Fabrication of Multifunctional Tents Using Canvas Fabric.

Herein, this study was compiled to investigate a suitable solution for the fabrication and development of the multifunctional defense tent from previously reported research. The military always needs to protect their soldiers and equipment from detection. The advancement of infrared detection technology emphasizes the significance of infrared camouflage materials, reducing thermal emissions for various applications. Objects emit infrared radiation detectable by devices, making military targets easily identifiable. Infrared camouflage mitigates detection by lowering an object's infrared radiation, achieved by methods such as reducing surface temperature, which is crucial in designing military tents with infrared (IR) camouflage, considering water repellency and antibacterial features. Water repellency, as well as antimicrobial properties, in army tents is also important as they have to survive in different situations. All these problems should be addressed with the required properties; therefore, the authors try to introduce a new method from which multifunctional tents can be produced through economical, multifunctional, and sustainable materials that have IR protection, water repellency, ultraviolet (UV) protection, air filtration and permeability, and antimicrobial properties. There is still no tent that performs multiple functions at a time, even those functions that do not correlate with each other such as water repellency, IR protection, antimicrobial, and air permeability. So, a multifunctional tent could be the solution to all these problems having all the properties discussed above. In this study based on the literature review, authors concluded a method for the required tent for canvas fabric coated with zinc sulfide (ZnS), graphene oxide (GO), and zinc oxide (ZnO), or these materials should be incorporated in fiber formation because fiber composition has more impact. These multifunctional tents will be very beneficial due to their multifunctions like weather resistance, durability, and long life. These would help the army in their missions by concealing their soldiers and equipment from detection by cameras and providing filtered air inside the tent in case of gases or explosions. The proposed method will help to fulfill the stated and implied needs of customers.

Exploring mosquito abundance and Plasmodium infection through nested-PCR: implications for disease surveillance and control.

The Plasmodium is responsible for malaria which poses a major health threat, globally. This study is based on the estimation of the relative abundance of mosquitoes, and finding out the correlations of meteorological parameters (temperature, humidity and rainfall) with the abundance of mosquitoes. In addition, this study also focused on the use of nested PCR (species-specific nucleotide sequences of 18S rRNA genes) to explore the Plasmodium spp. in female Anopheles. In the current study, the percentage relative abundance of Culex mosquitoes was 57.65% and Anopheles 42.34% among the study areas. In addition, the highest number of mosquitoes was found in March in district Mandi Bahauddin at 21 °C (Tmax = 27, Tmin = 15) average temperature, 69% average relative humidity and 131 mm rainfall, and these climatic factors were found to affect the abundance of the mosquitoes, directly or indirectly. Molecular analysis showed that overall, 41.3% of the female Anopheles pools were positive for genus Plasmodium. Among species, the prevalence of Plasmodium (P.) vivax (78.1%) was significantly higher than P. falciparum (21.9%). This study will be helpful in the estimation of future risk of mosquito-borne diseases along with population dynamic of mosquitoes to enhance the effectiveness of vector surveillance and control programs.

Assessment of Different Indices as Predictors of Difficult Airway in Obese Patients.

Introduction Difficulties with tracheal intubation contribute to the morbidity and mortality associated with anesthesia. Suggested predictors for difficult airway include, history of obstructive sleep apnea, high Mallampati score, elderly, male, short neck, and high Wilson score. However, none of these has high diagnostic accuracy particularly in obese population. Parameters used to quantify obesity such as Body Mass Index(BMI), mid arm circumference, skin fold thickness, etc. have not been used as independent predictors of difficult airway. This study has been designed to evaluate the accuracy of commonly used tools to assess difficult airway and to test other obesity markers as scale for assessing difficult airway i.e. Bag mask ventilation grade ≥3 or Cormack-Lehane Grade≥3 on Direct Laryngoscopy or number of intubation attempts ≥3. Aim To assess BMI, Mallampati grading, Neck circumference and Thyromental distance as predictors of difficult airway in obese patients and to validate neck circumference to thyromental distance ratio and skin fold thickness as a tool for assessment of difficult airway (Bag mask ventilation grade ≥3 or Cormack-Lehane Grade≥3 on Direct Laryngoscopy or number of intubation attempts ≥3.) in obese patients. Methods This prospective observational study was carried out on 51 obese patients (as per BMI) of ASA grade II, either sex, aged 23 to 57 years posted for elective surgery under general anesthesia with endotracheal intubation. After subjective assessment of difficult airway following data sets and variables were obtained - sex, weight, height, body mass index (BMI), Modified Mallampati class (MPG), Cormack-Lehane (CL) grade, adequacy of bag mask ventilation (BMV), number of endotracheal intubation attempts, patient's neck circumference (NC), thyromental distance (TMD), waist-hip ratio (WHR) and Skin fold thickness. The observations made during the study were statistically analyzed and correlated as predictors for difficult airway. Result Correlation of MPG to CL-grade (r-0.41, p-0.003), BMV (r-0.31, p-0.028) & No. of intubation attempts (r-0.37, p-0.007) was mild & statistically significant. Correlation of Neck Circumference with CL-grade (r-0.57, p-0.000), & No. of intubation attempts (r-0.62, p-0.000), found moderate & statistically significant, & with BMV was mild and statistically significant (r-0.48, p-0.000). Correlation of Thyromental Distance to CL-grade (r-0.65, p-0.000), BMV (r-0.70, p-0.000) & No. of intubation attempts (r-0.61, p-0.000) was moderate & statistically significant. Correlation of BMI to CL-grade (r-0.11, p-0.428), BMV (r-0.04, p-0.757) & No. of intubation attempts (r-0.16, p-0.257) was weak & not significant. Skin Fold Thickness showed no significant association with Difficult airway i.e., CL Grade (p-0.478), BMV (p-0.101), and No. of intubation attempts (p-0.143). Correlation of NC/TMD ratio with BMV (r-0.74, p-0.000), CL-grade (r-0.76, p-0.000), & No. of intubation attempts (r-0.77, p-0.000) was moderate & statistically significant. Conclusion NC, TMD and NC/TMD Ratio depicted a close association with airway difficulty in obese patients. Obesity grade is a risk factor for difficult airway but predictors of obesity including Skin Fold Thickness, individually did not show association with difficult airway (small sample size may be a limiting factor). None of the commonly performed tests alone has proven to be adequate in predicting difficult intubation in the obese population.

Stegomyia indices and pattern recognition of Aedes aegypti (Diptera: Culicidae) in selected agrogeoclimatic zones of Punjab, Pakistan.

Mosquito-borne diseases especially, dengue is gaining currency nowadays in Pakistan. As there is no approved dengue vaccine available worldwide, prevention and control of vector is the only solution amid prevailing circumstances. The present study is a maiden attempt to screen indoor and outdoor breeding containers for the presence of Aedes (Ae.) aegypti larvae from selected study districts of Punjab, Pakistan i.e., Dera Ghazi Khan (DG Khan), Chakwal, and Faisalabad. A total of 384 houses from each study districts were surveyed for a calendar year. Mosquito larvae were collected, preserved, and identified using standard taxonomic keys. House Index (HI), Container Index (CI), and Breteau Index (BI) were estimated. Chi-square analysis was applied to calculate the association between Ae. aegypti larvae and breeding containers. Chakwal was identified with the highest values of Stegomyia indices (HI = 46.61 %, BI = 91.67 %, and CI = 15.28 %) followed by Faisalabad (HI = 34.11 %, BI = 68.75 % and, CI = 13.04 %) and DG Khan (HI = 28.39 %, BI = 68.23 % and, CI = 11.29 %). Earthen jars, tree holes, and water tanks were found significantly (p < 0.05) associated with the abundance of larvae irrespective of the geographical location. However, flower tubs and plastic buckets were found significantly (p < 0.05) associated in Faisalabad and Chakwal while, tyres and plastic bottles were found associated (p < 0.05) with the abundance of Ae. aegypti larvae in Faisalabad and DG Khan. These findings will help the stakeholders to devise appropriate preventive measures in combating the risk of dengue transmission.

Inflicting Significant Losses in Slaughtered Animals: Exposing the Hidden Effects of Parasitic Infections.

We started a campaign in the heart of Faisalabad, Punjab, Pakistan, to expose the hidden threats of parasitic illnesses in ruminants and the severe financial consequences associated with them. Our in-depth investigations focused on the prevalence, impact, and astounding financial losses brought on by organ contamination in slaughtered animals. Of the 384 slaughtered ruminants examined for gastrointestinal parasites, a prevalence of 44.79% was recorded. It is interesting to note that we found no conclusive association between parasitic infection and the various ruminant species under study (p > 0.05). However, goats (52.0%) had the highest numerical prevalence of parasitic infection, followed by cattle (46.1%), buffalo (46.0%), and sheep (34.7%) in that order. A significant finding (p < 0.05) showed that the majority of animals had light parasitism (46.5%), as opposed to those with moderate (30.2%) or severe loads (23.2%). Our research revealed substantial (p < 0.05) relationships between ruminant age, sex, and parasitic infection prevalence. In comparison to females (56.4%) and adults (48.1%), males (36.1%) and young (36.9%) ruminants showed considerably decreased infection rates (p < 0.05). On the other hand, we discovered a non-significant (p > 0.05) association between the months and the prevalence of parasitic infection. As a result of the condemnation of contaminated organs such as the rumen, lungs, and liver, an estimated financial loss of PKR 133,731,400 (USD = 466,939.2) was incurred. The yearly economic losses caused by liver condemnation were much greater than those caused by rumen and lung condemnation (p < 0.05). Our research not only reported a significantly higher abundance but also economic threats of the parasitic diseases among the slaughtered animals in Faisalabad, Punjab, Pakistan. Our findings highlighted the critical need for preventive and therapeutic interventions for parasitic infections in animals, in order to mitigate the economic losses through strengthened animal health.

A Comparative Study of Morphine and Clonidine as an Adjunct to Ropivacaine in Paravertebral Block for Modified Radical Mastectomy.

Background General anesthesia (GA) is a standard for breast malignant surgery. The issue of postoperative pain as well as the high occurrence of nausea and vomiting have prompted the quest for a superior methodology for tormenting the executives with fewer complications. Over the most recent couple of years, paravertebral block (PVB) has acquired huge fame either in combination with GA or alone for anesthetic management. In this study, we aim to evaluate the efficacy of morphine and clonidine as an adjunct to ropivacaine in PVB in breast cancer patients undergoing modified radical mastectomy. Methods In this study, a total of 90 patients were divided into the following three groups (30 each) based on a computer-generated random table. Group C (control): PVB with 0.25% ropivacaine (19 ml) 1 ml saline; Group M: PVB with 0.25% ropivacaine (19 ml) + 20 microgram/kg body weight morphine; Group N: PVB with 0.25% ropivacaine (19 ml) + 1.0 microgram/kg body weight clonidine. The postoperative pain intensity was recorded using the visual analog scale (VAS), and sedation was observed by the Ramsay Sedation Scale (RSS) score. Results The VAS was similar at zero hours, two hours, and four hours in the postoperative period among all the groups. There was a significant (p = 0.003) difference in VAS from six hours to 20 hours in the postoperative period among the groups. A significant (p < 0.05) difference was observed among the groups at eight hours to 20 hours. The first requirement of analgesia was significantly (p = 0.001) higher in Group N (7.70 ± 1.74) than in Group C (4.43 ± 1.43) and Group M (7.33 ± 2.21). Conclusion Morphine in the PVB provides better postoperative analgesia. The consumption of rescue analgesia was significantly reduced in the morphine group as compared to the clonidine group. The procedure also proved to be safe as no complication was encountered in the PVB in our study.

Emerging memristive artificial neuron and synapse devices for the neuromorphic electronics era.

Growth of data eases the way to access the world but requires increasing amounts of energy to store and process. Neuromorphic electronics has emerged in the last decade, inspired by biological neurons and synapses, with in-memory computing ability, extenuating the 'von Neumann bottleneck' between the memory and processor and offering a promising solution to reduce the efforts both in data storage and processing, thanks to their multi-bit non-volatility, biology-emulated characteristics, and silicon compatibility. This work reviews the recent advances in emerging memristive devices for artificial neuron and synapse applications, including memory and data-processing ability: the physics and characteristics are discussed first, i.e., valence changing, electrochemical metallization, phase changing, interfaced-controlling, charge-trapping, ferroelectric tunnelling, and spin-transfer torquing. Next, we propose a universal benchmark for the artificial synapse and neuron devices on spiking energy consumption, standby power consumption, and spike timing. Based on the benchmark, we address the challenges, suggest the guidelines for intra-device and inter-device design, and provide an outlook for the neuromorphic applications of resistive switching-based artificial neuron and synapse devices.

Surviving Pneumonia: A Rare Outcome of Compensatory Hyperinflation in Fibrotic Lung Disease.

Chronic respiratory insufficiency can result from respiratory infections like pneumonia, which can permanently harm the lungs and respiratory system. A 21-year-old female patient arrived at our emergency medicine department (ED) complaining of acute lower-limb pain that worsened when she walked. She also reported feeling weak and having an acute, undiagnosed fever that was resolved by taking medicine two days after the day of admission. She was found to have a body temperature of 99.4°F, decreased air entry on the left side of the chest, and diminished bilateral plantar responsiveness. With the exception of a low calcium level and an increased liver function test, her biochemical indicators were normal. The left lung's basal region had fibrosis, and the right lung's hyperplasia served as a compensatory mechanism, according to the chest radiograph and CT scan of the thorax. The patient underwent treatment with intravenous pantoprazole, ondansetron, ceftriaxone, multivitamin supplementation, gabapentin, and tablets of amitriptyline. On Day 7, her lower limb pain had significantly recovered. After an eight-day hospital stay, she was discharged with instructions to follow up with the pulmonary medicine outpatient department (OPD) and the neurology OPD. A well-known occurrence known as compensatory hyperinflation of the lung happens when one lung is severely injured or rendered inoperable, leading the other lung to enlarge to make up for the loss of respiratory function. This case demonstrates the ability of the respiratory system to compensate for significant damage to one of the lungs.

Resistive random access memory: introduction to device mechanism, materials and application to neuromorphic computing.

The modern-day computing technologies are continuously undergoing a rapid changing landscape; thus, the demands of new memory types are growing that will be fast, energy efficient and durable. The limited scaling capabilities of the conventional memory technologies are pushing the limits of data-intense applications beyond the scope of silicon-based complementary metal oxide semiconductors (CMOS). Resistive random access memory (RRAM) is one of the most suitable emerging memory technologies candidates that have demonstrated potential to replace state-of-the-art integrated electronic devices for advanced computing and digital and analog circuit applications including neuromorphic networks. RRAM has grown in prominence in the recent years due to its simple structure, long retention, high operating speed, ultra-low-power operation capabilities, ability to scale to lower dimensions without affecting the device performance and the possibility of three-dimensional integration for high-density applications. Over the past few years, research has shown RRAM as one of the most suitable candidates for designing efficient, intelligent and secure computing system in the post-CMOS era. In this manuscript, the journey and the device engineering of RRAM with a special focus on the resistive switching mechanism are detailed. This review also focuses on the RRAM based on two-dimensional (2D) materials, as 2D materials offer unique electrical, chemical, mechanical and physical properties owing to their ultrathin, flexible and multilayer structure. Finally, the applications of RRAM in the field of neuromorphic computing are presented.

Fatal Curiosity: A Case of Suicidal Attempt by Abrus Seeds Consumption Through Online Research.

Abrus precatorius (Jequirity, Indian liquorice, rosary bead, Gunja, or rati) seeds are highly toxic and are often ingested as a means of suicide in India. Gastric symptoms like bleeding, diarrhea, vomiting, and epigastric pain are the common manifestations of this toxicity. Abrin, a toxic substance found in the seeds, is structurally and functionally similar to ricin and is considered even more fatal. We report the first case of Abrus precatorius poisoning, where the internet was utilized to procure a potentially deadly poison with the intention to commit suicide in north India. Such actions are relevant to the medical field, particularly regarding the potential risks associated with the unsupervised procurement and misuse of toxic substances. The case highlights the potentially fatal consequences of ingesting Abrus seeds and the need for prompt medical attention in such cases.

Practice Patterns and Management Protocols in Trauma across Indian Settings: A Nationwide Cross-sectional Survey.

Background: Trauma is the leading cause of death in India resulting in a significant public health burden. Indian Society of Critical Care Medicine (ISCCM) has established a trauma network committee to understand current practices and identify the gaps and challenges in trauma management in Indian settings. Material and methods: An online survey-based, cross-sectional, descriptive study was conducted with high-priority research questions based on hospital profile, resource availability, and trauma management protocols. Results: Data from 483 centers were analyzed. A significant difference was observed in infrastructure, resource utilization, and management protocols in different types of hospitals and between small and big size hospitals across different tier cities in India (p < 0.05). The advanced trauma life support (ATLS)-trained emergency room (ER) physician had a significant impact on infrastructure organization and trauma management protocols (p < 0.05). On multivariate analysis, the highest impact of ATLS-trained ER physicians was on the use of extended focused assessment with sonography in trauma (eFAST) (2.909 times), followed by hospital trauma code (2.778 times), dedicated trauma team (1.952 times), and following trauma scores (1.651 times). Conclusion: We found that majority of the centers are well equipped with optimal infrastructure, ATLS-trained physician, and management protocols. Still many aspects of trauma management need to be prioritized. There should be proactive involvement at an organizational level to manage trauma patients with a multidisciplinary approach. This survey gives us a deep insight into the current scenario of trauma care and can guide to strengthen across the country. How to cite this article: Sodhi K, Khasne RW, Chanchalani G, Jagathkar G, Kola VR, Mishra M et al. Practice Patterns and Management Protocols in Trauma across Indian Settings: A Nationwide Cross-sectional Survey. Indian J Crit Care Med 2023;27(1):38-51.

Inflammation-based scores as predictors of treatment response in advanced adrenocortical carcinoma.

Treatment for advanced adrenocortical carcinoma (ACC) consists of mitotane alone or combined with etoposide, doxorubicin, and cisplatin (EDP). Although both therapies are widely used, markers of response are still lacking. Since inflammation-based scores have been proposed as prognostic factors in ACC, we aimed to investigate their role in predicting the response to first-line chemotherapy. We performed a retrospective analysis of patients with advanced ACC treated with mitotane monotherapy or EDP ± mitotane. Clinical parameters (tumour stage at diagnosis, resection status, Ki67, time from diagnosis to treatment start, performance status, plasma mitotane levels, time in mitotane target ≥ 80%, clinically overt cortisol hypersecretion), and pretreatment inflammation-based scores (neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio, derived neutrophil-to-lymphocyte ratio) were investigated. The primary endpoints were overall survival (OS) and time-to-progression (TTP) from treatment initiation, the secondary endpoint was the best objective response to treatment. We included 90 patients (59% = women, median age = 51 years) treated with mitotane monotherapy (n = 40) or EDP ± mitotane (n = 50). In the mitotane monotherapy cohort, NLR ≥ 5 and PLR ≥ 190 predicted shorter OS (hazard ratio (HR): 145.83, 95% CI: 1.87-11,323.83; HR: 165.50, 95% CI: 1.76-15,538.04, respectively), remaining significant at multivariable analysis including clinical variables. NLR was also associated with shorter TTP (HR: 2.58, 95% CI: 1.28-5.20), but only at univariable analysis. Patients with NLR ≥ 5 showed a worse treatment response than those with NLR < 5 (P = 0.040). In the EDP ± mitotane cohort, NLR ≥ 5 predicted shorter OS (HR: 2.52, 95% CI: 1.30-4.88) and TTP (HR: 1.95, 95% CI: 1.04-3.66) at univariable analysis. In conclusion, inflammation-based scores, calculated from routinely measured parameters, may help predict response to chemotherapy in advanced ACC.

Discovery and evaluation of biphenyl derivatives of 2-iminobenzimidazoles as prototype dual PTP1B inhibitors and AMPK activators with in vivo antidiabetic activity.

This work describes the synthesis of series hydrobromides of N-(4-biphenyl)methyl-N'-dialkylaminoethyl-2-iminobenzimidazoles, which, due to the presence of two privileged structural fragments (benzimidazole and biphenyl moieties), can be considered as bi-privileged structures. Compound 7a proved to activate AMP-activated kinase (AMPK) and simultaneously inhibit protein tyrosine phosphatase 1B (PTP1B) with similar potency. This renders it an interesting prototype of potential antidiabetic agents with a dual-target mechanism of action. Using prove of concept in vivo study, we show that dual-targeting compound 7a has a disease-modifying effect in a rat model of type 2 diabetes mellitus via improving insulin sensitivity and lipid metabolism.

Comparative study of intubating conditions and hemodynamic changes during awake fiber-optic intubation using midazolam with fentanyl versus dexmedetomidine in cases of difficult airway.

Background: The aim of the study is to compare intubating conditions and hemodynamic changes during awake fiber-optic intubation (AFOI) using midazolam and fentanyl versus dexmedetomidine in cases of difficult airway. Materials and Methods: A randomized prospective study was conducted in the department of oral and maxillofacial surgery, with a total of 60 patients, 18-55 years of age, ASA class I-II, of either sex with anticipated difficult airway planned for elective surgery. They were divided into two groups; group I patients received 1 µg/kg of dexmedetomidine and then an infusion of 0.5 to 0.7 µg/kg/hr of dexmedetomidine, whereas group II patients received 1 µg/kg of intra-venous (iv) fentanyl and 0.05 mg/kg of iv midazolam with additional doses of 0.02 mg/kg to achieve a Ramsay Sedation Scale score of ≥2. The ease of placement of the fiber-optic scope and the endotracheal tube and the patient's reaction to placement of the fiber-optic scope were assessed on a scale of 1-4 and were recorded as endoscopist satisfaction score and patient discomfort score, respectively. Results: The endoscopy time ranged from 2.66 ± 1.00 (group I) to 3.90 ± 0.96 (group II) minutes and was found to be statistically significant (p < 0.05). Also, the patient discomfort score was recorded during endoscopy (1-4) and ranged from 1.3 ± 0.53 (group I) and 2.33 ± 0.66 (group II) and was found to be statistically significant (p value < 0.05). Patients undergoing the procedure who received dexmedetomidine were thus more comfortable than those who received fentanyl and midazolam combination. Conclusion: Dexmedetomidine provided better intubating conditions, patient tolerance, higher endoscopist satisfaction, and reduced hemodynamic responses compared to fentanyl and midazolam combinations. Also, the major advantage of dexmeditomidine for preservation of airway with a lesser degree of respiratory depression allows for safer use of AFOI in cases of difficult airway.

Memristive Switching and Density-Functional Theory Calculations in Double Nitride Insulating Layers.

In this paper, we demonstrate a device using a Ni/SiN/BN/p+-Si structure with improved performance in terms of a good ON/OFF ratio, excellent stability, and low power consumption when compared with single-layer Ni/SiN/p+-Si and Ni/BN/p+-Si devices. Its switching mechanism can be explained by trapping and de-trapping via nitride-related vacancies. We also reveal how higher nonlinearity and rectification ratio in a bilayer device is beneficial for enlarging the read margin in a cross-point array structure. In addition, we conduct a theoretical investigation for the interface charge accumulation/depletion in the SiN/BN layers that are responsible for defect creation at the interface and how this accounts for the improved switching characteristics.

Conductive Bridge Random Access Memory (CBRAM): Challenges and Opportunities for Memory and Neuromorphic Computing Applications.

Due to a rapid increase in the amount of data, there is a huge demand for the development of new memory technologies as well as emerging computing systems for high-density memory storage and efficient computing. As the conventional transistor-based storage devices and computing systems are approaching their scaling and technical limits, extensive research on emerging technologies is becoming more and more important. Among other emerging technologies, CBRAM offers excellent opportunities for future memory and neuromorphic computing applications. The principles of the CBRAM are explored in depth in this review, including the materials and issues associated with various materials, as well as the basic switching mechanisms. Furthermore, the opportunities that CBRAMs provide for memory and brain-inspired neuromorphic computing applications, as well as the challenges that CBRAMs confront in those applications, are thoroughly discussed. The emulation of biological synapses and neurons using CBRAM devices fabricated with various switching materials and device engineering and material innovation approaches are examined in depth.

Sepsis in Critically Ill Patients: Epidemiology, Risk Factors, and Role of Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry for Identification of Sepsis-Causing Organisms.

Background Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) is a rapid mass spectrometry technology for species identification. It is a useful, fast, and accurate tool for routine laboratory analysis. This study aimed to investigate the epidemiology of sepsis-causing organisms in patients admitted to tertiary-level intensive care units (ICU), the role of MALDI-TOF MS in species identification, and patients' clinical outcomes. Methodology A prospective observational study was performed in a tertiary-level ICU for one year. The first blood, urine, and endotracheal (ET) aspirate samples were sent before starting antibiotics. We received the antibiotic sensitivity report within 48 hours or earlier using MALDI-TOF MS. Treatment was modified based on MALDI-TOF MS reports. Response to treatment was monitored, and clinical outcomes were noted based on ICU stay. Patients were followed up until discharge, shifting to referring parent unit, or death. Results This study included 200 patients admitted to ICUs who at the time of admission did not have a fever. The most common organisms were Acinetobacter baumannii , Klebsiella pneumonia, and Escherichia coli in ET aspirates; Candida albicans and Enterococcus faecium in urine; and Pseudomonas aeruginosa , K. pneumonia, and A. baumaniiin blood. Of the 200 patients, 130 (65%) shifted to the parent unit ward, and 70 (35%) patients died, with an ICU stay of 12.89 ± 6.51 days. There was no significant difference in mortality when organisms grew from either ET or urine compared with sterile samples. If organisms resistant to all primary antibiotics grew from ET, mortality was 60.6%. Mortality was 56.8% if isolates were in the blood. Conclusions Early MALDI-TOF MS-based species identification and appropriate antibiotics initiation play a key role in the treatment and care for critically ill patients with sepsis. MALDI-TOF MS has the potential to significantly aid sepsis management.

Validation of the Postnatal Growth and Retinopathy of Prematurity (GROP) screening criteria.

Background: Retinopathy of prematurity (ROP) is a leading cause of irreversible blindness in infants. The Postnatal Growth and ROP (G-ROP) study proposed new screening criteria for ROP. This study aimed to validate the G-ROP screening criteria in a group of Iranian premature infants who were treated in the neonatal intensive care unit (NICU) for at least 40 days. Methods: In this retrospective study, we extracted the data pertaining to infants admitted to the NICU from January 2020 to December 2021. We screened all the included infants for ROP based on the Iranian national screening criteria. We applied the G-ROP criteria to our study population, and if no criterion was met, the infant was exempted from ROP screening. We determined the sensitivity and specificity of the G-ROP guidelines for ROP detection, along with its capacity for predicting the requirement for ROP treatment. Moreover, we compared the G-ROP guidelines with the Iranian and North American guidelines for ROP screening. Results: A total of 166 premature infants with complete datasets were included: 130 had ROP, of whom 61 were treated. There were 109 female infants (65.7%). The mean (standard deviation [SD]) birth weight and gestational age were 1080 (256) g and 28.28 (1.97) weeks, respectively. Applying the G-ROP criteria, 127 of 130 infants with ROP were identified (sensitivity, 97.69%; 95% confidence interval [CI], 95.11% - 100%), and of 36 infants without ROP, three were correctly excluded (specificity, 8.33%; 95% CI, 0% - 17.36%). The G-ROP criteria did not fail to identify infants who required treatment for ROP (sensitivity, 100%; 95% CI, 98.29 - 100) and had a specificity of 8.69% (95% CI, 2.04% - 15.34%). Although the Iranian and North American criteria had 100% sensitivity for infants with any stage of ROP, they could not detect infants without ROP (0% specificity). Conclusions: The G-ROP screening criteria had a sensitivity of 100% in identifying infants requiring treatment for ROP in our high-risk group; however, specificity was not sufficiently high. Further studies with larger numbers of referred infants could confirm a decrease in the burden of retinal examinations using these criteria.

Concurrent Trypanosomosis, Babesiosis and Toxocarosis in a Dog: a Case Report.

Background: Among the blood-borne parasitic infections of dogs, trypanosomosis and babesiosis are highly prevalent in the Indian subcontinent and highly pathogenic. Methods: A six-month-old dog was presented with complaint of lethargy, anorexia and loss of body weight over the previous 15 days on October 11, 2021. A full clinical and targeted haematologic and parasitological examination was undertaken. Results: Wet smears were positive for the motile trypanosomes while stained thin blood smears showed large number of extracellular trypanosomes and intra-erythrocytic ring-like inclusion bodies of Babesia spp. A high burden of Toxocara canis was identified on coprological examination. Conclusion: This report describes the clinical manifestation of concurrent infection of haemoparasites and gastrointestinal nematodes in Pakistani dogs, and highlights the importance of prompt veterinary intervention.

Structural and functional outcomes of pars plana vitrectomy in patients with lamellar macular hole.

PURPOSE: To investigate the short-term functional and microstructural outcomes of pars plana vitrectomy (PPV) without gas tamponade in lamellar macular holes (LH). MATERIALS AND METHODS: In this prospective case series, LH cases diagnosed by optical coherence tomography (OCT) underwent PPV with epiretinal membrane (ERM) removal and internal limiting membrane peeling without gas tamponade. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA) and OCT imaging preoperatively and 3 months after the surgery. RESULTS: Among 22 eyes, 10 degenerative (Deg) LH, 8 tractional (Trac) LH, and 4 mixed-type LH were assessed. After the surgery, anatomical closure occurred in 20 eyes (91%) without any significant difference between LH subgroups. Comparing preoperative and postoperative values, no significant changes was detected regarding BCVA neither totally (P = 0.5) nor in subgroups (P for Deg = 1.0, Trac = 0.71, Mix = 0.18). The overall central foveal thickness was increased significantly after surgery (P < 0.01), but in subgroup analysis, the increase was significant only for Trac LH (P = 0.02). The tractional LH eyes had less ellipsoid zone (EZ) disruptions compared to Deg or mixed subgroups before surgery. There were no changes in EZ integrity before and after the surgery. In regression analysis, no correlation was found between demographic or clinical characteristics and anatomical closure or BCVA improvement postoperatively. CONCLUSION: PPV resulted in 91% anatomical closure of all cases of LH but without functional improvement in short-term. Further prospective clinical trials with larger sample size and longer follow-up would be required to confirm the clinical significance of these findings.