Segmentation and Volumetric Analysis of Heart from Cardiac CT Images.

PURPOSE: Cardiac CT is a valuable diagnostic tool in evaluating cardiovascular diseases. Accurate segmentation of the heart and its structures from cardiac CT and MRI images is essential for diagnosing functional abnormalities, treatment plans and cardiovascular diseases management. Accurate segmentation and quantitative assessments are still a challenge. Manual delineation of the heart from the scan images is labour-intensive, time-consuming, and error prone as it depends on the radiologist's experience. Thus, automated techniques are highly desirable as they can significantly improve the efficiency and accuracy of image analysis. METHOD: This work addresses the above problems. A new, image-driven, fast, and fully automatic segmentation method was developed to segment the heart from CT images using a processing pipeline of adaptive median filter, multi-level thresholding, active contours, mathematical morphology, and the knowledge of human anatomy to delineate the regions of interest. RESULTS: The algorithm proposed is simple to implement and validate and requires no human intervention. The method is tested on the 'Image CHD' DICOM images (multi-centre, clinically approved single-phase de-identified images), and the results obtained were validated against the ground truths provided with the dataset. The results show an average Dice score, Jaccard score, and Hausdorff distance of 0.866, 0.776, and 33.29 mm, respectively, for the segmentation of the heart's chambers, aorta, and blood vessels. The results and the ground truths were compared using Bland-Altmon plots. CONCLUSION: The heart was correctly segmented from the CT images using the proposed method. Further this segmentation technique can be used to develop AI based solutions for segmentation.

Commercial suitability and characterization of newly developed Erucastrum canariense (Can) sterile cytoplasm based cytoplasmic male sterile (CMS) lines in Indian cauliflower.

The study presents the first to characterize novel Erucastrum canarianse Webb and Berthel (or Can) sterile cytoplasm-based CMS lines in Indian cauliflower (Brassica oleracea var. botrytis L.) and investigating their commercial suitability. Eleven Can-based CMS lines were examined for 12 agro-morphological and yield traits,18 floral traits, four seed yield traits together with three each of the Ogura (source: wild Japanese Radish) and Tour (Source: Brassica tournefortii) cytoplasms. All of the recorded floral and seed traits showed significant (P > 0.05) differences between the CMS lines of each group. Agro-morphological and yield traits in CMS lines and their maintainers, however, were non-significantly different. All the Can- and Ogura-based CMS lines showed flowering and appropriate seed formation by natural cross-pollination. Only two Tour cytoplasm-based CMS lines, Tour (DC-41-5) and Tour (DC-67), produced the smallest malformed flowers and stigma. The highest seed yield per plant in CMS lines was in Ogu (DC-98-4) and the lowest in Tour (DC-67). P14 and P15, two polymorphic mtDNA markers, were discovered for the Can CMS system for early detection. Five primers (ITS5a-ITS4, atpF-atpH, P16, rbeL and trnL), along with their maintainers, were sequenced and aligned to detect nucleotide changes including as additions and or deletions at different positions. The newly introduced E. canariense sterile cytoplasm-based CMS system in cauliflower is the subject of the first comprehensive report, which emphasises their potential as a further stable and reliable genetic mechanism for hybrid breeding.

A comparative study of clinical outcome in ALT free flap reconstruction using superficial or deep and single or dual recipient vein anastomosis in different sites.

BACKGROUND: During the free flap surgery obtaining a suitable recipient vein is an important factor for successful outcome. As in all other flaps even in ALT flap, single or double venous anastomosis, superficial or deep venous anastomosis is still a matter of debate among the micro vascular surgeons. Though dual vein anastomosis is a time-tested method, single vein anastomosis has the advantage of reducing the operative time and hospitalization cost. Similarly, in situation where the deep veins are dubious superficial veins are savior. This study explores the outcome of ALT flap using different system of recipient veins. PATIENTS AND METHODS: Retrospective analysis of the 54 free ALT flaps performed over a period of 5 years from June 2017 till June 2022, was carried out. Out of 54, 38 (63%) were male patients and 16 (37%) were females. The outcome of the flaps was evaluated in single or dual anastomosis group. Similarly, the outcome of the flaps with deep or superficial vein anastomosis was also evaluated. The flaps outcomes are evaluated as favorable (successful as well as partial loss are considered as favorable) and unfavorable (complete loss of the flap). RESULTS: Among the 54 flaps, 31 patients had lower limb reconstruction, majority were post-traumatic defects. Twenty patients had head and neck reconstruction following post malignancy excision. Three patients had upper-limb reconstruction for post traumatic and burn injury defects. The outcome was analyzed. Twenty patients had dual vein anastomosis, 90% (18 out of 20) of patients had favorable outcome and 10% (2 out of 20) had unfavorable outcome. Thirty-four patients underwent single vein anastomosis, 94% had favorable outcome and 6% had unfavorable outcome. The result was not statistically significant as p < .05. Seven patients underwent superficial vein recipient anastomosis, and all flaps were (100%) successful and no failure, whereas out of 27 patients who had undergone deep vein anastomosis 25 (92%) had favorable outcome and 2 (8%) had unfavorable outcome. The results were not statistically significant as p > .05. CONCLUSION: As in other free flaps venous anastomosis compromise is the cause for flap failure in majority of the times. Whenever possible, dual vein anastomosis should be considered. But when impervious, single vein anastomosis can be resorted to without any hesitation. Similarly, unavailability of deep veins should not deter the surgeons. Superficial veins were a savior in such situation and can be advantageous too.

Treatment algorithm for post sternotomy wound infection - our experience.

INTRODUCTION: Median sternotomy is the most commonly used approach in open cardiac surgery. As in any other surgery, surgical site infections are a known phenomenon, but morbidity depends on the depth of infection. Superficial wound infections can be managed conservatively; however, deep sternal wound infections need an aggressive approach to prevent disastrous consequence like mediastinitis. Hence, this study was conducted with the aim to classify sternotomy wound infection and to develop a treatment algorithm for superficial and deep sternotomy wound infections. MATERIAL AND METHODS: Between January 2016 to August 2021, 25 patients who had sternotomy wound infections were studied. These wound infections were classified as superficial or deep sternal wound infections. RESULTS: Superficial wound infections underwent treatment with diluted vinegar dressings and deep infections underwent treatment with bilateral pectoralis major muscle advancement flaps. Patients were followed up till the wounds healed completely without complications. Patient characteristics, comorbidities, duration of treatment and outcomes of treatment were analyzed. Superficial sternal wound infection patients responded favorably to diluted vinegar dressings and deep sternal wound infection patients to pectoralis major muscle advancement flaps. Average time duration of healing for superficial and deep wound infections was 66.2 days and 18 days respectively. None of the patients had an increased severity of infection or re-dehiscence following treatment and during follow-up. CONCLUSION: Relatively conservative approach using diluted vinegar (1% acetic acid) dressing for superficial sternal wound infections was efficacious, whereas aggressive debridement and bilateral pectoralis major advancement muscle flaps for deep sternal wound infections are necessary for favorable outcomes. However, more studies are needed to ascertain this treatment algorithm.

Localization of lung abnormalities on chest X-rays using self-supervised equivariant attention.

Chest X-Ray (CXR) images provide most anatomical details and the abnormalities on a 2D plane. Therefore, a 2D view of the 3D anatomy is sometimes sufficient for the initial diagnosis. However, close to fourteen commonly occurring diseases are sometimes difficult to identify by visually inspecting the images. Therefore, there is a drift toward developing computer-aided assistive systems to help radiologists. This paper proposes a deep learning model for the classification and localization of chest diseases by using image-level annotations. The model consists of a modified Resnet50 backbone for extracting feature corpus from the images, a classifier, and a pixel correlation module (PCM). During PCM training, the network is a weight-shared siamese architecture where the first branch applies the affine transform to the image before feeding to the network, while the second applies the same transform to the network output. The method was evaluated on CXR from the clinical center in the ratio of 70:20 for training and testing. The model was developed and tested using the cloud computing platform Google Colaboratory (NVidia Tesla P100 GPU, 16 GB of RAM). A radiologist subjectively validated the results. Our model trained with the configurations mentioned in this paper outperformed benchmark results. Supplementary Information: The online version contains supplementary material available at 10.1007/s13534-022-00249-5.

A telepathology based screening tool for COVID-19 by leveraging morphological changes related to leukocytes in peripheral blood smears.

As we approach the aftermath of a global pandemic caused by Severe Acute Respiratory Syndrome-Corona Virus (SARS-CoV-2), the importance of quickly developing rapid screening tests has become very clear from the point of view of containment and also saving lives. Here, we present an explorative study to develop a telepathology-based screening tool using peripheral blood smears (PBS) to identify Coronavirus Disease (COVID-19)-positive cases from a group of 138 patients with flu-like symptoms, consisting of 82 positive and 56 negative samples. Stained blood smear slides were imaged using an automated slide scanner (AI 100) and the images uploaded to the cloud were analyzed by a pathologist to generate semi-quantitative leukocyte morphology-related data. These telepathology data were compared with the data generated from manual microscopy of the same set of smear slides and also the same pathologist. Besides good correlation between the data from telepathology and manual microscopy, we were able to achieve a sensitivity and specificity of 0.83 and 0.71, respectively, for identifying positive and negative COVID-19 cases using a six-parameter combination associated with leukocyte morphology. The morphological features included plasmacytoid cells, neutrophil dysplastic promyelocyte, neutrophil blast-like cells, apoptotic cells, smudged neutrophil, and neutrophil-to-immature granulocyte ratio. Although Polymerase Chain Reaction (PCR) and antibody tests have a superior performance, the PBS-based telepathology tool presented here has the potential to be an interim screening tool in resource-limited settings in underdeveloped and developing countries.

Modified Technique of Pectoralis Major Myocutaneous Flap Inset for Buccal Mucosa Reconstruction.

BACKGROUND: Conventional technique of flap inset in buccal mucosa reconstruction is by direct suturing of cutaneous margin of Pectoralis Major Myocutaneous (PMMC) flap to hard and soft palate mucosa and margin of floor of mouth with simple interrupted sutures. We have done a prospective study of the efficacy of anchoring the upper margin of PMMC flap to the hard palate by a modified method in reconstruction of buccal mucosa defects following tumour excision. This is to prevent disruption of suture line from the mucoperiosteum of hard palate and resultant oro-cutaneous fistula. METHODS: This hospital-based prospective study was carried out in the Department of Plastic Surgery at Bangalore, India for a period of 18 months (2015-2017). Patients (N=48) with buccal mucosa defects requiring reconstruction with PMMC flap either with conventional (n=24) or modified method (n=24) following tumour excision were included. Clinico-demographic profile of the patients including age, gender, size of defect, staging of illness, site and type of reconstruction, disruption of suture margin in the hard palate, development of oro-cutaneous fistula (OCF), day of starting oral feeds, removal of Ryle's tube and post-operative average length of stay in the hospital were recorded. RESULTS: Disruption of suture line in hard palate and Oro-cutaneous fistula were statistically significant in study group in both the variables (P-0.033, P-0.033). The median days on which patients were started with oral clear liquids and removal of Ryle's tube were also statistically significant between study and control groups. Post-operative average length of hospital stay which is the outcome of favourable results in the study group was found to be statistically significant (P-0.021) between the groups. CONCLUSION: Overall, modified technique of anchorage of PMMC flap can be considered as a reliable technique in buccal mucosa reconstruction because of its stability, lower complication rates and shorter length of hospital stay.

Spatial distribution and identification of potential risk regions to rice blast disease in different rice ecosystems of Karnataka.

Rice is a globally important crop and highly vulnerable to rice blast disease (RBD). We studied the spatial distribution of RBD by considering the 2-year exploratory data from 120 sampling sites over varied rice ecosystems of Karnataka, India. Point pattern and surface interpolation analyses were performed to identify the spatial distribution of RBD. The spatial clusters of RBD were generated by spatial autocorrelation and Ripley's K function. Further, inverse distance weighting (IDW), ordinary kriging (OK), and indicator kriging (IK) approaches were utilized to generate spatial maps by predicting the values at unvisited locations using neighboring observations. Hierarchical cluster analysis using the average linkage method identified two main clusters of RBD severity. From the Local Moran's I, most of the districts were clustered together (at I > 0), except the coastal and interior districts (at I < 0). Positive spatial dependency was observed in the Coastal, Hilly, Bhadra, and Upper Krishna Project ecosystems (p > 0.05), while Tungabhadra and Kaveri ecosystem districts were clustered together at p < 0.05. From the kriging, Hilly ecosystem, middle and southern parts of Karnataka were found vulnerable to RBD. This is the first intensive study in India on understanding the spatial distribution of RBD using geostatistical approaches, and the findings from this study help in setting up ecosystem-specific management strategies against RBD.

Efficacy of pedicled anterolateral thigh flap for reconstruction of regional defects - a record analysis.

BACKGROUND: The anterolateral thigh (ALT) flap was described as the fasciocutaneous flap. It can be harvested as a pedicled and/or free flap. Majority of the free flaps are harvested as a fasciocutaneous flap. Their use in head and neck reconstruction and limb trauma is well established. Apart from these advantages, this flap has various applications which are less utilized. ALT flap can be used as a myocutaneous flap along with vastus lateralis muscle. When muscle and fasciocutaneous flaps are required, both can be harvested as a chimeric flap which can cover two different regions of the wound. Moreover, harvest of the pedicled flap procedure is less time-consuming than that of a free flap. Since it has a long vascular pedicle, when used as pedicled flap, it can reach up to the gluteal region. To evaluate these less applied advantages of pedicled ALT flap, our study was undertaken. This study aimed to evaluate the efficiency of ALT flap in terms of the surface area of coverage, arc of rotation and the advantages of including vastus lateralis muscle as part of the flap. METHODS: A retrospective record analysis of all pedicled ALT flap reconstruction of trochanteric, upper thigh, gluteal and flank regions from 2016 to 2018 was undertaken; 7 patients with 8 defects were included. RESULTS: All the flaps healed successfully. There was no major necrosis of the flap and minor complications like wound gapping were found in three patients. CONCLUSION: The ALT-vastus lateralis flap dimensions can be very large and can be easily harvested in a very short time. Vastus lateralis muscle harvested can be used to fill the defect or can be used as chimera to cover the defect. The use of muscle over long standing infective pressure sores can sterilize the wound bed and help in preventing recurrence. The vascularity of this flap is robust and highly reliable. Even after a maximum arc of rotation (up to 170°) all the flaps survived without any major complications.

Multilocus sequence analysis and identification of mating-type idiomorphs distribution in Magnaporthe oryzae population of Karnataka state of India.

AIMS: To investigate the genetic diversity, population structure and mating-type distribution among the eco-distinct isolates of Magnaporthe oryzae from Karnataka, India. METHODS AND RESULTS: A set of 38 isolates of M. oryzae associated with leaf blast disease of rice were collected from different rice ecosystems of Karnataka, India, and analysed for their diversity at actin, ß-tubulin, calmodulin, translation elongation factor 1-α (TEF-1-α), and internal transcribed spacer (ITS) genes/region. The isolates were grouped into two clusters based on the multilocus sequence diversity, the majority being in cluster-IA (n = 37), and only one isolate formed cluster-IB. Population structure was analysed using 123 SNP data to understand the genetic relationship. Based on K = 2 and ancestry threshold of >70%, blast strains were classified into two subgroups (SG1 and SG2) whereas, based on K = 4 and ancestry threshold of >70%, blast strains were classified into four subgroups (SG1, SG2, SG3 and SG4). We have identified 13 haplotype groups where haplotype group 2 was predominant (n = 20) in the population. The Tajima's and Fu's Fs neutrality tests exhibited many rare alleles. Further, the mating-type analysis was also performed using MAT1 gene-specific primers to find the potentiality of sexual reproduction in different ecosystems. The majority of the isolates (54.5%) had MAT1-2 idiomorph, whereas 45.5% of the isolates possessed MAT1-1 idiomorph. CONCLUSIONS: The present study found the genetically homogenous population of M. oryzae by multilocus sequence analysis. Both mating types, MAT1-1 and MAT1-2, were found within the M. oryzae population of Karnataka. SIGNIFICANCE AND IMPACT OF STUDY: The study on the population structure and sexual mating behaviour of M. oryzae is important in developing region-specific blast-resistant rice cultivars. This is the first report of MAT1 idiomorphs distribution in the M. oryzae population in any Southern state of India.

Atomic Layer Deposited Ti2 O3 Thin Films.

Ti2 O3 thin films have been prepared through atomic layer deposition and subjected to electrical resistivity measurements as a function of temperature. The as-prepared films were stable for up to three weeks. In Ti2 O3 thin films, the insulator-metal transition is observed at ∼80 K, with nearly 3-4 orders of magnitude change in resistivity. The anomalous increase in electrical resistivity in the films is in accordance with the two-band model. However, the energy interval between the bands depending on the crystallographic c/a ratio leads to a change in electrical resistivity as a function of temperature.

Morpho-molecular diversity and avirulence genes distribution among the diverse isolates of Magnaporthe oryzae from Southern India.

AIMS: To investigate the diversity of eco-distinct isolates of Magnaporthe oryzae for their morphological, virulence and molecular diversity and relative distribution of five Avr genes. METHODS AND RESULTS: Fifty-two M. oryzae isolates were collected from different rice ecosystems of southern India. A majority of them (n = 28) formed a circular colony on culture media. Based on the disease reaction on susceptible cultivar (cv. HR-12), all 52 isolates were classified in to highly virulent (n = 28), moderately virulent (n = 11) and less-virulent (13) types. Among the 52 isolates, 38 were selected for deducing internal transcribed spacer (ITS) sequence diversity. For deducing phylogeny, another set of 36 isolates from other parts of the world was included, which yielded two distinct phylogenetic clusters. We identified eight haplotype groups and 91 variable sites within the ITS sequences, and haplotype-group-2 (Hap_2) was predominant (n = 24). The Tajima's and Fu's Fs neutrality tests exhibited many rare alleles. Furthermore, PCR analysis for detecting the presence of five Avr genes in the different M. oryzae isolates using Avr gene-specific primers in PCR revealed that Avr-Piz-t, Avr-Pik, Avr-Pia and Avr-Pita were present in 73.68%, 73.68%, 63.16% and 47.37% of the isolates studied, respectively; whereas, Avr-Pii was identified only in 13.16% of the isolates. CONCLUSIONS: Morpho-molecular and virulence studies revealed the significant diversity among eco-distinct isolates. PCR detection of Avr genes among the M. oryzae population revealed the presence of five Avr genes. Among them, Avr-Piz-t, Avr-Pik and Avr-Pia were more predominant. SIGNIFICANCE AND IMPACT OF THE STUDY: The study documented the morphological and genetic variability of eco-distinct M. oryzae isolates. This is the first study demonstrating the distribution of the Avr genes among the eco-distinct population of M. oryzae from southern India. The information generated will help plant breeders to select appropriate resistant gene/s combinations to develop blast disease-resistant rice cultivars.

Necrotising Fasciitis: Appearances Can Be Deceptive.

BACKGROUND: Necrotizing fasciitis is a potentially fatal infection of ß hemolytic Group-A Streptococcus, often occurring in patients with other comorbidities, but can occur in healthy individuals as well. It commonly affects the extremities, perineum, and abdominal wall. The aim of this study was to highlight various presentations of necrotizing fasciitis in unusual anatomical sites with delayed diagnosis and treatment. METHODS: In a retrospective analysis, seven cases of unusual presentations of necrotizing fasciitis were enrolled during a period of five years treated in a tertiary centre. RESULTS: The patients were between 23 and 80 years. Four were males and three were females. Four out of seven were diabetic. All patients had septicemia (hypovolemic shock, with leucocytosis, thrombocytopenia and deranged coagulation parameters) on admission in the intensive care unit. All seven patients had minimal cutaneous manifestation and the remote primary pathology was diagnosed in two patients. Six patients out of seven survived and the morbid state continued in one patient in view of malignancy of rectum in one patient. The overall outcome was satisfactory in five out of seven cases. CONCLUSION: Pain disproportionate to the local inflammation with florid constitutional symptoms should raise suspicion of necrotizing fasciitis. Early diagnosis, of stabilization of hemodynamics, emergency fasciotomy, staged debridement and the initiation of broad spectrum antibiotics reduced the morbidity and mortality. The disease may manifest with uncommon presentations and sometimes lead to the diagnosis of primary aetiology.

VR Glasses based Measurement of Responses to Dichoptic Stimuli: A Potential Tool for Quantifying Amblyopia?

Amblyopia is a medical condition in which the visual inputs from one of the eyes is suppressed by the brain. This leads to reduced visual acuity and poor or complete loss of stereopsis. Conventional clinical tests such as Worth 4-dot test and Bagolini striated lens test can only detect the presence of suppression but cannot quantify the extent of suppression, which is important for identifying the effectiveness of treatments for amblyopia. A novel approach for quantifying the level of suppression in amblyopia is proposed in this paper. We hypothesize that the level of suppression in amblyopia can be measured by measuring the symmetry/asymmetry in the suppression experienced during a dichoptic image recognition task. Preliminary studies done on fifty one normal subjects prove that the differences between the accuracies of the left and right eyes can be used as a measure of asymmetry. Equivalence test performed using 'two-one-sided t-tests' procedure shows that the equivalence of the accuracies of left and right eyes for normal subjects is statistically significant (p = .03, symmetric equivalence margin of 5 percentage points). To validate this method, six amblyopic children underwent this test and the results obtained are promising. To the knowledge of the authors, this is the first work to make use of VR glasses and dichoptic image recognition task for quantifying the level of ocular suppression in amblyopic patients.

Computer-aided diagnosis of liver lesions using CT images: A systematic review.

BACKGROUND: Medical image processing has a strong footprint in radio diagnosis for the detection of diseases from the images. Several computer-aided systems were researched in the recent past to assist the radiologist in diagnosing liver diseases and reducing the interpretation time. The aim of this paper is to provide an overview of the state-of-the-art techniques in computer-assisted diagnosis systems to predict benign and malignant lesions using computed tomography images. METHODS: The research articles published between 1998 and 2020 obtained from various standard databases were considered for preparing the review. The research papers include both conventional as well as deep learning-based systems for liver lesion diagnosis. The paper initially discusses the various hepatic lesions that are identifiable on computed tomography images, then the computer-aided diagnosis systems and their workflow. The conventional and deep learning-based systems are presented in stages wherein the various methods used for preprocessing, liver and lesion segmentation, radiological feature extraction and classification are discussed. CONCLUSION: The review suggests the scope for future, work as efficient and effective segmentation methods that work well with diverse images have not been developed. Furthermore, unsupervised and semi-supervised deep learning models were not investigated for liver disease diagnosis in the reviewed papers. Other areas to be explored include image fusion and inclusion of essential clinical features along with the radiological features for better classification accuracy.

A quantitative validation of segmented colon in virtual colonoscopy using image moments.

BACKGROUND: Evaluation of segmented colon is one of the challenges in Computed Tomography Colonography (CTC). The objective of the study was to measure the segmented colon accurately using image processing techniques. METHODS: This was a retrospective study, and the Institutional Ethical clearance was obtained for the secondary dataset. The technique was tested on 85 CTC dataset. The CTC dataset of 100-120 kVp, 100 mA, and ST (Slice Thickness) of 1.25 and 2.5 mm were used for empirical testing. The initial results of the work appear in the conference proceedings. Post colon segmentation, three distance measurement techniques, and one volumetric overlap computation were applied in Euclidian space in which the distances were measured on MPR views of the segmented and unsegmented colons and the volumetric overlap calculation between these two volumes. RESULTS: The key finding was that the measurements on both the segmented and the unsegmented volumes remain same without much difference noticed. This was statistically proved. The results were validated quantitatively on 2D MPR images. An accuracy of 95.265±0.4551% was achieved through volumetric overlap computation. Through pairedt-test, at α=5%, statistical values were p=0.6769, and t=0.4169 which infer that there was no much significant difference. CONCLUSION: The combination of different validation techniques was applied to check the robustness of colon segmentation method, and good results were achieved with this approach. Through quantitative validation, the results were accepted at α=5%.

The insulin sharps disposal study: Evaluation of a structured patient education initiative in an urban community health centre in India.

CONTEXT: India has witnessed an increase in people suffering from diabetes mellitus and also those on insulin. The issue of handling used sharps in the community is an area of concern. AIMS: Our study aimed to assess the change in knowledge and practise concerning the disposal of used insulin sharps in patients with diabetes, pre- and post-evaluation, a structured, health provider-initiated, patient-centred insulin-use health education (PIHE). SETTINGS AND DESIGN: A pre- and post-evaluation study of PIHE set in an urban health centre in south India. METHODS AND MATERIALS: A pre-evaluation study was done on a cross-sectional sample of type II diabetes patients, who visited the urban health centre and were on insulin for at least 1 year. A semi-structured pilot-tested questionnaire was used for the study. For 18 months, PIHE was provided to all insulin users at outpatient contact, after which a post-evaluation study among another cross-sectional sample of patients in the same centre, was done to assess change in knowledge and practise. STATISTICAL ANALYSIS USED: Univariate analysis followed by logistic regression. RESULTS: The participants in the pre- and post-evaluation studies had a mean (SD) age of 54.9 (11.33) years and 57.2 (11.01) years, respectively. The baseline characteristics of gender, socioeconomic status and diabetes duration were similar. There was a statistically significant (P < 0.001) difference in knowledge (19 [19%] to 81 [81%]) and practise (7 [7%] to 73 [73%]) of participants regarding the correct disposal method of used insulin syringes and sharps before and after PIHE. CONCLUSIONS: PIHE over an 18-month period for diabetic patients on insulin significantly improved knowledge and practises relating to insulin use and correct disposal of syringes and sharps.

New dual peroxisome proliferator activated receptor agonist-Saroglitazar in diabetic dyslipidemia and non-alcoholic fatty liver disease: integrated analysis of the real world evidence.

BACKGROUND: Saroglitazar, a novel dual peroxisome proliferator activated receptor (PPAR) agonist, in clinical trials, has shown an improvement in lipid and glycemic parameters through the PPAR-α and γ agonist actions, respectively. It was granted marketing authorization in India in 2013 for diabetic dyslipidemia. This review was conducted to summarize the effects of Saroglitazar in patients with diabetic dyslipidemia in real world clinical studies conducted after marketing authorization in India. METHODS: In this review, we selected real world clinical studies of Saroglitazar published as manuscripts and abstracts presented at scientific conferences. In all these studies, patients with diabetic dyslipidemia were treated with Saroglitazar 4 mg once daily for at least 12 weeks and different lipid and glycemic parameters were measured at the baseline and end of the study. RESULTS: In 18 selected studies (5 published manuscripts and 13 abstracts), a total of 5824 patients with diabetic dyslipidemia were prescribed Saroglitazar 4 mg for a duration ranging from 12 to 58 weeks. Across all the studies, mean age of patients ranged from 49.6 to 59.1 years and the proportion of female patients ranged from 22% to 42%. Across all the studies, there was a consistent mean reduction in triglyceride levels (~ 45% to 62%), total cholesterol levels (~ 17% to 26%), non-high-density lipoprotein cholesterol levels (~ 21% to 36%), low-density lipoprotein cholesterol levels (~ 11% to 27%), and glycosylated hemoglobin levels (~ 0.7% to 1.6%) with an increase in mean high-density lipoprotein cholesterol levels (up to 9%) from baseline to end of the study. Saroglitazar also improved alanine aminotransferase levels and fatty liver (evaluated by FibroScan™) in non-alcoholic fatty liver disease patients with diabetic dyslipidemia. Body weight remained unchanged and no significant adverse events (AEs) were reported in the studies. CONCLUSION: Saroglitazar effectively improved lipid and glycemic parameters without significant AEs in patients with diabetic dyslipidemia in real-world clinical studies of up to 58 weeks duration.

Trends of HIV prevalence in rural South India.

BACKGROUND: India, with its large number of migrant workers, had a large number of people affected by HIV. This included antenatal women who are a vulnerable population. The Government of India along with nongovernmental organizations worked on a large number of programs to screen and decrease mother-to-child transmission. This in turn has brought down the prevalence of HIV. MATERIALS AND METHODS: Retrospective analysis of data from the block being provided with healthcare was carried out over a period of 14 years from January 2002 to December 2016. RESULTS: The observed HIV prevalence was 5.9 per 1000 in 2002 and showed a declining trend to 1.2 per 1000 in 2016. CONCLUSION: Consistent work at health education and preventive methods has helped bring down the prevalence of HIV over the years.

Anti-microbial and anti-mycotoxigenic activities of endophytic Alternaria alternata isolated from Catharanthus roseus (L.) G. Don.: molecular characterisation and bioactive compound isolation.

The present study investigated the anti-microbial and anti-mycotoxigenic activities of the ethyl acetate extract (EA) and a bioactive compound obtained from an endophytic fungus Alternaria alternata isolated from Catharanthus roseus leaves. A. alternata was identified using PCR-based 5.8S rDNA sequencing. The EA and bioactive compound, p-Coumaric acid (PC), showed concentration-dependent broad-spectrum anti-microbial activity against the tested bacteria, yeast, and fungi with MICs ranging from 7.8 to 250 µg/mL. The in vitro production of aflatoxin B1 (AFB1) from Aspergillus flavus and fumonisin B1 (FB1) from Fusarium verticillioides was completely inhibited by EA and PC at 400 µg/mL. The synthesis of the membrane-bound ergosterol from A. flavus and F. verticillioides was strongly inhibited by PC at 200 µg/mL. The EA and PC were found to show significant anti-microbial and anti-mycotoxigenic activities, hence, they could be explored as protective agents for preventing microbial deterioration and mycotoxins accumulation in food and feedstuffs during pre- and post-harvest and storage.