A Rare Case of Acute Pancreatitis as an Initial Presentation of Acute Myeloid Leukemia.

Acute pancreatitis is a rare manifestation of acute myeloid leukemia which can be a presentation at the initial diagnosis or during or after the onset of the disease. Acute myeloid leukemia occurs due to the abnormal proliferation of undifferentiated hematopoietic stem cells in the bone marrow which alter the normal hematopoiesis. We report the case of a 32-year-old male admitted with a one-month history of fever and backache, followed by 15 days of blackish stool discoloration and two days of abdominal pain and reduced urine output. On clinical examination, he was hypoxic with respiratory distress with epigastric tenderness. Blood investigations and imaging were consistent with acute pancreatitis. A complete blood count with peripheral smear showed severe normocytic normochromic anemia and an increased myeloid series containing 50% myeloblasts and 30% monoblasts. Additionally, some cells displayed cytoplasmic vacuolations, with a reticulocyte count of 2%. These findings were suggestive of acute myeloid leukemia M5. Due to the poor Glasgow Coma Scale (GCS), he was intubated and placed on mechanical ventilation. Unfortunately, he did not improve despite treatment and succumbed to the illness.

Machine learning algorithm for ventilator mode selection, pressure and volume control.

Mechanical ventilation techniques are vital for preserving individuals with a serious condition lives in the prolonged hospitalization unit. Nevertheless, an imbalance amid the hospitalized people demands and the respiratory structure could cause to inconsistencies in the patient's inhalation. To tackle this problem, this study presents an Iterative Learning PID Controller (ILC-PID), a unique current cycle feedback type controller that helps in gaining the correct pressure and volume. The paper also offers a clear and complete examination of the primarily efficient neural approach for generating optimal inhalation strategies. Moreover, machine learning-based classifiers are used to evaluate the precision and performance of the ILC-PID controller. These classifiers able to forecast and choose the perfect type for various inhalation modes, eliminating the likelihood that patients will require mechanical ventilation. In pressure control, the suggested accurate neural categorization exhibited an average accuracy rate of 88.2% in continuous positive airway pressure (CPAP) mode and 91.7% in proportional assist ventilation (PAV) mode while comparing with the other classifiers like ensemble classifier has reduced accuracy rate of 69.5% in CPAP mode and also 71.7% in PAV mode. An average accuracy of 78.9% rate in other classifiers compared to neutral network in CPAP. The neural model had an typical range of 81.6% in CPAP mode and 84.59% in PAV mode for 20 cm H2O of volume created by the neural network classifier in the volume investigation. Compared to the other classifiers, an average of 72.17% was in CPAP mode, and 77.83% was in PAV mode in volume control. Different approaches, such as decision trees, optimizable Bayes trees, naive Bayes trees, nearest neighbour trees, and an ensemble of trees, were also evaluated regarding the accuracy by confusion matrix concept, training duration, specificity, sensitivity, and F1 score.

Identifying the Transients and Transformation Products in Hydroxyl Radical-Methimazole Reactions Using DFT and UPLC-Q-TOF MS/MS Approaches.

Oxidative reactions of the hydroxyl radical (·OH) with methimazole (MMI), an antithyroid drug, are crucial for understanding its fate in oxidizing environments. By synergistically integrating density functional theory and ultraperformance liquid chromatography-quadrupole time-of-flight tandem mass spectrometry (UPLC-Q-TOF MS/MS) techniques, we elucidated the transients and transformation products (TPs) arising from the ·OH-MMI reactions. We probed two hydrogen-atom abstraction (HA) reactions, three radical adduct formation reactions, and single electron transfer (SET) at the M06-2X/6-311++G(d,p)/SMD(water) level. All proposed reaction channels, except for HA from the methyl group and SET, were found to be barrier-free. SET is the dominant oxidation pathway, accounting for 44% of oxidations, as determined by branching ratio analysis. The selenium analogue, MSeI, exhibited minor reactivity differences compared to MMI, yet its overall patterns resembled those of ·OH-MMI reactions. TPs were generated experimentally by reacting MMI with ·OH produced by UV-photolysis of H2O2. Eight TPs were identified from an approximately 24% degradation of MMI using UPLC-Q-TOF MS/MS analysis, and an additional two TPs were identified from the approximately 52% degraded MMI sample. The exact identities of all of the TPs were established through their corresponding fragmentation patterns. This study elucidates the drug's susceptibility to free radical species under physiologically relevant conditions.

Verifying institutionally developed hybrid 3D-printed coaxial cylindrical phantom for patient-specific quality assurance in stereotactic body radiation therapy of hepatocellular carcinoma.

An accurate and reliable patient-specific quality assurance (PSQA) is crucial to ensure the safety and precision of Stereotactic body radiation therapy (SBRT) in treating Hepatocellular carcinoma (HCC). This study examines the effectiveness of a novel hybrid 3D-printed hybrid coaxial cylindrical phantom for PSQA in the SBRT of HCC. The study compared three different point dose verification techniques for PSQA: a traditional solid water phantom, two dimensional detector array I'MatriXX, and a newly developed hybrid 3D-printed phantom. Thirty SBRT HCC liver cases were examined using these techniques, and point doses were measured and compared to planned doses using the perpendicular composite method with solid water and I'MatriXX phantoms. Unlike the other two methods, the point dose was compared in true composite geometry using the hybrid 3D-printed phantom, which enhanced the accuracy and consistency of PSQA. The study aims to assess the statistical significance and accuracy of the hybrid 3D-printed phantom compared to other methods. The results showed all techniques complied with the institutional threshold criteria of within ± 3% for point-dose measurement discrepancies. The hybrid 3D-printed phantom was found to have better consistency with a lower standard deviation than traditional methods. Statistical analysis using Student's t-test revealed the statistical significance of the hybrid 3D-printed phantom technique in patient-specific point-dose assessments with a p-value < 0.01. The hybrid 3D-printed phantom developed institutionally is cost-effective and easy to handle. It has been proven to be a valuable tool for PSQA in SBRT for the treatment of HCC and has demonstrated its practicality and reliability.

Human exposure to methyl and butyl parabens and their transformation products in settled dust collected from urban, semi-urban, rural, and tribal settlements in a tropical environment.

The present study involved monitoring the distribution of two widely consumed parabens (methyl paraben (MeP) and butyl paraben (BuP)) and their transformation products in indoor dust from different categories of settlement (urban, semi-urban, rural, and tribal homes). The results revealed a prevalent occurrence of parabens in all the settlement categories. A non-normal distribution pattern for MeP and BuP levels across the sampling sites was noted. While comparing the residence time of parabens in dust samples, it was found that the half-lives of the analytes were greater in the dust from urban (MeP t1/2: 47.510 h; BuP t1/2: 22.354 h) and rural (MeP t1/2: 27.725 h and BuP t1/2: 31.500 h) areas. The presence of paraben metabolites, such as hydroxy methylparaben (OH-MeP), para hydroxy benzoic acid (p-HBA), and benzoic acid (BA) in dust samples supports their transformation within indoor spaces. The average daily intake of parabens through dust ingestion and dermal absorption by children was higher than adults. BuP was the prime contributor (>85%) to the total estradiol equivalency quotient (tEEQ) in all the settlement categories.

A multiplex immunoprofiling approach for detecting the co-localization of breast cancer biomarkers using a combination of Alexafluor - Quantum dot conjugates and a panel of chromogenic dyes.

There is a plethora of information embedded in a tissue section that the conventional IHC understands only partially. Predictive biomarkers for precision immuno-oncology heavily dependent on the spatial arrangement of cells and the co-expression patterns in the tissue sections. Here we have explored the versatility of indirect multiplex immunofluorescence (mIF) and indirect multiplex immunohistochemistry (mIHC) for the labeling of breast cancer prognostic markers in routinely processed, formalin-fixed paraffin-embedded (FFPE) tissues at high resolution. The multiplex immunohistochemistry protocol utilized sequential staining for the chromogenic immunolabelling of Estrogen Receptor α (ERα) or Progesterone Receptor (PR), Human Epidermal Growth Factor Receptor 2 (HER2), and Nucleoside diphosphate kinase 1 (NM23) by multicolor chromogens in different combinations. A feasible workflow for multiplex immunofluorescence was also effectively standardized for ERα, PR, and HER2 using combinations of commercially available Alexa Fluor and Quantum dots semiconductor nanocrystal conjugated secondary antibodies. Multiplex chromogenic immunolabeling revealed differential expression of the markers on the same slide. Kappa statistics revealed perfect agreement with uniplex immunohistochemistry. For multiplex fluorescence approach, surface receptor detection using Quantum dots and Alexa fluor dyes for cytoplasmic or nuclear markers performed well for profiling multiple co-localized biomarkers on a single paraffin tissue section. The technique developed reveals additional information such as co-expression, spatial relationships, and tumor heterogeneity, providing a deeper insight into developing combinatorial therapeutic strategies in clinical care. This high throughput workflow complements the outcomes of traditional IHC while saving tissue, time, labour, and reagents.

A novel fractional-order dead-time compensating controller for the wireless networks.

Wireless technology is becoming increasingly critical in industrial environments in recent years, and the popular wireless standards are WirelessHART, ZigBee, WLAN and ISA100.11a, commonly used in closed-loop systems. However, wireless networks in closed-loop control experience packet loss or drops, system delay and data threats, leading to process instability and catastrophic system failure. To prevent such issues, it is necessary to implement dead-time compensation control. Traditional techniques like model predictive and predictive PI controllers are frequently employed. However, these methods' performance is sluggish in wireless networks, with processes having long dead times and set-point variations, potentially affecting network and process performance. Therefore, this paper proposes a fractional calculus-based predictive PI compensator for wired and wireless networks in the process control industries. The proposed technique has been simulated and evaluated on industrial process models, including pressure, flow, and temperature, where measurement and control are carried out wirelessly. The wireless network's performance has been evaluated based on packet loss, reduced throughput, and increased system latency. The proposed compensator outperformed traditional methods, demonstrating superior set-point tracking, disturbance rejection, and delay compensation characteristics in the performance evaluations of the first, second, and third-order systems. Overall, the findings indicate that the proposed compensator enhances wireless networks' performance in the process control industry and improves system stability and reliability by reducing almost half of the overshoot and settling an average of 8.3927% faster than the conventional techniques in most of the systems.

A Novel Hybrid Harris Hawk-Arithmetic Optimization Algorithm for Industrial Wireless Mesh Networks.

A novel hybrid Harris Hawk-Arithmetic Optimization Algorithm (HHAOA) for optimizing the Industrial Wireless Mesh Networks (WMNs) and real-time pressure process control was proposed in this research article. The proposed algorithm uses inspiration from Harris Hawk Optimization and the Arithmetic Optimization Algorithm to improve position relocation problems, premature convergence, and the poor accuracy the existing techniques face. The HHAOA algorithm was evaluated on various benchmark functions and compared with other optimization algorithms, namely Arithmetic Optimization Algorithm, Moth Flame Optimization, Sine Cosine Algorithm, Grey Wolf Optimization, and Harris Hawk Optimization. The proposed algorithm was also applied to a real-world industrial wireless mesh network simulation and experimentation on the real-time pressure process control system. All the results demonstrate that the HHAOA algorithm outperforms different algorithms regarding mean, standard deviation, convergence speed, accuracy, and robustness and improves client router connectivity and network congestion with a 31.7% reduction in Wireless Mesh Network routers. In the real-time pressure process, the HHAOA optimized Fractional-order Predictive PI (FOPPI) Controller produced a robust and smoother control signal leading to minimal peak overshoot and an average of a 53.244% faster settling. Based on the results, the algorithm enhanced the efficiency and reliability of industrial wireless networks and real-time pressure process control systems, which are critical for industrial automation and control applications.

National HIV programme testing recommendations.

In recognition of the morbidity and mortality associated with human immunodeficiency virus (HIV), the Joint United Nations Programme on HIV/acquired immunodeficiency syndrome (AIDS) (UNAIDS) aims to end the epidemic by setting and striving to achieve the ambitious 95-95-95 targets. However, Singapore is still not performing well in the first UNAIDS target. The National HIV Programme (NHIVP) developed this set of recommendations based on an adaptation of major international guidelines from the World Health Organization and the US Centers for Disease Control and Prevention. The goals of this recommendation are: (1) to increase the uptake of HIV testing; (2) to allow earlier detection and identification of individuals with unrecognised HIV infection; (3) to facilitate linkage to clinical services; and (4) reduce further transmission of HIV infection in Singapore.

Local Corticosteroid Injection Versus Dry Needling in the Treatment of Lateral Epicondylitis.

Background Lateral epicondylitis (LE) is an inflammation or micro-tearing of the tendons that join the forearm muscles on the lateral aspect of the elbow. Primary treatment of LE includes rest from offending activity and corticosteroid therapy for pain control. Dry needling (DN) is a relatively new therapy for LE. This study examined the results of DN therapy with corticosteroid injection. We aimed to compare pain relief and improvements in functional disability of LE patients treated via DN and corticosteroid injection in a tertiary care center. Methodology A prospective randomized control study was conducted among 54 patients in the Orthopaedics Department of R L Jalappa Hospital from January 2022 to May 2022. Patients received either DN or injectable corticosteroid therapy, and treatment groups were randomized using single-blinded randomization with sealed envelopes. Patients were evaluated using the Patient-Related Tennis Elbow Evaluation (PRTEE) score before the intervention and four and eight weeks after the intervention. Results A total of 54 patients were included in the final analysis. The mean age in the DN group was 43.96 ± 8.15 years and 44.74 ± 8.33 years in the corticosteroid group. In the DN group, 17 (62.96%) patients were male, and in the corticosteroid group, 16 (59.26%) patients were male. The differences in the PRTEE score at the fourth and eighth-week follow-up with baseline value (pre-injection) were statistically significant (p < 0.001). Conclusions DN is a low-cost, minimally invasive, and low-risk therapy whereas corticosteroid therapy is costly and produces systemic side effects in the long term. In this study, during the last follow-up visit, the PRTEE score improved in the DN group compared to the corticosteroid group.

Silver-manganese nanocomposite modified screen-printed carbon electrode in the fabrication of an electrochemical, disposable biosensor strip for cystic fibrosis.

A silver-manganese nanocomposite was successfully prepared by the urea hydrolysis method and used to detect chloride ions in sweat electrochemically. The synthesis involves the reaction of manganese sulphate, silver nitrate, and urea at 100 °C for 24 h. The crystalline nature of the particle was studied by diffraction analysis and found to be mixed-phase oxides of manganese alongside the oxides of silver. Morphological studies revealed the presence of quasi-prism-like structures, which is characteristic of ß-MnO2. A disposable sensor was fabricated by screen-printing the catalyst and used for the electrochemical detection of chloride ions in sweat. The sensor exhibited good selectivity, a sensitivity of 22.93 ± 0.64 µA mM-1 cm-2 in solution and 3010 ± 60 µA (log mM) -1 cm-2 for the fabricated sensor strip with a detection range from 5 mM up to 200 mM. The detection limit is 207 ± 7 µM (S/N = 3) in solution and 17 ± 6 µM for the fabricated sensor strip. The relative standard deviation (RSD) of sensor response is 2.38%. A prototype of the biosensor strip was fabricated and validated using real samples. This brings the possibility of developing a real-time biosensor strip for cystic fibrosis in point-of-care testing applications.

Early Total Care Versus Damage Control Orthopedics in Floating Knee Injury: Analysis of Radiological and Functional Outcomes.

Introduction Floating knee injury (FKI) occurs as a result of a high-velocity impact. We assessed the radiological and functional outcomes of FKIs treated by various fixation methods, by damage control orthopedics (DCO) or early total care (ETC). Materials and methods We investigated 46 patients with FKI who were operated on between January 2013 and January 2018 at the RL Jalappa Hospital and Research Center, Kolar, India. Functional assessments were evaluated using Karlström and Olerud's criteria (KOC). Based on their treatments, the patients were divided into the damage control orthopedics group (n = 21) and the ETC group (n = 25). Statistical analyses were used to obtain and compare summary data. Results The data of 46 patients were collected. Fractures were classified using the modified Fraser's classification. Five patients were not included in the final analysis because of death due to complications in the immediate postoperative period. In patients managed by DCO, after radiological union, the functional outcome was excellent in three cases, good in eight, fair in seven, and poor in two. The average time required for radiological union of the femur was 10.75 ± 1.482 months (P = 0.001); for tibia union, it was 10.25 ± 1.682 months (P = 0.011). The average range of knee flexion was 85°± 16.059° (P = 0.001), which was statistically significant. In patients managed by ETC, there were six cases with an excellent functional outcome, 13 with a good outcome, and two with a fair outcome. The average time required for radiological union of the femur was 9.29 ± 1.765 months (P = 0.006); for the tibia, it was 9.05 ± 1.161 months (P = 0.012). The average range of knee flexion was 100° ± 10.954° (P = 0.001), which was statistically significant. Fat embolism was noted in eight cases; four of these patients died due to multiorgan dysfunction. This was the major life-threatening complication in the early definitive fixation group. In the DCO group, only three cases had fat embolism, with one death due to multiorgan dysfunction. Early postoperative infection was a concern in the ETC group, evident in six cases. Conclusion The classification system for FKI needs further research, which must include multiple parameters. Fracture classification and patient selection are crucial considerations in deciding the best treatment for a particular fracture.

The crosstalk of the human microbiome in breast and colon cancer: A metabolomics analysis.

The human microbiome's role in colon and breast cancer is described in this review. Understanding how the human microbiome and metabolomics interact with breast and colon cancer is the chief area of this study. First, the role of the gut and distal microbiome in breast and colon cancer is investigated, and the direct relationship between microbial dysbiosis and breast and colon cancer is highlighted. This work also focuses on the many metabolomic techniques used to locate prospective biomarkers, make an accurate diagnosis, and research new therapeutic targets for cancer treatment. This review clarifies the influence of anti-tumor medications on the microbiota and the proactive measures that can be taken to treat cancer using a variety of therapies, including radiotherapy, chemotherapy, next-generation biotherapeutics, gene-based therapy, integrated omics technology, and machine learning.

Recommendations for the use of antiretroviral therapy in adults living with HIV in Singapore.

Since the advent of combination antiretroviral therapy (ART), the mortality attributable to HIV infection has been reduced by 80%. Newer antiretroviral agents are highly efficacious, have minimal side effects as compared to older drugs, and can be formulated as combination tablets, which reduces patients' pill burden. Despite these advances, 680,000 people died of AIDS-related illnesses worldwide in 2020. The National ART and Monitoring Recommendations by the National HIV Programme are created to guide physicians on the prescribing of ART based on the patients' needs. These recommendations are based on international guidelines and tailored to the local context and unique domestic considerations. It is hoped that with the publication of these recommendations, the care of people living with HIV can be enhanced, bringing us closer to the ending of HIV in our lifetime.

An Arithmetic-Trigonometric Optimization Algorithm with Application for Control of Real-Time Pressure Process Plant.

This paper proposes a novel hybrid arithmetic-trigonometric optimization algorithm (ATOA) using different trigonometric functions for complex and continuously evolving real-time problems. The proposed algorithm adopts different trigonometric functions, namely sin, cos, and tan, with the conventional sine cosine algorithm (SCA) and arithmetic optimization algorithm (AOA) to improve the convergence rate and optimal search area in the exploration and exploitation phases. The proposed algorithm is simulated with 33 distinct optimization test problems consisting of multiple dimensions to showcase the effectiveness of ATOA. Furthermore, the different variants of the ATOA optimization technique are used to obtain the controller parameters for the real-time pressure process plant to investigate its performance. The obtained results have shown a remarkable performance improvement compared with the existing algorithms.

A Survey on the Application of WirelessHART for Industrial Process Monitoring and Control.

Industrialization has led to a huge demand for a network control system to monitor and control multi-loop processes with high effectiveness. Due to these advancements, new industrial wireless sensor network (IWSN) standards such as ZigBee, WirelessHART, ISA 100.11a wireless, and Wireless network for Industrial Automation-Process Automation (WIA-PA) have begun to emerge based on their wired conventional structure with additional developments. This advancement improved flexibility, scalability, needed fewer cables, reduced the network installation and commissioning time, increased productivity, and reduced maintenance costs compared to wired networks. On the other hand, using IWSNs for process control comes with the critical challenge of handling stochastic network delays, packet drop, and external noises which are capable of degrading the controller performance. Thus, this paper presents a detailed study focusing only on the adoption of WirelessHART in simulations and real-time applications for industrial process monitoring and control with its crucial challenges and design requirements.

A technique for quantifying the sensitivity of dosimetric tool gamma with 2D detector array in pretreatment IMRT plans by segment deletion method.

OBJECTIVES: Motivation of this study is to check the sensitivity of dosimetric tool gamma with 2D detector array combination when unexpected errors occur while transferring intensity-modulated radiation therapy treatment plans from planning system to treatment unit. METHODS: This study consists of 17 head and neck cancer patient's treatment plans. Nine types of verification plans are created for all 17 clinically approved treatment plans by consecutively deleting different segments (up to eight) one by one from each field of the plan. Decrement factor (χ) is introduced in our study which illustrated the degree of decay of gamma passing rate when intentional errors are introduced. We analyzed the data by two different methods-one without selecting the region of interest (ROI) in dose distributions and the other by selecting the region of interest. RESULTS: By linear regression, the absolute value of slopes is 0.025, 0.024 and 0.015 without ROI and 0.030, 0.027 and 0.015 with ROI for 2%/2 mm, 3%/3 mm and 5%/5 mm criteria, respectively. The higher absolute value of the fitted slope indicates the higher sensitivity of this method to identify erroneous plan in treatment unit. The threshold value for 2%/2 mm equivalent to 95% passing criteria in 3%/3 mm used in clinical practice is obtained as 83.44%. CONCLUSIONS: The 2D detector array with dosimetric tool gamma is less sensitive in detecting errors when unprecedented errors of segment deletion occur within the treatment plans.

An evaluation of antimicrobial potential of irreversible hydrocolloid impression material incorporated with chitosan.

AIM: To evaluate the antimicrobial potential of irreversible hydrocolloid impression material manipulated using chitosan impregnated solution at various time intervals. SETTING AND DESIGN: Evaluative invivo study design. MATERIALS AND METHODS: Maxillary impressions made for 20 dentulous volunteers using irreversible hydrocolloid impression material manipulated using distilled water as control and using 1% chitosan impregnated solution as test group using stock metal trays with one-week interval. Bacterial samples were collected using dry sterile cotton swab in the mid-palatal region at the time intervals of 0, 10, 20 minutes. Bacterial swabs were inoculated on nutrient agar media and incubated at 37° C for 24 hours. Bacterial colonies were counted with the aid of colony counter. STATISTICAL ANALYSIS USED: The resultant data was subjected to statistical analysis using repeated measures ANOVA and independent t test. RESULTS: Adding water soluble chitosan to irreversible hydrocolloid impression material resulted in superior antimicrobial activity. With the passage of time there was a significant decrease in the microbial colony count upto 10min (p=0.016). However, the rate of decrease of microbial colony count was statistically insignificant between the samples collected at 10 and 20 min. CONCLUSION: Incorporation of water soluble chitosan to irreversible hydrocolloid impression material showed significant antimicrobial activity in 10 minutes.