Classic paroxysmal nocturnal haemoglobinuria presenting with intestinal malabsorption syndrome, acute abdomen and acute kidney injury.

A male patient in his 30s presented with complaints of acute abdominal pain, black stools and red-coloured urine. CT revealed thrombi in the splenic and left renal veins, leading to infarctions. An endoscopy displayed scalloping of the duodenal folds, indicative of intestinal malabsorption syndrome (IMS). Histopathological examination confirmed IMS. Due to the presence of intravascular haemolysis, haemoglobinuria and thrombotic complications, paroxysmal nocturnal haemoglobinuria (PNH) was suspected and subsequently confirmed by flow cytometry. Thus, a diagnosis of classic PNH with IMS and thrombotic complications was established. This unique case highlights the coexistence of PNH and IMS, resembling the complement hyperactivation, angiopathic thrombosis and protein-losing enteropathy disease, suggesting potential shared pathophysiology.

Budget impact and cost-utility analysis of prophylactic emicizumab versus on-demand bypassing agents for adolescent severe haemophilia A patients with inhibitors in India.

Introduction: Severe Haemophilia A patients with inhibitors are currently being treated with bypassing agents like activated prothrombin complex concentrates (aPCC) and recombinant factor VIIa. Emicizumab is a recombinant humanized monoclonal antibody, introduced to reduce the bleeding events, improve treatment adherence, and quality of life. However, cost-effectiveness and long-term sustainability of the intervention is not studied in a low middle income setting like India. Aim: The primary objective of this study was to evaluate the cost-utility of Emicizumab compared to traditional bypassing agents in the treatment of severe haemophilia A patients with inhibitors in India. Secondary objective was to analyze the budgetary impact of introducing Emicizumab for this patient population from the perspective of public health system in India. Methods: Markov model was created to compare the prophylactic emicizumab therapy against bypassing agents for a hypothetical cohort of 10-year-old adolescents in India. The time horizon was 10 years and model built based on health system perspective. Cost utility was expressed as costs per quality-adjusted life-years (QALYs) gained. All costs were expressed as 2021 US dollars. Probabilistic sensitivity analysis was performed to check the robustness of the estimates. Results: Prophylactic emicizumab was a cost saving intervention with negative Incremental Cost Utility Ratio (ICUR) against recombinant factor VIIa of -853,573 USD (INR -63,109,773), and negative ICUR of -211,675 USD (INR -15,650,403) against APCC. The estimated total budget for treating all the severe Haemophilia A patients with inhibitors in India was USD 59,042,000 (INR 4,365,329,312) for 10 years' time horizon (per patient cost of USD 295,210 [INR 21,826,646.56]). Conclusion: Prophylactic emicizumab therapy is a cost saving intervention when compared to both the bypassing agents as it is less costly and more effective for severe Haemophilia A patients with inhibitors in India.

Can glycated haemoglobin (HbA1c) be used as a predictor of left ventricular diastolic dysfunction in non-hypertensive patients with newly diagnosed type 2 diabetes mellitus: a cross-sectional study at a tertiary care centre in Eastern India.

OBJECTIVES: This study was conducted to establish the association between glycated haemoglobin (HbA1c) and left ventricular diastolic dysfunction (LVDD) in non-hypertensive patients with newly diagnosed type 2 diabetes mellitus (DM) and determine the cut-off value of HbA1c for detecting LVDD. DESIGN: Cross-sectional study. SETTING: This study was conducted in General Medicine Department in collaboration with the Cardiology Department at All India Institute of Medical Sciences, Patna. PARTICIPANTS: The study population comprised patients with newly diagnosed type 2 DM within the past 3 months, aged between 18 years and 80 years, who were not hypertensive and without any systemic diseases and who presented to the General Medicine Department. PRIMARY AND SECONDARY OUTCOME MEASURES: The presence of LVDD was the primary outcome measure. RESULTS: Among the total of 60 participants, it was observed that age (adjusted odds ratio (AOR): 1.169, 95% CI: 1.066 to 1.283) and HbA1c (AOR: 2.625, 95% CI: 1.264 to 5.450) were found to be independent predictors for the presence of LVDD. Receiver operating characteristic analysis identified a cut-off value of HbA1c at 9.5% (80 mmol/mol) for detecting LVDD, with a specificity of 96.43%, a sensitivity of 37.5% and a positive predictive value (PPV) of 91.62%. CONCLUSIONS: This study demonstrated that age and HbA1c levels are independent predictors of LVDD in patients with newly diagnosed type 2 DM without hypertension. A cut-off value of 9.5% for HbA1c was identified with a high specificity and PPV for predicting LVDD in patients with newly diagnosed type 2 diabetes. This underscores the importance of conducting echocardiography in patients with newly diagnosed asymptomatic type 2 diabetes with HbA1c 9.5% or more to assess LVDD, allowing for prompt interventions if necessary and to decelerate the progression towards heart failure.

Association between acute liver injury & severity and mortality of COVID-19 patients: A systematic review and meta-analysis.

Background: Acute liver injury (ALI), a complication often seen in COVID-19 patients, can lead to severe liver damage, multi-organ failure, acute vascular events, and can potentially escalate to patient mortality. Given this, we initiated a meta-analysis to investigate the correlation between ALI and adverse outcomes in COVID-19 patients. Methods: We conducted an exhaustive search of databases, including Medline, Embase, PubMed Central, ScienceDirect, Google Scholar, and the Cochrane Library, from the November 2019 until January 2022. The quality of the included studies was evaluated using the Newcastle Ottawa (NO) scale. Our meta-analysis was carried out using a random-effects model and results were presented as pooled odds ratios (ORs) with their corresponding 95% confidence intervals (CIs). Results: Our analysis incorporated 20 studies involving a total of 13,850 participants, predominantly from China and the United States. According to the NO scale, the majority of these studies were categorized as low-quality. Patients with ALI faced approximately 7 times higher odds of severe COVID-19 symptoms (pooled OR = 7.09; 95%CI: 4.97 to 10.12) and over 5 times higher odds of mortality (pooled OR = 5.50; 95%CI: 3.37 to 8.99) when compared to those without ALI. Conclusion: Our findings affirm that ALI is a potent predictor of adverse outcomes, including severity and mortality, among COVID-19 patients. Recognizing and promptly addressing ALI in COVID-19 patients could be pivotal in improving prognosis and tailoring individualized patient management strategies. This underscores the need for clinicians to be vigilant about liver complications in the COVID-19 patients and integrate appropriate interventions in the treatment paradigm.

Efficacy of Interventions Based on WHO Multimodal Hand Hygiene Improvement Strategy in a Tertiary Care Hospital in Eastern India: A Quasi-Experimental Study.

The study aimed to evaluate the efficacy of the World Health Organization (WHO) multimodal hand hygiene improvement (WHO-5) strategy in enhancing hand hygiene compliance among health care workers at a tertiary care hospital. The interrupted time series study included preintervention, intervention, and postintervention phases, with 2 points of observation each during the pre- and postintervention phases. The baseline hand hygiene compliance was 16%, which improved to 43.9% after the intervention. Health care workers were 4 times more likely to adhere to proper hand hygiene postintervention (odds ratio [OR], 4.117). Independent predictors of hand hygiene compliance included the week of observation (week 3: adjusted odds ratio [AOR], 0.872; week 5: AOR, 3.427; and week 7: AOR, 4.713), health care worker type (consultants: AOR, 0.964; residents: AOR, 2.187; and interns: AOR, 6.684), daytime (AOR, 1.232), and "after" type of hand hygiene opportunity (AOR, 1.577). No significant differences were found in knowledge, attitude, and practices pre- and postintervention, and the interventions' effect was sustained and increased over time, supporting implementation in hospitals across India.

Effect of Target Power on Microstructure, Tribological Performance and Biocompatibility of Magnetron Sputtered Amorphous Carbon Coatings.

The tribological properties and preosteoblast behavior of an RF magnetron-sputtered amorphous carbon coating on a Si (100) substrate were evaluated. The graphite target power was varied from 200 to 500 W to obtain various coating structures. The amorphous nature of the coatings was confirmed via Raman analysis. The contact angle also increased from 58º to 103º, which confirmed the transformation of the a-C surface from a hydrophilic to hydrophobic nature with an increasing graphite target power. A minimum wear rate of about 4.73 × 10-8 mm3/N*mm was obtained for an a-C coating deposited at a 300 W target power. The 300 W and 400 W target power coatings possessed good tribological properties, and the 500 W coating possessed better cell viability and adhesion on the substrate. The results suggest that the microstructure, wettability, tribological behavior and biocompatibility of the a-C coating were highly dependent on the target power of the graphite. A Finite Element Analysis (FEA) showed a considerable increase in the Von Mises stress as the mesh size decreased. Considering both the cell viability and tribological properties, the 400 W target power coating was identified to have the best tribological property as well as biocompatibility.

The Effectiveness of Adjuvant Attangaogam (Athanam) Yoga Asana-Pranayamam Practices With Regard to Biochemical, Inflammatory, and Hematological Markers Among COVID-19 Patients at a Tertiary Care Hospital in Southern Tamilnadu.

Background and objective Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a highly contagious infectious disease that has affected many countries globally. Attangaogam, known in Sanskrit as "Ashtanga yoga", is a practice associated with the spiritual and cultural heritage of India whose origins can be traced back to the very dawn of civilization; the practice of yoga promotes health, healing, and longevity. This study aimed to analyze the effects of Attangaogam (Athanam) yoga asana-Pranayamam practice on biochemical, inflammatory, and hematological markers in the management of COVID-19. Materials and methods A prospective observational study was conducted from August 2021 to February 2022 among hospitalized adult patients of both sexes who consented to participate and tested positive for COVID-19 reverse transcription-polymerase chain reaction (RT-PCR). Convenience sampling was employed and the study was approved by Institutional Ethics Committee (VMCIEC/74/2021). Clinical details, inflammatory markers, D-dimer, lactate dehydrogenase (LDH), ferritin, procalcitonin (PCT), interleukin 6 (IL-6), and complete blood count (CBC) were analyzed for all the volunteering patients on admission and before commencing yoga-pranayamam practices. Also, the parameters were recorded after practicing the scheduled protocol: on the day of discharge, and after the first and third months of discharge. Microsoft Excel 2013 was used for statistical analysis. Results Of the 76 patients, 32 were followed up regularly; the mean age of the cohort was 50.6 ± 4.95 years, and 62% were males. All the patients attained normal oxygen saturation and got discharged in 7-14 days. The comparison of clinical, hematological, inflammatory, and biochemical investigations between pre- and post-Attangaogam yoga-Pranayamam practice sessions showed statistically significant differences and the patients attained normal levels for all variables within three months except for serum albumin. Conclusion Based on our findings, the practice of Attangaogam yoga-Pranayamam contributed to the successful treatment of COVID-19 with the early restoration of protracted hypermetabolic and hyperinflammatory markers to normal status. The evidence related to biomarkers revealed that the patients attained metabolic normalcy of cell health with the aid of personalized physical rehabilitation counteracting inflammation and promoting tissue repair thanks to holistic natural and innate immunity provided by Attangaogam yoga-pranayamam practices.

Investigation on Physico Chemical and X-ray Shielding Performance of Zinc Doped Nano-WO3 Epoxy Composite for Light Weight Lead Free Aprons.

This report addresses a way to reduce the usage of highly toxic lead in diagnostic X-ray shielding by developing a cost-effective, eco-friendly nano-tungsten trioxide (WO3) epoxy composite for low-weight aprons. Zinc (Zn)-doped WO3 nanoparticles of 20 to 400 nm were synthesized by an inexpensive and scalable chemical acid-precipitation method. The prepared nanoparticles were subjected to X-ray diffraction, Raman spectroscopy, UV-visible spectroscopy, photoluminescence, high-resolution-transmission electron microscope, scanning electron microscope, and the results showed that doping plays a critical role in influencing the physico-chemical properties. The prepared nanoparticles were used as shielding material in this study, which were dispersed in a non-water soluble durable epoxy resin polymer matrix and the dispersed materials were coated over a rexine cloth using the drop-casting method. The X-ray shielding performance was evaluated by estimating the linear attenuation coefficient (µ), mass attenuation coefficient (µm), half value layer (HVL), and X-ray percentage of attenuation. Overall, an improvement in X-ray attenuation in the range of 40-100 kVp was observed for the undoped WO3 nanoparticles and Zn-doped WO3 nanoparticles, which was nearly equal to lead oxide-based aprons (reference material). At 40 kVp, the percentage of attenuation of 2% Zn doped WO3 was 97% which was better than that of other prepared aprons. This study proves that 2% Zn doped WO3 epoxy composite yields a better particle size distribution, µm, and lower HVL value and hence it can be a convenient lead free X-ray shielding apron.

Effectiveness of nursing interventions for management of children with bronchial asthma: A systematic review and meta-analysis.

AIM: Nursing interventions include the preventive care that can support and guide the nurse's effort to provide asthma interventions for children. Hence, this review was done to assess the effectiveness of nursing interventions for management of childhood asthma. METHODS: We conducted a search in Medline, the Cochrane library, EMBASE, ScienceDirect and Google Scholar from 1964 until April 2022. Meta-analysis was done using a random-effects model and pooled weighted mean difference (WMD) or standardized mean difference (SMD) and/or risk ratio (RR) with 95% confidence intervals (CIs). RESULTS: Fourteen studies were analysed. The pooled RR was 0.49 for emergency visits (95% CI: 0.32 to 0.77) and 0.46 for hospitalizations (95% CI: 0.27 to 0.79). The pooled WMD was -1.20 for number of days with symptoms (95% CI: -3.50 to 1.11), -0.98 for number of nights with symptoms (95% CI: -2.94 to 0.98) and -0.69 for frequency of asthma attacks (95% CI: -1.19 to -0.20). The pooled SMD was 0.39 for quality of life (95% CI: 0.11 to 0.66) and 0.58 for asthma control (95% CI: -0.29 to 1.46). CONCLUSION: Nursing interventions were relatively effective in improving the quality of life and reducing asthma related emergencies, acute attacks and hospitalization amongst childhood asthma patients.

Diagnostic accuracy of ultrasonography for the confirmation of endotracheal tube intubation: a systematic review and meta-analysis.

AIM: Despite several studies and reviews reporting data accuracy of ultrasonography for confirmation of endotracheal intubation, there has been limited pooled evidence summarizing the diagnostic accuracy of this imaging modality, especially based on recent evidence. Hence, the current study reviews the recent literature and conducts a meta-analysis to compare the accuracy of ultrasonography for the confirmation of endotracheal tube placement. MATERIAL AND METHODS: We conducted a systematic search for all studies reporting the diagnostic accuracy of ultrasonography in the databases of Medline, EMBASE,PubMed Central, ScienceDirect, Google Scholar & Cochrane library from inception till December 2021. Meta-analysis was performed using STATA software "midas" package. RESULTS: Thirty-eight studies with 3,268 participants were included. Thepooled sensitivity was 98% (95% CI, 97%-99%) and specificity was 95% (95% CI, 90%-98%), respectively. The AUC was 0.98 (95%CI: 0.96-1.00). The pooled DOR was 1090 (95% CI, 408-2910). Pooled LRP was 19 (95% CI, 9-39) and pooled LRN was 0.02 (0.01-0.03). There was significant heterogeneity found in the outcome with significant chi-square tests and I2 statistics > 75%. CONCLUSION: Findings from our review demonstrate promise in the applicability of ultrasonography as a major diagnostic tool for confirming the endotracheal tube intubation.

Assessment of the Synergetic Performance of Nanostructured CeO2-SnO2/Al2O3 Mixed Oxides on Automobile Exhaust Control.

In order to control diesel exhaust emission, CeO2-SnO2/Al2O3 (CTA) mixed oxides were prepared and coated on perforated stainless steel (SS) filter plates, and the catalytic activities were analyzed in this work. The CeO2-SnO2 (different compositions of Ce/Sn-2:8; 1:1; 8:2) composites and Al2O3 were prepared separately via a co-precipitation approach, and CeO2-SnO2/Al2O3 (CTA) mixed oxides were attained by mechanical mixing of 75 wt% CeO2-SnO2 composites with 25 wt% Al2O3. X-ray diffraction (XRD) and Raman spectroscopy were performed for all three CeO2-SnO2/Al2O3 (CTA) mixed oxides; the CeO2-SnO2/Al2O3 (Ce/Sn-1:1) sample confirmed the presence of cubic and tetragonal mixed faces, which enhances the redox nature (catalytic activities). Various characterizations such as high-resolution transmission electron microscopy (HRTEM), Brunauer-Emmett-Teller (BET) analysis, X-ray photoelectron spectroscopy (XPS), and a scanning electron microscope (SEM) were employed on CeO2-SnO2/Al2O3 (Ce/Sn-1:1) sample to investigate the structural, textural, compositional, and morphological properties. The CeO2-SnO2/Al2O3 (Ce/Sn-1:1) sample was coated on a perforated stainless steel (SS) filter plate via a simple, cost-effective, and novel method, and an exhaust emission test for various compression ratios (CR), injection pressure (IP), and load (L) was completed using an AVL Digas analyzer. The CeO2-SnO2/Al2O3 (Ce/Sn-1:1) sample, with a size of 10.22 nm and a high surface area of about 73 m2 g-1, exhibit appreciable catalytic properties.

COVID-19 Severity and Mortality Among Chronic Liver Disease Patients: A Systematic Review and Meta-Analysis.

INTRODUCTION: Pre-existing comorbid conditions in COVID-19 patients are risk factors for developing severe disease and death. We aimed to determine the association of chronic liver disease (CLD), a comorbid condition, with severity of disease and death among COVID-19 patients. METHODS: We searched for studies reporting COVID-19 outcomes among CLD and non-CLD patients in databases including Medline, EMBASE, ScienceDirect, Google Scholar, and Cochrane Library from inception of the pandemic until February 2022. Risk of bias assessment was conducted by using the Newcastle-Ottawa Scale for assessing the quality of nonrandomized studies in meta-analyses. We conducted a meta-analysis with a random-effects model and reported pooled odds ratios (ORs) with 95% CIs. RESULTS: We included 40 studies with 908,032 participants. Most studies were conducted in China and the US. COVID-19 patients with CLD had significantly higher odds of having a severe form of COVID-19 (pooled OR = 2.44; 95% CI, 1.89-3.16) and death (pooled OR = 2.35; 95% CI, 1.85-3.00) when compared with COVID-19 patients without CLD. CONCLUSION: The presence of CLD is significantly related to adverse clinical outcomes among COVID-19 patients in terms of severity and mortality. Clinicians should develop a comprehensive intervention plan to manage these high-risk patients and reduce COVID-19-related deaths.

Formation of discrete periodic nanolayered coatings through tailoring of nanointerfaces-Toward zero macroscale wear.

Notwithstanding the success of nanolayered coatings in the reduction of wear at nano-/microscales, the improvement of the wear resistance at the macroscale remains an issue. Moreover, the effects of nanointerfaces in nanolayered coatings on their macrotribological properties are not understood well. This paper reports on the engineering of nanointerfaces in diamond-like C/Cr nanolayered coatings to tailor their characteristics including the degree of intermixing, defects, and Cr growth mode. The result was the fabrication of a coating with subnanometer-thick periodic albeit discrete Cr interlayers. This was achieved using our patented deposition technique. This coating contained less interfacial defects compared to classic nanolayered coatings with continuous nanolayers and presented record-breaking wear rates at the macroscale. Finite Element analysis was performed and micropatterning strategy was used to reduce the wear rate further. Last, we report on discovery of a dimensionless parameter that can be used to predict the wear resistance of carbon-based nanolayered coatings.

An Open Repository of Real-Time COVID-19 Indicators

The COVID-19 pandemic presented enormous data challenges in the United States. Policy makers, epidemiological modelers, and health researchers all require up-to-date data on the pandemic and relevant public behavior, ideally at fine spatial and temporal resolution. The COVIDcast API is our attempt to fill this need: operational since April 2020, it provides open access to both traditional public health surveillance signals (cases, deaths, and hospitalizations) and many auxiliary indicators of COVID-19 activity, such as signals extracted from de-identified medical claims data, massive online surveys, cell phone mobility data, and internet search trends. These are available at a fine geographic resolution (mostly at the county level) and are updated daily. The COVIDcast API also tracks all revisions to historical data, allowing modelers to account for the frequent revisions and backfill that are common for many public health data sources. All of the data is available in a common format through the API and accompanying R and Python software packages. This paper describes the data sources and signals, and provides examples demonstrating that the auxiliary signals in the COVIDcast API present information relevant to tracking COVID activity, augmenting traditional public health reporting and empowering research and decision-making.

Diagnostic accuracy of fine-needle aspiration cytology for lymphoma: A systematic review and meta-analysis.

BACKGROUND: Fine-needle aspiration cytology (FNAC) has become one of the most useful modalities for diagnosis and staging of lymphoma. However, diagnostic accuracy of this technique has been reported with varying results across several studies around the world. Hence, this meta-analysis was done to assess the accuracy of FNAC for lymphoma diagnosis. METHODS: We conducted a systematic search for all studies reporting the diagnostic accuracy of FNAC for lymphoma in the databases of PubMed Central, MEDLINE, EMBASE, MEDLINE, SCOPUS and Cochrane library from inception till January 2021. Meta-analysis was performed using STATA software "midas" package. RESULTS: Forty-seven studies with 7268 patients were included. The pooled sensitivity and specificity of FNAC for diagnosing lymphoma were 93% (95% CI, 90%-95%) and 97% (95% CI, 95%-98%), respectively. Likelihood ratio positive was 33.5 (95% CI, 18.5-60.7) and likelihood ratio negative was 0.07 (0.05-0.11) making the technique to occupy the left upper quadrant in LR scattergram indicating that FNAC can be used for confirmation and exclusion. There was significant heterogeneity with significant chi-square test and I2 statistic >75%. There was significant publication bias as per Deek's test and funnel plot. CONCLUSION: To summarize, our study found that FNAC has a vital role as a diagnostic tool for lymphoma with higher sensitivity and specificity. Further studies assessing the accuracy of FNAC on specific types of lymphoma is required.

RF magnetron sputtering mediated NiTi/Ag coating on Ti-alloy substrate with enhanced biocompatibility and durability.

Mechanically robust, biocompatible and corrosion resistant Ag doped NiTi (NiTi/Ag) coatings were formed on implant grade commercially pure titanium substrates by R.F. magnetron sputtering. Five samples with varying silver content (0, 1, 3, 7, and 10 at.%) were prepared by controlling the power applied to Ag and NiTi targets. The intensity of X-ray photoelectron spectra peaks corresponding to Ni2p, Ti2p, Ag3d components were found proportional to respective coating compositions. The soft Ag crystallites were decreased the roughness and crystallinity of NiTi/Ag. Among all compositions, NiTi/Ag coating with 3 at.% Ag exhibited lowest friction coefficient (0.1) and wear rate (0.69 × 10-07 mm3/N ∗ mm). Electrochemical corrosion measurements indicated that Ag incorporation increased the corrosion resistance of NiTi. Increase in Ag content shifted Ecorr values in the anodic direction, and reduced the current density by one-order-of-magnitude. When cultured on NiTi/Ag coating with 3 at.% Ag, human dermal fibroblast neonatal cells demonstrated highest cell viability. The fluorescence micrographic image of the immunostained cells showed a well grown actin filament network. Overall, NiTi/Ag coated titanium substrates were found to be a promising orthopedic implant material.