Enhancing Early Detection of Necrotizing Soft Tissue Infections: The Role of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Score.

Background There is great variation in the etiology, predisposing organisms, incidence, clinical characteristics, severity, and consequences of skin and/or subcutaneous tissue infections. Extensive necrosis of the subcutaneous tissues and fascia is a characteristic of necrotizing soft tissue infections, which are frequently deadly. To change the course of treatment, this study highlights the need to find a tool that can quickly and accurately identify patients with necrotizing fasciitis (NF) and assist in making an early treatment decision. Methodology A prospective evaluation of 30 individuals with soft tissue infections was conducted using the laboratory risk indicator for necrotizing fasciitis (LRINEC). The patients were classified as low, intermediate, and high risk for the start of NF based on their LRINEC score. To assess the importance of the LRINEC score in forecasting the start of NF and its clinical consequences, patients in each group underwent appropriate management and statistical analysis. Results This study included 28 males (93.3%) and two females (6.7%). The associated p-value, recorded as 0.039, signifies statistical significance in the observed area under the receiver operating characteristic (ROC) curve. The p-value in risk categorization was found to be 0.296, which suggests that LRINEC helps in risk categorization with 100% sensitivity when used as a screening tool. Conclusion The early detection of necrotizing soft tissue infections, such as NF, is vital. The LRINEC score, based on routine lab tests, accurately distinguishes these infections. With high sensitivity and significant p-values, it helps stratify patients, guiding timely interventions and saving lives.

Explainable lung cancer classification with ensemble transfer learning of VGG16, Resnet50 and InceptionV3 using grad-cam.

Medical imaging stands as a critical component in diagnosing various diseases, where traditional methods often rely on manual interpretation and conventional machine learning techniques. These approaches, while effective, come with inherent limitations such as subjectivity in interpretation and constraints in handling complex image features. This research paper proposes an integrated deep learning approach utilizing pre-trained models-VGG16, ResNet50, and InceptionV3-combined within a unified framework to improve diagnostic accuracy in medical imaging. The method focuses on lung cancer detection using images resized and converted to a uniform format to optimize performance and ensure consistency across datasets. Our proposed model leverages the strengths of each pre-trained network, achieving a high degree of feature extraction and robustness by freezing the early convolutional layers and fine-tuning the deeper layers. Additionally, techniques like SMOTE and Gaussian Blur are applied to address class imbalance, enhancing model training on underrepresented classes. The model's performance was validated on the IQ-OTH/NCCD lung cancer dataset, which was collected from the Iraq-Oncology Teaching Hospital/National Center for Cancer Diseases over a period of three months in fall 2019. The proposed model achieved an accuracy of 98.18%, with precision and recall rates notably high across all classes. This improvement highlights the potential of integrated deep learning systems in medical diagnostics, providing a more accurate, reliable, and efficient means of disease detection.

A Rare Case of Coronavirus Disease 2019 Encephalitis Mimicking Creutzfeldt-Jacob Disease in an Immunocompromised Patient: A Case Report.

Introduction: Coronavirus disease 2019 (COVID-19) encephalitis is characterized by viral entry into the brain, resulting in inflammation and a cascade of neuronal damage. Clinical manifestations include headaches, seizures, and movement disorders. A mortality rate of 20% and infrequent presentation make COVID-19 encephalitis a diagnostic challenge. Case Presentation: We hereby present the case of a 55-year-old man with a history of diabetes mellitus (potential impact on COVID-19 severity discussed in the supplementary material) presenting with altered sensorium, swelling in the left eye, and involuntary jerky limb movements. Neurological examination revealed neck rigidity, myoclonic jerks, and an extensor plantar response. Brain magnetic resonance imaging (MRI) was performed, which revealed cortical enhancement in the bifrontal, temporal, and occipital lobes. Rapid progression of myoclonus, altered sensorium, and cortical enhancement on MRI suggested Creutzfeldt-Jacob disease. After a thorough workup, the diagnosis was COVID-19 encephalitis with rhino-orbital mucormycosis. The treatment regimen consisted of adequate glycemic control, remdesivir injection, intravenous and retroorbital liposomal amphotericin, and levetiracetam. The patient's condition improved, and he was eventually discharged. Conclusion: This case illustrates the uncommon presentation of COVID-19 with neurological involvement and emphasizes the value of history-taking, neuroimaging, and cerebrospinal fluid analysis. A high index of suspicion is critical for a prompt diagnosis and initiating therapy.

Glomerulonephritis and Septic Pulmonary Embolism: A Rare but Life-Threatening Complication of Permanent Pacemaker Implantation.

Infection-related glomerulonephritis (IRGN) is an immunologically mediated glomerular injury triggered by an extrarenal infection. Infective endocarditis-associated glomerular nephritis is an entity caused by infection of the cardiac valves. IRGN is most common in children, and post-streptococcal glomerulonephritis (PSGN) is commonest in the age group of 2-14 years. In contrast to childhood PSGN and epidemic PSGN, which usually resolve completely with antibiotics, IRGN in adults has a guarded prognosis. Cardiovascular implantable electronic device-associated infective endocarditis (CIED-IE) is a phenomenon for which the incidence is on the rise (0.1-5.1%). The most frequent CIED-IE pathogens were staphylococci or other Gram-positive bacteria. CIED-IE poses difficult management problems for the clinician. We present the case of a 50-year-old patient with a pacemaker who was found to have infective endocarditis and septic embolism.

Understanding the Complexity of Hyperglycemic Emergencies: Exploring the Influence of the Type and Duration of Diabetes Mellitus and Its Impact on Mortality.

Background Diabetes mellitus remains a pressing global health issue, characterized by chronic metabolic dysfunction and the potential for life-threatening acute hyperglycemic emergencies. These emergencies, known as diabetic ketoacidosis and hyperosmolar hyperglycemic states, trigger a series of physiological disruptions. This article delves deeply into how the type and duration of diabetes mellitus affect the occurrence of hyperglycemic emergencies and mortality rates. Methods The study was conducted at the Institute of Internal Medicine, Rajiv Gandhi General Hospital, affiliated with Madras Medical College, spanning from July 2021 to December 2021. It encompassed both individuals newly diagnosed with diabetic ketoacidosis and patients already undergoing diabetic treatment who developed diabetic ketoacidosis and hyperosmolar hyperglycemic states. Results Within the study cohort of 110 patients, 37.27% were diagnosed with Type 1 diabetes mellitus, while 62.73% were classified as Type 2 diabetes mellitus patients. Among these individuals, 23.60% were newly diagnosed with diabetes, 22.70% had been diabetic for less than one year, 47.30% had a diabetic history of two to five years, and 6.40% had been diabetic for over six years. However, upon investigating the relationship between diabetes duration and mortality rate, no statistically significant findings were observed. Conclusion Hyperglycemic emergencies represent multifaceted clinical challenges influenced by the interplay of various factors, including the type and duration of the disease. By maintaining effective management of hyperglycemia from the outset and sustaining it throughout their lives, people with diabetes can improve their physical and mental health and reduce the likelihood of developing long-term complications that may negatively impact their overall well-being.

Carboplatin-Induced Hematuria With Obstructive Acute Kidney Injury.

Platinum-based chemotherapeutic agents such as cisplatin, carboplatin, and oxaliplatin are used as adjuvant or neoadjuvant agents in malignancies of the ovary, cervix, lymphoma, head and neck, and breast. Cisplatin is most commonly used until the carboplatin is approved by the Food and Drug Administration (FDA). Cisplatin is not tolerated in many patients due to severe nausea and renal tubular injury. Carboplatin is used in patients where side effects limit the uses of cisplatin. Although carboplatin is least commonly associated with hematuria, we report a case of carboplatin-induced hematuria with obstructive acute kidney injury (AKI). Our patient, a 63-year-old female diagnosed with triple-negative breast carcinoma and post-mastectomy, was started on adjuvant chemotherapy, with carboplatin 700 mg and paclitaxel 250 mg. She developed hematuria with ureter obstruction due to clots, resulting in obstructive AKI. The patient continued to have oliguria and worsening symptoms, and thus, the ureter was stented. The patient's renal function returned to the baseline. In this case, we highlight the fact that carboplatin can cause hematuria with ureter obstruction. Adequate hydration before infusing carboplatin as in cisplatin can reduce the complications.

A Case Series of Dengue Myocarditis: A Complication Observed in Dengue Patients.

Dengue is a prevalent arthropod-born viral disease with a wide spectrum of clinical presentations ranging from undifferentiated fever to a more severe form of the disease, dengue hemorrhagic fever, and dengue shock syndrome. However, atypical manifestations such as hepatic, neurological, cardiac, and kidney involvement are increasingly being reported, thus the term "expanded dengue syndrome". We report a series of cases with an atypical presentation of dengue fever marked by various cardiac manifestations, including cardiogenic shock secondary to myocardial involvement.

A Comparative Study on Survivors Versus Non-Survivors Among Diabetic Patients Having Mucormycosis.

Introduction Mucormycosis is a rare opportunistic fungal infection caused by fungi belonging to the Mucorales order and Mucoraceae family. It ranks as the third most prevalent angioinvasive fungal infection, following aspergillosis and candidiasis. This severe infection typically affects individuals with compromised immune systems, including those with hematological malignancies like leukemia and lymphoma, individuals who have undergone stem cell transplants, and people with diabetes mellitus. Individuals in good health are rarely affected, making immunocompromised individuals particularly vulnerable to this potentially fatal fungal disease. The aim of this study was to perform a comparative analysis of survivors versus non-survivors among diabetes patients admitted with mucormycosis. Methodology This was a descriptive observational study. A total of 338 patients were enrolled in the study. The study variables included demographics, COVID-19 infection, diabetes mellitus history, steroid use, use of oxygen support, and steam inhalation. Results Of the total 338 patients enrolled in the study, 253 (74.9%) were male and 85 (25.01%) were female. The number of survivors were 305 (90.2%) and non-survivors were 33(9.8%). The mean age of survivors was 52.50 ± 11.31 and non-survivors was 54.06 ± 8.54 years. Patients who underwent steam inhalation had a higher chance of survival compared to those who did not undergo steam inhalation and this association was statistically significant (p=0.01). Males showed a higher chance of survival (93.7%) as compared to females (80.0%). The associations between oxygen support, steroid use, and COVID-19 infection with the survival status were statistically non-significant. Conclusion There was a strong association between the history of steam inhalation and the outcome of mucormycosis among diabetes patients admitted with mucormycosis. Female patients demonstrated a higher fatality rate than males indicating a significant gender disparity observed in cases. Our findings may help to better identify and treat patients who are at higher risk for severe forms of mucormycosis.

Acute Methemoglobinemia Due to Crop-Flowering Stimulant (Nitrobenzene) Poisoning: A Case Report.

Nitrobenzene poisoning is an uncommon but serious form of intoxication. Nitrobenzene is used in dyes, paints, lubricating oils, and crop-flowering stimulants. Ingestion produces acute methemoglobinemia and cyanosis, which fails to produce improvement in high-flow oxygen therapy. We present here a case of a 25-year-old male presenting with diffuse headache, fatigue, and cyanosis after attempting suicide by consumption of 15 mL of 20% nitrobenzene. Oxygen saturation (SpO2) was 85% on room air and was not improving on oxygen therapy. Serum methemoglobin level was 22% of hemoglobin. The patient was treated with IV methylene blue and oral ascorbic acid along with supportive management. He attained recovery by day three and was subsequently discharged. Acute methemoglobinemia following nitrobenzene poisoning is of grave concern and demands timely identification and diligent management with methylene blue and ascorbic acid alongside supportive measures.

Sympathovagal Balance and Body Shape Index in Elite and Amateur Athletes: The Relationship Unraveled.

Background Heart rate variability (HRV) is one piece among a complex network of adaptations existent in athletes that help them gain a better understanding of their own physiology. Sympathovagal balance is one of the spectral components of HRV analysis and is used to assess the frequently changing oscillations of a healthy heart, which can help in gauging the response of cardiac function towards physiological stress during exercise. This index is extensively used in appraising cardiac autonomic modulation. An evaluation of body composition in athletes has become a critical consideration when tracking HRV, as it helps practitioners understand the role of the autonomic nervous system (ANS) in obesity. The body shape index (BSI), which is based on waist circumference (WC), is an anthropometric parameter with decent predictive ability when measuring centripetal obesity. In this regard, the current study is an attempt to unravel the relationship between BSI and sympathovagal balance during exercise performed on two different instruments (treadmill and ergometer) by elite and amateur athletes. Methods It was an observational case-control study that included 30 elite and 120 amateur athletes. Symptom-limited exercise testing was performed by athletes on a motorized treadmill and ergometer in the sports physiology laboratory of a rural medical college in central India. Different anthropometric parameters like BSI and body surface area (BSA) were also recorded. Short-term HRV extracted from electrocardiogram (ECG) recordings was obtained using the Power Lab system and HRV analysis by LabChart software. Results The sympathovagal ratio, i.e., ratio of low frequency (LF) to high frequency (HF) in elite and amateur male populations showed a higher value than that in females, indicating a dominant sympathetic response in the males. There was a significant (p=0.042) positive correlation (r=0.24) between BSI and LF/HF Ratio in amateur females during treadmill exercise, whereas a significant (p=0.049) negative correlation (r=-0.27) was obtained in amateur males during ergometer exercise. Hence, increased weight and BSI were found to be associated with high sympathetic dominance, indicating a sympathovagal imbalance. Conclusion We attempted to explore the interaction between BSI and LF/HF during exercise performed on two different instruments (treadmill and ergometer) by elite and amateur athletes, which can help in testing the response of cardiac function to stress experienced during exercise. The study's uniqueness stems from discovering the relationship between BSI and HRV and how this relationship impacts sports performance. BSI measurement in athletes, both elite and amateur, allows for the assessment and forecasting of potential autonomic activity under exercise-induced stress by linking HRV with BSI.

Examining Body Fat Percentage, Galvanic Skin Response, and Muscle Grip Strength in Female Hypothyroid Patients.

Background The thyroid gland is an indispensable organ exerting control over the activity of multiple organ systems including the autonomic nervous system. This study attempted to monitor the variations in autonomic function parameters such as galvanic skin response (GSR) and muscle grip strength (HGS) in conjunction with changes in body fat percentage (BFP). Methodology This case-control study was conducted among 40 female hypothyroid patients as cases and 40 age-matched female healthy volunteers as controls. Anthropometric data were collected using standard techniques. GSR and HGS were measured using Equivital Sensory Electronic Module and Grip Force Transducer, respectively. Data extraction and analysis were done using the LabChart software. Results The mean age of the 40 female hypothyroid patients was 30.14 ± 5.91 years, whereas the mean age of the female controls was 29.37 ± 6.59 years. The waist circumference of cases was 85.81 ± 10.39 cm while that of controls was 80.90 ± 11.18 cm. The BFP of cases was 35.38% ± 6.74% while that of controls was 31.72% ± 5.63%. The GSR amplitude showed a significant difference between hypothyroid and healthy volunteers with values of 1.34 ± 1.14 µS and 2.40 ± 1.86 µS, respectively. The HGS indices showed no significant difference between the two groups. A statistically negative correlation was noted between BFP and GSR amplitude (-0.32), whereas a positive correlation was noted between BFP and mean handgrip strength (0.31) in hypothyroid patients. Conclusions The changes in BFP and autonomic function through GSR and HGS were evaluated in female hypothyroid patients with respect to healthy females. The interrelationship between anthropometry and autonomic function was also explored in this study. The findings of this study can augment prognosis in patients and ensure timely corrective treatment for improving quality of life.

Assessing the Effect of the Anti-tuberculosis Drug Rifampicin on Known Hypertensive Patients With Tuberculosis in a Tertiary Care Center.

Background Epidemiological evidence suggests an indirect link between hypertension and tuberculosis, and several studies have reported that rifampicin has potentially diminished the hypotensive effects of many anti-hypertensive agents by inducing cytochrome P450. This study investigates rifampicin's effect on the target blood pressure in known hypertensive patients whose blood pressure had been previously controlled with anti-hypertensive drugs. Methodology This prospective observational study was conducted at the Institute of Internal Medicine, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, from June 2021 to December 2022. A total of 160 patients with known hypertension on anti-hypertensive drugs were recruited for this study. All these patients had been recently diagnosed with tuberculosis and had been treated with rifampicin-based anti-tuberculosis therapy (ATT). Results The maximum number of patients were under 50 years of age and predominantly male (67%). A total of 91 (57%) patients were hypertensive for less than five years, and the remaining patients were hypertensive within 6-10 years or more than 10 years. However, these patients had other comorbidities such as diabetes mellitus (32%) and coronary artery disease (27%). Before ATT, the mean systolic blood pressure (SBP)/diastolic blood pressure (DBP) was recorded to be 130/80 mmHg. The last six months' course of ATT showed mean values around 154/96 mmHg even after adding additional/multiple anti-hypertensive drugs. After discontinuation of ATT, the mean SBP/DBP was effectively 130/80 mmHg at four weeks. Conclusions Rifampicin significantly diminishes the hypotensive effects of many well-established anti-hypertensives such as calcium channel blockers, beta-blockers, and diuretics to maintain blood pressure.

A new distribution record of Albunea groeningi (Crustacea: Anomura: Decapoda: Albuneidae) from the Digha Coast, West Bengal, India.

Members of the genus Albunea Weber, 1795 (family Albuneidae) are commonly known as sand crabs. Albuneidae contains 59 species belonging to 13 genera (Boyko McLaughlin 2010; WoRMS 2019), of which four genera and nine species are known only as fossils. Most species are relatively uncommon and adapted to living in sandy habitats (Boyko Harvey 1999). Among the 24 species of Albunea, four are known only as fossils (WoRMS 2019). The diversity and distributions of most albuneids were reported by Boyko (2002, 2010).

Preconception nutrition intervention improved birth length and reduced stunting and wasting in newborns in South Asia: The Women First Randomized Controlled Trial.

South Asia has >50% of the global burden of low birth weight (LBW). The objective was to determine the extent to which maternal nutrition interventions commenced before conception or in the 1st trimester improved fetal growth in this region. This was a secondary analysis of combined newborn anthropometric data for the South Asian sites (India and Pakistan) in the Women First Preconception Maternal Nutrition Trial. Participants were 972 newborn of mothers who were poor, rural, unselected on basis of nutritional status, and had been randomized to receive a daily lipid-based micronutrient supplement commencing ≥3 months prior to conception (Arm 1), in the 1st trimester (Arm 2), or not at all (Arm 3). An additional protein-energy supplement was provided if BMI <20 kg/m2 or gestational weight gain was less than guidelines. Gestational age was established in the 1st trimester and newborn anthropometry obtained <48-hours post-delivery. Mean differences at birth between Arm 1 vs. 3 were length +5.3mm and weight +89g. Effect sizes (ES) and relative risks (RR) with 95% CI for Arm 1 vs. 3 were: length-for-age Z-score (LAZ) +0.29 (0.11-0.46, p = 0.0011); weight-for-age Z-score (WAZ) +0.22 (0.07-0.37, p = 0.0043); weight-to-length-ratio-for-age Z-score (WLRAZ) +0.27 (0.06-0.48, p = 0.0133); LAZ<-2, 0.56 (0.38-0.82, p = 0.0032); WAZ <-2, 0.68 (0.53-0.88, p = 0.0028); WLRAZ <-2, 0.76 (0.64-0.89, p = 0.0011); small-for-gestational-age (SGA), 0.74 (0.66-0.83, p<0.0001); low birth weight 0.81 (0.66-1.00, p = 0.0461). For Arm 2 vs. 3, LAZ, 0.21 (0.04-0.38); WAZ <-2, 0.70 (0.53-0.92); and SGA, 0.88 (0.79-0.97) were only marginally different. ES or RR did not differ for preterm birth for either Arm 1 vs. 3 or 2 vs. 3. In conclusion, point estimates for both continuous and binary anthropometric outcomes were consistently more favorable when maternal nutrition supplements were commenced ≥3 months prior to conception indicating benefits to fetal growth of improving women's nutrition in this population.

Biofibers and biocomposites from sabai grass: A unique renewable resource.

Natural cellulose fibers were extracted from a fast growing perennial grass Eulaliopsis binata (commonly known as Sabai) and characterized for their structure and properties. The untreated sabai grass has been used as reinforcement for polypropylene composites and properties of the composites have been investigated. Although the composition of the sabai grass is typical to other lignocellulosic sources, there is a high content of flavonoids (630 mg/g) and phenols (510 mg/g) which provides high antibacterial, and antifungal properties to the fibers and composites developed. Fiber bundles extracted from the grass had tensile strength of 493 MPa and tensile modulus of 21 GPa, similar to common natural cellulose fibers. Both tensile and flexural properties of polypropylene composites increased with increasing ratio of sabai grass. Polypropylene composites reinforced with sabai grass show high noise insulation and thermal resistance properties suggesting their suitability for automotive and building applications.

Rehabilitation of a total maxillectomy patient by three different methods.

Rehabilitation of a patient with orbital defect is highly a challenging task, requiring an individualized design of the technique for each patient. The disfigurement associated with the loss of facial structures causes significant emotional stress and physical burdens.Various treatment modalities are available, one of which is the use of implants. Although implant-supported orbital prosthesis has a superior outcome, it may not be advisable in all the patients due to economic factors. The treatment of choice includes the silicone orbital prosthesis due to its life-like appearance. This article describes three different techniques, it's advantages and limitations of fabricating a silicone orbital prosthesis for the same patient to achieve ideal fit and aesthetics.

Decolorization of sulfonated azo dye Metanil Yellow by newly isolated bacterial strains: Bacillus sp. strain AK1 and Lysinibacillus sp. strain AK2.

Two different bacterial strains capable of decolorizing a highly water soluble azo dye Metanil Yellow were isolated from dye contaminated soil sample collected from Atul Dyeing Industry, Bellary, India. The individual bacterial strains Bacillus sp. AK1 and Lysinibacillus sp. AK2 decolorized Metanil Yellow (200 mg L(-1)) completely within 27 and 12h respectively. Various parameters like pH, temperature, NaCl and initial dye concentrations were optimized to develop an economically feasible decolorization process. The maximum concentration of Metanil Yellow (1000 mg L(-1)) was decolorized by strains AK2 and AK1 within 78 and 84 h respectively. These strains could decolorize Metanil Yellow over a broad pH range 5.5-9.0; the optimum pH was 7.2. The decolorization of Metanil Yellow was most efficient at 40°C and confirmed by UV-visible spectroscopy, TLC, HPLC and GC/MS analysis. Further, both the strains showed the involvement of azoreductase in the decolorization process. Phytotoxicity studies of catabolic products of Metanil Yellow on the seeds of chick pea and pigeon pea revealed much reduction in the toxicity of metabolites as compared to the parent dye. These results indicating the effectiveness of strains AK1 and AK2 for the treatment of textile effluents containing azo dyes.