Assessing the Diagnostic Performance and Clinical Utility of Nasal Methicillin Resistant Staphylococcus aureus PCR Testing in Pediatric Orbital Cellulitis.

Data are limited on the clinical impact of nasal methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) testing (nMRSA-PCR) for orbital cellulitis. This two-center, retrospective study demonstrated a negative predictive value of 98.0% and an overall lower use of anti-MRSA antibiotics, without a concomitant increase in hospital readmission.

Hybrid Recommender System for Mental Illness Detection in Social Media Using Deep Learning Techniques.

Recommender systems are chiefly renowned for their applicability in e-commerce sites and social media. For system optimization, this work introduces a method of behaviour pattern mining to analyze the person's mental stability. With the utilization of the sequential pattern mining algorithm, efficient extraction of frequent patterns from the database is achieved. A candidate sub-sequence generation-and-test method is adopted in conventional sequential mining algorithms like the Generalized Sequential Pattern Algorithm (GSP). However, since this approach will yield a huge candidate set, it is not ideal when a large amount of data is involved from the social media analysis. Since the data is composed of numerous features, all of which may not have any relation with one another, the utilization of feature selection helps remove unrelated features from the data with minimal information loss. In this work, Frequent Pattern (FP) mining operations will employ the Systolic tree. The systolic tree-based reconfigurable architecture will offer various benefits such as high throughput as well as cost-effective performance. The database's frequently occurring item sets can be found by using the FP mining algorithms. Numerous research areas related to machine learning and data mining are fascinated by feature selection since it will enable the classifiers to be swift, more accurate, and cost-effective. Over the last ten years or so, there have been significant technological advancements in heuristic techniques. These techniques are beneficial because they improve the search procedure's efficiency, albeit at the potential sacrifice of completeness claims. A new recommender system for mental illness detection was based on features selected using River Formation Dynamics (RFD), Particle Swarm Optimization (PSO), and hybrid RFD-PSO algorithm is proposed in this paper. The experiments use the depressive patient datasets for evaluation, and the results demonstrate the improved performance of the proposed technique.

Enhanced skin burn assessment through transfer learning: a novel framework for human tissue analysis.

Visual inspection is the typical way for evaluating burns, due to the rising occurrence of burns globally, visual inspection may not be sufficient to detect skin burns because the severity of burns can vary and some burns may not be immediately apparent to the naked eye. Burns can have catastrophic and incapacitating effects and if they are not treated on time can cause scarring, organ failure, and even death. Burns are a prominent cause of considerable morbidity, but for a variety of reasons, traditional clinical approaches may struggle to effectively predict the severity of burn wounds at an early stage. Since computer-aided diagnosis is growing in popularity, our proposed study tackles the gap in artificial intelligence research, where machine learning has received a lot of attention but transfer learning has received less attention. In this paper, we describe a method that makes use of transfer learning to improve the performance of ML models, showcasing its usefulness in diverse applications. The transfer learning approach estimates the severity of skin burn damage using the image data of skin burns and uses the results to improve future methods. The DL technique consists of a basic CNN and seven distinct transfer learning model types. The photos are separated into those displaying first, second, and third-degree burns as well as those showing healthy skin using a fully connected feed-forward neural network. The results demonstrate that the accuracy of 93.87% for the basic CNN model which is significantly lower, with the VGG-16 model achieving the greatest accuracy at 97.43% and being followed by the DenseNet121 model at 96.66%. The proposed approach based on CNN and transfer learning techniques are tested on datasets from Kaggle 2022 and Maharashtra Institute of Technology open-school medical repository datasets that are clubbed together. The suggested CNN-based approach can assist healthcare professionals in promptly and precisely assessing burn damage, resulting in appropriate therapies and greatly minimising the detrimental effects of burn injuries.

Intelligent Wearable Devices Enabled Automatic Vehicle Detection and Tracking System with Video-Enabled UAV Networks Using Deep Convolutional Neural Network and IoT Surveillance.

The discipline of computer vision is becoming more popular as a research subject. In a surveillance-based computer vision application, item identification and tracking are the core procedures. They consist of segmenting and tracking an object of interest from a sequence of video frames, and they are both performed using computer vision algorithms. In situations when the camera is fixed and the backdrop remains constant, it is possible to detect items in the background using more straightforward methods. Aerial surveillance, on the other hand, is characterized by the fact that the target, as well as the background and video camera, are all constantly moving. It is feasible to recognize targets in the video data captured by an unmanned aerial vehicle (UAV) using the mean shift tracking technique in combination with a deep convolutional neural network (DCNN). It is critical that the target detection algorithm maintains its accuracy even in the presence of changing lighting conditions, dynamic clutter, and changes in the scene environment. Even though there are several approaches for identifying moving objects in the video, background reduction is the one that is most often used. An adaptive background model is used to create a mean shift tracking technique, which is shown and implemented in this work. In this situation, the background model is provided and updated frame-by-frame, and therefore, the problem of occlusion is fully eliminated from the equation. The target tracking algorithm is fed the same video stream that was used for the target identification algorithm to work with. In MATLAB, the works are simulated, and their performance is evaluated using image-based and video-based metrics to establish how well they operate in the real world.

Multiple heavy metal immobilization and strength improvement of contaminated soil using bio-mediated calcite precipitation technique.

Bio-mediated calcite precipitation potential for multiple heavy metal immobilization in contaminated soils at industrial, waste dump, abandoned mine, and landfill sites is not explored yet. This study includes investigation of bio-mediated calcite precipitation for strength improvement and immobilization of heavy metals, specifically lead (Pb), zinc (Zn), and hexavalent chromium (Cr(VI)), in contaminated soils. Firstly, the toxicity resistance of bacteria against different concentrations (1000, 2000, 3000, 4000, and 5000 mg/l) of each heavy metals was investigated and observed that Pb and Cr were less toxic to Sporosarcina pasteurii than Zn. The poorly graded sand was spiked with 333-2000 mg/kg concentrations of a selected individual or mixed metal solutions, i.e., 1000 mg/kg and 2000 mg/kg individual concentrations of Pb, Zn, and Cr(VI); 500 mg/kg and 1000 mg/kg concentration of each metal in "Pb and Zn," "Pb and Cr(VI)," and "Zn and Cr(VI)" mixture of heavy metals; and 333 mg/kg and 666 mg/kg concentration of each metal in "Pb, Zn, and Cr(VI)" mixed metal concentration. Contaminated soil was biotreated with Sporosarcina pasteurii and cementation (a solution of urea and calcium chloride dihydrate) solutions for 18 days. Biocemented sand specimens were subjected to testing of hydraulic conductivity, ultrasonic pulse velocity (UPV), unconfined compressive strength (UCS), calcite content, pH, toxicity characteristic leaching procedure (TCLP), X-ray diffraction (XRD), and scanning electron microscopy (SEM). The heavy metal contaminated samples showed decrease in hydraulic conductivity and increase in UPV and UCS after biotreatment; however, the changes in engineering properties were found more moderate than clean biocemented sand. The conversion of Cr(VI) to Cr(III) followed by Cr2O3 precipitation in calcite lattice was observed. Zn was precipitated as smithsonite (ZnCO3), while no Pb precipitate was identified in XRD results. TCLP leaching showed Pb and Cr immobilized proportional to calcite precipitated amount, and higher calcite amounts yielded levels within regulatory limits. Pb and Cr(VI) immobilization up to 92 % and 94 % was achieved, respectively, in contaminated biocemented sand. Zn was found completely leachable as smithsonite is only stable down to pH~5, and strongly acidic TCLP solution reversed all immobilization at natural soil pH~8-9.

Clozapine levels as a predictor for therapeutic response: A systematic review and meta-analysis.

OBJECTIVES: Clozapine levels may be a more useful predictor of therapeutic response than the dose, given the variability in clozapine metabolism between individuals. We therefore systematically reviewed and meta-analysed the impact of clozapine levels on response and/or relapse to provide guidance on optimal clozapine levels. METHODS: We systematically searched PubMed, PsycInfo and Embase for studies exploring clozapine levels and response and/or relapse. Our primary meta-analysis was rates of response above and below clozapine level thresholds of 350 ng/ml and 600 ng/ml. Secondary analyses were undertaken of mean clozapine levels, dose and concentration/dose (C/D) ratio and response and/or relapse. A meta-regression by study duration was conducted. RESULTS: Twenty studies met inclusion criteria. Clozapine levels above 350 ng/ml were associated with statistically significantly higher rates of response (OR 2.27 95% CI 1.40-3.67, p < 0.001), but not above 600 ng/ml (OR 1.40 95% CI 0.85-2.31, p = 0.19). Higher mean clozapine levels were associated with better rates of response (SMD 0.24, 95% CI 0.00-0.49, p = 0.05), and lower rates of relapse (SMD -0.72, 95% CI -1.26 to -0.19, p = 0.008). By contrast, neither clozapine dose nor C/D ratio was associated with differing rates of response. Similarly, study duration did not affect outcome. CONCLUSIONS: Our findings are in keeping with current guidelines that recommend targeting clozapine levels above 350 ng/ml before augmentation is considered. As some clozapine associated ADRs are dose dependent, levels above 600 ng/ml may have an unfavourable risk-benefit ratio.

Vasodilators for primary Raynaud's phenomenon.

BACKGROUND: Numerous agents have been suggested for the symptomatic treatment of primary Raynaud's phenomenon. Apart from calcium channel blockers, which are considered to be the drugs of choice, evidence of the effects of alternative pharmacological treatments is limited. This is an update of a review first published in 2008. OBJECTIVES: To assess the effects of drugs with vasodilator effects on primary Raynaud's phenomenon as determined by frequency, severity, and duration of vasospastic attacks; quality of life; adverse events; and Raynauds Condition Score. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases, and the World Health Organization International Clinical Trials Registry Platform and the ClinicalTrials.gov trial register to November 16, 2020. SELECTION CRITERIA: We included randomized controlled trials evaluating effects of oral, intravenous, and topical formulations of any drug with vasodilator effects on subjective symptoms, severity scores, and radiological outcomes in primary Raynaud's phenomenon. Treatment with calcium channel blockers was not assessed in this review, nor were these agents compared. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies for inclusion, assessed studies using the Cochrane "Risk of bias" tool, and extracted study data. Outcomes of interest included frequency, severity, and duration of attacks; quality of life (QoL); adverse events (AEs); and the Raynaud Condition Score (RCS). We assessed the certainty of the evidence using GRADE. MAIN RESULTS: We identified seven new studies for this update. In total, we included 15 studies involving 635 participants. These studies compared different vasodilators to placebo. Individual studies used different methods and measures to report different outcomes. Angiotensin-converting enzyme (ACE) inhibitors Combining data from three studies revealed a possible small increase in the frequency of attacks per week after treatment (captopril or enalapril) compared to placebo (mean difference [MD] 0.79, 95% confidence interval [CI] 0.43 to 1.17; low-certainty evidence). There was no evidence of a difference between groups in severity of attacks (MD -0.17, 95% CI -4.66 to 4.31; 34 participants, 2 studies; low-certainty evidence); duration of attacks (MD 0.54, 95% CI -2.42 to 1.34; 14 participants, 1 study; low-certainty evidence); or AEs (risk ratio [RR] 1.35, 95% CI 0.67 to 2.73; 46 participants, 3 studies; low-certainty evidence). QoL and RCS were not reported. Alpha blockers Two studies used alpha blockers (buflomedil or moxisylyte). We were unable to combine data due to the way results were presented. Buflomedil probably reduced the frequency of attacks compared to placebo (MD -8.82, 95% CI -11.04 to -6.60; 31 participants, 1 study; moderate-certainty evidence) and may improve severity scores (MD -0.41, 95% CI -0.62 to -0.30; moderate-certainty evidence). With moxisylyte, investigators reported fewer attacks (P < 0.02), less severe symptoms (P < 0.01), and shorter duration of attacks, but the clinical relevance of these results is unclear. No evidence of a difference in AEs between buflomedil and placebo groups was noted (RR 1.41, 95% CI 0.27 to 7.28; 31 participants, 1 study; moderate-certainty evidence). More AEs were observed in participants in the moxisylyte group than in the placebo group. Prostaglandin/prostacyclin analogues One study compared beraprost versus placebo. There was no evidence of benefit for frequency (MD 2.00, 95% CI -0.35 to 4.35; 118 participants, low-certainty evidence) or severity (MD -0.06, 95% CI -0.34 to 0.22; 118 participants, low-certainty evidence) of attacks. Overall, more AEs were noted in the beraprost group (RR 1.59, 95% CI 1.05 to 2.42; 125 participants; low-certainty evidence). This study did not report on duration of attacks, QoL, or RCS. Thromboxane synthase inhibitors One study compared a thromboxane synthase inhibitor (dazoxiben) versus placebo. There was no evidence of benefit for frequency of attacks (MD 0.8, 95% CI -1.81 to 3.41; 6 participants; very low-certainty evidence). Adverse events were not reported in subgroup analyses of participants with primary Raynaud's phenomenon, and the study did not report on duration of attacks, severity of symptoms, QoL, or RCS. Selective serotonin reuptake inhibitors One study compared ketanserin with placebo. There may be a slight reduction in the number of attacks per week with ketanserin compared to placebo (MD -14.0, 95% CI -27.72 to -0.28; 41 participants; very low-certainty evidence) and reduced severity score (MD -133.00, 95% CI -162.40 to -103.60; 41 participants; very low-certainty evidence). There was no evidence that ketanserin reduced the duration of attacks (MD -4.00, 95% CI -14.82 to 6.82; 41 participants; very low-certainty evidence), or that AEs were increased in either group (RR 1.54, 95% CI 0.89 to 2.65; 41 participants; very low-certainty evidence). This study did not report on QoL or RCS. Nitrate/nitrate derivatives Four studies compared topical treatments of nitroglycerin or glyceryl trinitrate versus placebo, each reporting on limited outcomes. Meta-analysis demonstrated no evidence of effect on frequency of attacks per week (MD -1.57, 95% CI -4.31 to 1.17; 86 participants, 2 studies; very low-certainty evidence). We were unable to pool any data for the remaining outcomes. Phosphodiesterase inhibitors Three studies compared phosphodiesterase inhibitors (vardenafil, cilostazol or PF-00489791) to an equivalent placebo. Results showed no evidence of a difference in frequency of attacks (standardized MD [SMD] -0.05, 95% CI -6.71 to 6.61; 111 participants, 2 studies; low-certainty evidence), severity of attacks (MD -0.03, 95% CI -1.04 to 0.97; 111 participants, 2 studies; very low-certainty evidence), duration of attacks (MD -1.60, 95% CI -7.51 to 4.31; 73 participants, 1 study; low-certainty evidence), or RCS (SMD -0.8, 95% CI -1.74 to 0.13; 79 participants, 2 studies; low-certainty evidence). Study authors reported that 35% of participants on cilostazol complained of headaches, which were not reported in the placebo group. PF-00489791 caused 34 of 54 participants to experience AEs versus 43 of 102 participants receiving placebo (RR 1.49). Headache was most common, affecting 14 participants (PF-00489791) versus nine participants (placebo). AUTHORS' CONCLUSIONS: The included studies investigated several different vasodilators (topical and oral) for treatment of primary Raynaud's phenomenon. Small sample sizes, limited data, and variability in outcome reporting yielded evidence of very low to moderate certainty. Evidence is insufficient to support the use of vasodilators and suggests that vasodilator use may even worsen disease.

Micro-mechanical performance evaluation of expansive soil biotreated with indigenous bacteria using MICP method.

This study explored the effect of indigenous bacteria present in the soil to stabilized swelling behavior and improving the mechanical property of expansive soil. The objective of the research is to investigate the effectiveness of the biostimulation microbial induced calcite precipitation (MICP) for controlling the swelling-shrinkage behavior and improving shear strength of expansive soil. An attempt was made to develop an effective procedure to culture the indigenous bacteria for treating clays with varying plasticity and improve their engineering behavior. The detailed procedure has been investigated to effectively apply the MICP technique in clay soil, considering its low permeable nature. The applicability of biostimulation to clayey soils in minimizing their swelling potential and improving the strength is assessed. Both macroscale and microscale studies were conducted on untreated and biostimulated soils to observe changes in plasticity, strength, swelling, mineralogical, chemical characteristics. The present method has shown an effective alternative to improve the road pavement subgrade without affecting the eco-system of natural soil. The method investigated the effective way of providing the enrichment and cementation solution in clayey soil, which is the major concern in current literature. The study confirms that the calcite content has been increased with biostimulated MICP treatment up to 205% in the treated specimens and which future increased the unconfined compressive strength and split tensile strength. A reduction in the swelling pressure and swell strain is also observed. The results show that a cost-effect and eco-friendly method can be deployed for stabilizing the road pavement subgrades. The statistical assessment using multivariate analysis and hierarchical clustering dendrogram has been carried out to investigate the effect of the MICP treatment protocol on different soil and engineering parameters.

How effective is the virtual primary healthcare centers? An experience from rural India.

INTRODUCTION: Virtual clinic is a new concept in India. This summary describes that how a virtual clinic is transforming the healthcare scenario in rural India. Virtual clinic is based on a social business model, which may involve diverse stakeholders to promote primary care. AIM: This virtual e-clinic aims to expand health outreach in rural and hard-to-reach areas of India and provide primary health care services by connecting local practitioners and health workers visiting patients with qualified allopathic doctors in city through video conferencing technologies. METHODOLOGY: This was a cross-sectional study evaluating the feasibility and acceptance of virtual primary care. A convenient sampling method was used. Data on demographic profiles, morbidity patterns, and referrals were collected with proper consent. This virtual clinic comprises of smartphones, monitors, and assistive devices so that patient can interact with the doctors through video-conferencing and can have authenticated prescriptions with standardized protocols. The private organization who initiated the virtual care program had two centers at the beginning and gradually expanded them to 20 in Uttar Pradesh. Consultations charges were kept minimum to no-profit, no-loss. Data were collected from January 2019 to June 2010. RESULTS: Total number of consultations made was 800. Out of 800 patients, 157 patients belonged to age group of ≥60 years. Mean age the patient was 56 ± 1.56 years, among them 421 (52.62%) were male. The participants actively engaged in clinical interactions and completed full sessions of consultations, which highlight the acceptability of the virtual care system and feasibility of effective patient-provider communication and service delivery using digital technologies. CONCLUSION: The concept of virtual primary care is becoming very popular in rural region where no qualified doctors are available. The initial results of this technological startup appears to be promising; however, it is necessary to evaluate the quality of care, health outcomes, potentials to integrate such innovations in existing primary care, and the legal as well as ethical issues in the future research.

Extensive hypertrophic lupus erythematosus: atypical presentation.

Lupus erythematosus (LE) is a disease with a wide spectrum of cutaneous and systemic manifestations. Clinical features of patients with LE show a great variation, and for this reason it is difficult to develop a unifying concept of this disease. Our objective is to present a case of hypertrophic LE with atypical morphology and extensive involvement, who responded favorably to isotretinoin. Diagnosis of hypertrophic lupus erythematosus (HLE) was confirmed by characteristic histopathological findings. Combination therapy with isotretinoin and hydroxychloroquine resulted in flattening and repression of previously refractory skin lesions. Sometimes, HLE lesions may present a diagnostic and therapeutic dilemma. In long standing lesions, squamous cell carcinoma may arise. Therefore, HLE requires adequate therapy with clinical and histopathological follow up.

Vesicular palmoplantar pityriasis rosea.

A 16-year-old young man presented with intensely itchy erythematous dermatitis on the body for 1 week and vesicular lesions on the palms and soles for 4 to 5 days. Lesions on the palms and soles were accompanied by severe burning and itching. The patient gave a history of sore throat and fever, 1 week prior to the onset of lesions. A general physical examination was normal, and cutaneous examination revealed multiple, well-defined erythematous scaly plaques with collaret scaling on the trunk and extremities (Figure 1). Vesicular lesions were seen on the palms and soles (Figure 2). The differential diagnoses we considered were pityriasis rosea and secondary syphilis. The possibility of dermatophytid, vesicular pityriasis rosea, and pompholyx was limited to the palms and sole lesions. Complete blood cell count was within normal limits. Results from antistreptolysin O titer, potassium hydroxide mount, and venereal disease research laboratory were negative. Skin biopsies were taken from the back and left palm. The biopsy specimen from the back revealed focal spongiosis, lymphocyte exocytosis, vacuolar changes in the basal layer, and perivascular lymphocytic infiltrate in the dermis (Figure 3). The biopsy obtained from the vesicular lesion on the left palm revealed an intraepidermal vesicle with no evidence of acantolytic process (Figure 4). A diagnosis of pityriasis rosea was made and the patient was started on clarithromycin 500 mg once a day for 7 days, along with antihistamines and emollients. The lesions faded dramatically in a very short period, and there was significant involution of almost all of the lesions after 7 days of clarithromycin. During the 6 months of follow-up, no recurrence was observed.