course treatment was statistically significant (p<0.0001). The majority of patients developed leukocytosis, neutrophilia, and elevated ESR.  Conclusion Short-course parenteral antibiotics therapy was equally effective as long-course therapy in severe pneumonia. However, very severe pneumonia patients required a longer course of parenteral antibiotics therapy. Very severe pneumonia was significantly associated with high mortality and treatment failure.

Assessment of the Occupational Risk of Tuberculosis & Air Borne Infection Control in High-Risk Hospital Wards and Its Implications on Healthcare Workers in a Tertiary Care Hospital in South India.

Introduction The indoor air in hospitals could play a significant role in the transmission of a wide array of infections, especially in respiratory intensive care units, pulmonary outpatient departments, and other areas. Unprotected coughing and sneezing may facilitate the release of aerosols and contaminate the indoor environment. The majority of infections transmitted through these modes include viral diseases, including tuberculosis (TB), influenza, and measles, among several others. Moreover, the possibility of direct and indirect transmission of microbes by air has been underestimated in hospital settings, especially in developing countries. This study therefore was carried out to assess the burden of microbes in the air of selected wards in a tertiary care hospital and evaluate the occupational risk of some infections among healthcare workers (HCWs). Methods This study was carried out between September 2019 and February 2021 at a tertiary care teaching hospital in South India. A total of 30 symptomatic healthcare workers (HCWs) were included in the study and were screened for present and past tuberculosis (TB) as well as other lower respiratory tract infections. A tuberculin skin test, chest X-ray, and sputum acid-fast staining were performed on all the HCWs who were negative for other bacterial infections and were symptomatic. The study was conducted in coordination with the pulmonology department. Active monitoring of air was performed by microbiological air sampler in the respiratory intensive care unit (RICU) and other high-risk areas including the pulmonology outpatient department (OPD), the radiology OPD, and the microbiology department.  Results Sputum for tuberculous bacteria was positive in four (16.6%) HCWs. The chest X-ray showed radiological findings suggestive of TB in five (20.8%) HCWs. Three (12.5%) HCWs who were screened for extrapulmonary TB revealed one (33.3%) was positive for TB of the hip joint. Among the HCWs, eight (33%) returned positive tuberculin tests. Assessment of the hospital air in the RICU revealed the bacterial count (288 CFU/m3) exceeded the normal limit (≤50 CFU/m3). The COVID-19 isolation ward showed the lowest bacterial count (06 CFU/m3) and no fungi. The predominant bacterial isolates were gram-positive cocci in clusters (Methicillin-sensitive Staphylococcus aureus). After proper disinfection and correction of ventilation techniques, the resampling results noted microbial colonies under normal limits. Conclusion A high burden of TB was noted among the HCWs. The airborne infection control strategies are essential to minimize the risk of nosocomial infections and occupational TB risk to HCWs. Most microbes are transmitted through the airborne route and therefore it is extremely important to take measures to control the transmission of such pathogens in hospital settings.

Knowledge, Awareness, and Perception of Common Eye Diseases and Eye Donation Among People Seeking Healthcare in a Tertiary Hospital in Telangana, South India.

Background Globally billions of people have vision impairment (VI) or blindness, and at least half of the VI could have been prevented or has yet to be addressed. With the policies focused exclusively on treating ailments, we need to recognize the need to educate the country's population regarding diseases and their outcomes. This is evident in the poor eye donation rates, as documented by the Eye Bank Association of India (EBAI). The National Programme for Prevention of Blindness (NPCB) also advocates the need for active campaigning to promote eye donations and improve the corneal procurement rate by increasing health awareness. This study aimed to assess the knowledge, awareness, and perception regarding eye diseases and eye donation among the rural population of Telangana, South India. Methods A cross-sectional study involving 150 participants who were randomly selected from non-triaged attendants in the outpatient queue at Mahavir institute of medical sciences (MIMS) was included. Trained enumerators used verbally administered, semi-structured questionnaires on their awareness and knowledge of cataracts, glaucoma, diabetic retinopathy, and night blindness. The Chi-square test was applied to determine the statistical significance of the results obtained from the pre-test and post-test. The significance threshold of the p-value was set at <0.05. Results The population studied belonged to a mean age of 34.98 years. The study included 72 (48%) male and 78 (52%) female subjects, and the majority (48.6%) of them belonged to the age range of 21-30 years. More than 85% of subjects belonged to the middle and lower middle class, and the majority (74.7%) were Hindus by religion. Regarding cataracts, 64 (42.7%) did not know, and 86 (57.3%) had varied perceptions. The awareness regarding glaucoma was the least (88.7%) of all common ocular diseases. The study showed a significant association between knowledge of eye diseases and literacy status plus the population's socioeconomic status (p<0.05 ). A significant association was found to exist between willingness to eye donation and the religion of the study population (p<0.05). Conclusion This study identifies that the awareness regarding various ocular diseases was poor. Moreover, the participants had an alarmingly high misconception regarding different aspects of eye donation. Increasing public awareness is essential to minimize eye diseases, improve eye care, and encourage eye donations.

Stroke as a Paraneoplastic Manifestation of Ovarian Cancer: A Case Report.

People with gynecologic neoplasms have the highest risk of having an ischemic stroke. A 76-year-old woman came into the stroke unit of our hospital complaining of anosmia and acutely developing dysarthria. She was ultimately determined to have ovarian cancer after extensive testing. Ovarian carcinoma is one of the neoplasms that cause ischemic stroke and is most commonly documented in case studies. Identifying the underlying neoplastic condition in female ischemic stroke patients who are otherwise "healthy" is crucial as an early surgical intervention on cancer offers therapeutic treatment for both malignancy and thromboembolism.

Surgical Conundrum: A Case of Giant Renal Angiomyolipoma Abutting Inferior Vena Cava With Haemorrhage.

Renal angiomyolipoma (AML) is not only uncommon but often an accidental diagnosis, as it is frequently asymptomatic and affects females disproportionately. Although they may exhibit symptoms of tuberous sclerosis complex and lymphangioleiomyomatosis, the vast majority are sporadic. Due to its vascular nature, AML is prone to bleeding, and AML that bleeds typically belongs to the tuberous sclerosis complex. AMLs are mostly benign, but they can proliferate and invade locally, necessitating a strict management strategy. We hereby delineate the manifestations of a 32-year-old man who complained of increased abdominal size and pain without any history of injury. On examination, abdominal distension was demonstrated, and a palpable mass was detected in the right hypochondrium and right lumbar area. All findings from various diagnostic methods indicated that it was a classic kind of renal AML. We are keeping track of this case because it is rare and quite uncommon in males. The case presented a challenging time for the surgeons to plan the line of treatment.

Assessment of Breastfeeding, Weaning, and Complementary Feeding Practices Among Women Attending a Tertiary Care Teaching Hospital in South India.

Introduction Infants depend exclusively on mothers' milk for nutrition in their early months of life. However, some infants are given cow/buffalo milk during insufficiency. After six months, the children are supplemented with complementary food, including solid food, to meet the nutritional requirements of a growing infant, a process known as weaning. Therefore, it is important for mothers to have a clear understanding of the nature of food, and the nutritional requirements of the children. This study aimed to understand the knowledge, awareness, and practice of breastfeeding, weaning, and complementary feeding among women. Methods A cross-sectional questionnaire-based observational study was carried out between May and June 2021. The study included 150 women attending the outpatient department of pediatrics attached to Mahavir Institute of Medical Sciences (MIMS), Vikarabad, Telangana, India. After taking the informed consent, the researcher filled out a pre-validated questionnaire based on the subjects' responses. The data regarding socio-demographic details and information regarding knowledge, timing, practices of weaning, knowledge of nutritional requirements, and child feeding practices were collected as a pre-test. An educational briefing of the essentials of child feeding practices, weaning, and dietary requirements was undertaken using chalk and board and audio-visual aids, among others. In the post-test, the knowledge of mothers regarding weaning practices, the importance of weaning, and understanding of the nutritional requirements and their inclusion in a child's diet was assessed. The quantitative data were represented as percentages. The Chi-square test was applied to find out the statistical significance of the results obtained from the study. Results Of the 150 women who participated in the study, the majority belonged to the age group of 18-23 years (66.7%). Most women were illiterate (34%) and only 12% were graduates. More than 70% of the participants belonged to the middle and lower middle class. The majority of participants (96.7%) had carried out exclusive breastfeeding for the first six months, and 63.35% of mothers had initiated weaning their child between the age of 6-12 months. Only 37.4% of mothers started breastfeeding within hours after the delivery. A combination of all foods (36%), rice/wheat (29%), processed food (18.8%), fruits and vegetables (9.2%), and pulses (6.7%) were chosen for weaning. Many felt that eggs and meat supplementation can be done between 12-18 months. Conclusion The knowledge of breastfeeding and best practices of weaning and complementary feeding habits significantly affects the child's growth and overall health. The women in this study had a moderate level of understanding regarding the aspects of breastfeeding, weaning practices, and complementary dietary requirements during weaning.

Polycystic Ovarian Syndrome: Prevalence, Predisposing Factors, and Awareness Among Adolescent and Young Girls of South India.

Introduction Polycystic ovarian syndrome (PCOS) is a leading cause of infertility among women throughout the world. PCOS is an endocrine abnormality that presents as hyperandrogenemia, anovulation, and/or polycystic ovaries. The exact causes of PCOS are not entirely understood. However, PCOS may be hereditary and associated with abnormalities such as high body mass index (BMI) and obesity, among others. This study is carried out to assess the prevalence and awareness among adolescents and young girls belonging to South India. Methods This was a prospective study that included 250 adolescent and young girls aged between 13 and 25 years. Demographic details including age, educational status, and family income were collected from all the participants after obtaining informed consent. BMI was measured in all the participants. A pre-test was conducted to assess the level of awareness followed by a 30-minute informative briefing on PCOS. All participants were asked to fill up a post-briefing questionnaire. The data collected were processed using statistical software SPSS 11.0, and the chi-square test was applied to find out the significance of the results. Results Of the total 250 participants included, the mean age was 16.96 years and most participants (78%) belonged to the age group of 13 to 19 years. Most (78%) of the study participants had normal BMI (18-24.9 kg/m2), 17.6% were underweight (BMI < 18), and 4.4% were overweight (BMI > 25). A PCOS prevalence rate of 6.8% was noted among the study participants. A majority (78.4%) of the study participants were unaware of PCOS, and 6.8% were being treated for PCOS. The source of knowledge of PCOS was majorly teachers (37%), followed by doctors (31.5%), the internet (11%), and friends (7.5%). Lack of information and publicity (63%) were found to be the most significant reason for low levels of awareness. Conclusion PCOS is a common health problem among adolescents and young girls. Most study participants were unaware of the symptoms and management of the condition. Therefore, the disease burden noted in this study does not necessarily depict the real prevalence. Increasing awareness programs will facilitate improved understanding, increased diagnoses, and effective management of PCOS.