Virgin coconut oil - its methods of extraction, properties and clinical usage: a review.

Abstract: Virgin coconut oil (VCO) is a processed edible oil, which is removed from the mature coconuts. It is a colourless water insoluble liquid and obtained by the hot and cold extraction processes. The nutritional components of VCO are mainly contributed to by lauric acid, its primary content. VCO has shown its anticancer, antimicrobial, analgesic, antipyretic and antiinflammatory properties. Because of these medicinal properties, VCO has gained the wider attention among the medical field. Most evidently VCO has shown its potential antioxidant property, because of its phenolic compounds and medium chain fatty acids. It is one of the beneficial compounds used to prevent and treat the oxidative stress induced neurological disorders like stress, depression and Alzheimer's disease. Dietary supplementation of VCO is easy and economical and safer in daily life among all age groups. It is also beneficial for the cardiovascular, respiratory, dermatological, reproductive and bone health. It can also be applied to the skin as a moisturizer in the paediatric age group. Hence, exploration of antioxidant property as well as other beneficial effects of VCO in various health conditions will be valuable.

Association of ABO blood groups with the severity of coronary artery disease in southern India population: A prospective cross-sectional study.

This study aimed to find an association between ABO blood groups with presence and severity of Coronary artery disease (CAD) among Indian population. 1500 patients undergoing elective coronary angiogram (CAG) at a tertiary care hospital in Karnataka were enrolled in the study. Baseline demographic data and the presence of cardiac comorbidities were documented. Data from baseline echocardiography and angiographic studies were compiled. The incidence of CAD was higher among patients with blood group A. Blood group A also showed a higher incidence of acute coronary syndrome (ACS), left ventricular dysfunction, triple vessel disease, and severe CAD among the patients who underwent CAG.

Novel Radiomics Features for Automated Detection of Cardiac Abnormality in Patients with Pacemaker.

Cardiac pacemakers are used in the treatment of patients with symptomatic bradycardia. The pacemaker paces the heart at the predetermined rate to maintain uninterrupted cardiac activity. Usually, pacemaker lead will be connected to the right atrium (RA) and right ventricle (RV) in dual-chamber pacemaker implantation and RV alone in single-chamber pacemaker implantation. This alters the route of proper conduction across the myocardial cells. The cell-to-cell conduction transmission in pacing delays the activation of selected intraventricular myocardial activation. Pacing-induced cardiomyopathy (PICM) is most commonly defined as a drop in left ventricle ejection fraction (LVEF) in the setting of chronic, high-burden right ventricle (RV) pacing. Currently, very few effective treatments are standard for PICM which rely on the detection of the RV pacing. Such treatments have primarily focused on upgrading to cardiac resynchronization therapy (CRT) when LVEF has dropped. However, the early and accurate detection of these stress factors is challenging. Cardiac desynchrony and interventricular desynchrony can be determined by various echocardiographic techniques, including M-mode, Doppler method, tissue Doppler method, and speckle tracking echocardiography which is subjective measures and shows a significant difference between RV and LV preejection period where the activation of LV is delayed considerably. Computer-aided diagnosis (CAD) is a noninvasive technique that can classify the ultrasound images of the heart in pacemaker-implanted patients and healthy patients with normal left ventricular systolic function and further detect the variations in pacemaker functions in its early stage using heart ultrasound images. Developing such a system requires a vast and diverse database to reach optimum performance. This paper proposes a novel CAD tool for the accurate detection of pacemaker variations using machine learning models of decision tree, SVM, random forest, and AdaBoost. The models have been used to extract radiomics features in terms of textures and then screened by their Relief-F scores for selection and ranking to be classified into nine groups consisting of up to 250 radiomics features. Ten best features were fed to the machine learning models. The R-wave dataset achieved a maximum test performance accuracy of 97.73% with four features in the random forest model. The T-wave dataset achieved a maximum test performance accuracy of 96.59% with three features in the SVM model. Our experimental results demonstrate the system's robustness, which can be developed as an early and accurate detection system for pacing-induced cardiomyopathy.

A 20-44 GHz Wideband LNA Design Using the SiGe Technology for 5G Millimeter-Wave Applications.

This paper presents the design and implementation of a low-noise amplifier (LNA) for millimeter-wave (mm-Wave) 5G wireless applications. The LNA was based on a common-emitter configuration with cascode amplifier topology using an IHP's 0.13 µm Silicon Germanium (SiGe) heterojunction bipolar transistor (HBT) whose f_T/f_MAX/gate-delay is 360/450 GHz/2.0 ps, utilizing transmission lines for simultaneous noise and input matching. A noise figure of 3.02-3.4 dB was obtained for the entire wide bandwidth from 20 to 44 GHz. The designed LNA exhibited a gain (S_21) greater than 20 dB across the 20-44 GHz frequency range and dissipated 9.6 mW power from a 1.2 V supply. The input reflection coefficient (S_11) and output reflection coefficient (S_22) were below -10 dB, and reverse isolation (S_12) was below -55 dB for the 20-44 GHz frequency band. The input 1 dB (P1dB) compression point of -18 dBm at 34.5 GHz was obtained. The proposed LNA occupies only a 0.715 mm2 area, with input and output RF (Radio Frequency) bond pads. To the authors' knowledge, this work evidences the lowest noise figure, lowest power consumption with reasonable highest gain, and highest bandwidth attained so far at this frequency band in any silicon-based technology.

TB case fatality and recurrence in a private sector cohort in Mumbai, India.

BACKGROUND: Half of India´s three million TB patients are treated in the largely unregulated private sector, where quality of care is often poor. Private provider interface agencies (PPIAs) seek to improve private sector quality of care, which can be measured in terms of case fatality and recurrence rates.METHODS: We conducted a retrospective cohort survey of 4,000 private sector patients managed by the PATH PPIA between 2014 and 2017. We estimated treatment and post-treatment case-fatality ratios (CFRs) and recurrence rates. We used Cox proportional hazards models to identify predictors of fatality and recurrence. Patient loss to follow-up was adjusted for using selection weighting.RESULTS: The treatment CFR was 7.1% (95% CI 6.0-8.2). At 24 months post-treatment, the CFR was 2.4% (95% CI 1.7-3.0) and the recurrence rate was 1.9% (95% CI 1.3-2.5). Treatment fatality was associated with age (HR 1.02, 95% CI 1.02-1.03), clinical diagnosis (HR 0.61, 95% CI 0.45-0.84), treatment duration (HR 0.09, 95% CI 0.06-0.10) and adherence. Post-treatment fatality was associated with treatment duration (HR 0.87, 95% CI 0.79-0.91) and adherence.CONCLUSIONS: We found a moderate treatment phase CFR among PPIA-managed private sector patient with low rates of post-treatment fatality and recurrence. Routine monitoring of patient outcomes after treatment would strengthen PPIAs and inform future post TB interventions.

Novel ensemble of optimized CNN and dynamic selection techniques for accurate Covid-19 screening using chest CT images.

The world is significantly affected by infectious coronavirus disease (covid-19). Timely prognosis and treatment are important to control the spread of this infection. Unreliable screening systems and limited number of clinical facilities are the major hurdles in controlling the spread of covid-19. Nowadays, many automated detection systems based on deep learning techniques using computed tomography (CT) images have been proposed to detect covid-19. However, these systems have the following drawbacks: (i) limited data problem poses a major hindrance to train the deep neural network model to provide accurate diagnosis, (ii) random choice of hyperparameters of Convolutional Neural Network (CNN) significantly affects the classification performance, since the hyperparameters have to be application dependent and, (iii) the generalization ability using CNN classification is usually not validated. To address the aforementioned issues, we propose two models: (i) based on a transfer learning approach, and (ii) using novel strategy to optimize the CNN hyperparameters using Whale optimization-based BAT algorithm + AdaBoost classifier built using dynamic ensemble selection techniques. According to our second method depending on the characteristics of test sample, the classifier is chosen, thereby reducing the risk of overfitting and simultaneously produced promising results. Our proposed methodologies are developed using 746 CT images. Our method obtained a sensitivity, specificity, accuracy, F-1 score, and precision of 0.98, 0.97, 0.98, 0.98, and 0.98, respectively with five-fold cross-validation strategy. Our developed prototype is ready to be tested with huge chest CT images database before its real-world application.

Gene and protein expression of myosin heavy chain in Nellore cattle comparing growth or meat tenderness traits.

The objective was to investigate gene and protein expression of myosin heavy chain (MyHC) in Nellore cattle slaughtered at different weights (BW) or degrees of meat tenderness. Ninety animals with initial BW 370 ± 37 kg, 24 months of age, were slaughtered after 95 days on feed. We evaluated shear force (SF), myofibrillar fragmentation index, ribeye area, backfat thickness, marbling, color, and cooking losses. Subsequently, 24 animals were selected and divided into four contrasting groups, in which light (BW = 504.58 ± 32.36 kg) versus heavy animals (BW = 604.83 ± 42.97 kg) and animals with tender (SF = 3.88 ± 0.57 kg) versus tough meat (SF = 7.95 ± 1.04 kg) were compared. The MYH7, MYH2 and MYH1 genes were analyzed by real-time PCR. The MyHC isoforms (MyHC-I, MyHC-IIa, and MyHC-IIx) were quantified by SDS-PAGE electrophoresis. We found lower expression of MYH2 and MYH1 genes in heavy compared to light animals and a higher amount of MyHC-I isoform in the tough meat group compared to the tender meat group. Protein expression of MyHC-IIa was higher in the tender meat group. A negative correlation was found of this protein and SF (tenderness), suggesting MyHC-IIa as a biomarker of meat quality.

Supplementation of nano-selenium in fish diet: Impact on selenium assimilation and immune-regulated selenoproteome expression in monosex Nile tilapia (Oreochromis niloticus).

Selenium (Se), a fundamental element of nutrigenomic science in fish nutrition, was used to investigate its impact on selenoproteome expression and Se regulation in tilapia. Different concentrations (T1 - 0, T2 - 0.5, T3 - 1.0 and T4 - 2.0 mg/kg of feed) of dietary nano-Se were incorporated in the diets of monosex Nile tilapia. A total of 180 tilapia fingerlings with initial weight (15.73 ± 0.05 g) were stocked in 150 L capacity FRP tanks categorized into four diet groups with triplicate each for a feeding trial of 90 days. At the end of first, second and third months of the feeding trial, gill, liver, kidney and muscle tissues were harvested to evaluate the effect on the kinetics of Se bioaccumulation and assimilation as well as immune-regulated selenoprotein transcripts (GPx2, SelJ, SelL, SelK, SelS, SelW and Sepp1a) and their synthesis factors (SPS1 and Scly). The findings depicted that significantly (p < 0.05) higher weight gain was found in the diet supplemented with 1.0 mg/kg of nano-Se. The theory of second-order polynomial regression supported the same. The liver showed significantly (p < 0.05) higher Se accumulation and concentration factor among the harvested tissues in a different timeline. All the selected immune-regulated selenoproteins and synthesis factors in different fish tissues showed significantly (p < 0.05) up-regulation in the diet supplemented with 1.0 mg/kg of nano-Se for the second month. Therefore, the present findings suggested that the supplementation of nano-Se could be more effective for improved growth, better selenium regulation and expression of immune-regulated selenoproteins in the fish model.

A Preliminary Study of Real-time Capturing and Sharing of Routine Health Data among the Public Health Professionals.

CONTEXT: Electronic health record (EHR) has the potential to make available the real-time data of the patient to the healthcare professionals by connecting all levels of the public health system, irrespective of their geographical boundaries. AIM: This study aims to test the capturing and sharing of real-time patient data at primary, secondary, and the tertiary level. SETTINGS AND DESIGN: The cloud-based EHR system developed earlier was used to capture real-time data of the patient visiting a primay health center (PHC) in Udupi District of Karnataka. SUBJECTS AND METHODS: About 100 patient records including laboratory and pharmacy data have been captured into the EHR system. The confidentiality of patient data is assured. RESULTS: The result of the study indicated no errors while capturing and sharing the patient data in real time. The system also evidenced the availability of vital statistics about the patient visiting PHCs. The system also allowed the professionals at referral level to view patient data for providing quality healthcare. CONCLUSION: EHR plays a vital role in capturing, storing, and sharing patient data for providing quality healthcare and it should be made mandatory by the central health agencies in the provision of patient care and reporting of notifiable communicable diseases at all levels.

COVID-19 and tuberculosis in South Africa: A dangerous combination.

There has been much speculation during the past week about the catastrophe that awaits once coronavirus disease 2019 (COVID-19) establishes itself in the poorest communities of South Africa (SA) and, importantly, in informal settlements. Evidence to date suggests that COVID-19 is efficiently passed from infected individuals via large droplets and hard-surface fomites.

Promoting developmental supportive care in preterm infants and families in a level III neonatal intensive care unit (NICU) setting in India.

Despite evidence of short- and long-term benefits of developmental care, several studies have documented nurses' lack of knowledge and skills related to developmental care concepts. This study aims to enhance neonatal nurses' abilities to acquire care practices (knowledge and skills) regarding Developmental Supportive Care (DSC). A nonrandomized before and after intervention design was adopted to improve the knowledge and skills of staff nurses in DSC practices for preterm infants in Level III B NICU. The study included 50 level III B NICU nurses (25 in interventional group, 25 in control group) located within a tertiary care hospital in India. A significant increase in the mean knowledge score was seen among participants in the intervention group (pre-test: 16.6 ±â€¯3.1, post-test: 29.9 ±â€¯4.1, p = 0.01) but not in the control group (pre: 16.4 ±â€¯2.2, post: 18.6 ±â€¯3.6, p = 0.98). The improvement in the skills of providing DSC among neonatal nurses was also higher in the intervention group (106.4 ±â€¯7.4) relative to the control group (65.8 ±â€¯3.6), p < 0.01, at 0.05 level of significance. The Developmental Supportive Care Program (DSCP) had a significant impact in improving the knowledge and skills of nurses in providing care and preventing complications in preterm infants.

Tackling drug-resistant tuberculosis: we need a critical synergy of product and process innovations.

The End TB Strategy diagnostic pillar calls for access to high-sensitivity diagnostic testing and universal rapid drug susceptibility testing (DST). The recommended diagnostic technologies available in low and middle-income, high-burden countries for multidrug-resistant tuberculosis (MDR-TB) are essentially limited to Xpert® MTB/RIF and MTB/RIF Ultra assays, culture DST and the line-probe assays. The primary reasons for slow scale-up are insufficient political will, and therefore, insufficient funding for qualified human resources, and safe laboratory and health system infrastructure. Innovative approaches to enable the private health sector to provide high-quality diagnosis are also needed. The Essential Diagnostics List provides impetus and a standard benchmark for the rational implementation of MDR-TB diagnostics, but the epidemic will ultimately only be favorably impacted by complete end-to-end solutions to patients that address the complete cascade of care, including patient-centered diagnosis and treatment of TB and MDR-TB, management of comorbidities and social protection. By scaling up access to the currently available diagnostics, we lay the groundwork for future innovations for rapid accurate diagnosis of MDR-TB, which in turn will bring us closer to meeting the targets in the End TB Strategy.

What will it take to eliminate drug-resistant tuberculosis?

Drug-resistant tuberculosis (DR-TB) is challenging to diagnose, treat, and prevent, but this situation is slowly changing. If the world is to drastically reduce the incidence of DR-TB, we must stop creating new DR-TB as an essential first step. The DR-TB epidemic that is ongoing should also be directly addressed. First-line drug resistance must be rapidly detected using universal molecular testing for resistance to at least rifampin and, preferably, other key drugs at initial TB diagnosis. DR-TB treatment outcomes must also improve dramatically. Effective use of currently available, new, and repurposed drugs, combined with patient-centered treatment that aids adherence and reduces catastrophic costs, are essential. Innovations within sight, such as short, highly effective, broadly indicated regimens, paired with point-of-care drug susceptibility testing, could accelerate progress in treatment outcomes. Preventing or containing resistance to second-line and novel drugs is also critical and will require high-quality systems for diagnosis, regimen selection, and treatment monitoring. Finally, earlier detection and/or prevention of DR-TB is necessary, with particular attention to airborne infection control, case finding, and preventive therapy for contacts of patients with DR-TB. Implementing these strategies can overcome the barrier that DR-TB represents for global TB elimination efforts, and could ultimately make global elimination of DR-TB (fewer than one annual case per million population worldwide) attainable. There is a strong cost-effectiveness case to support pursuing DR-TB elimination; however, achieving this goal will require substantial global investment plus political and societal commitment at national and local levels.

Health care gaps in the global burden of drug-resistant tuberculosis.

The drug-resistant tuberculosis (DR-TB) cascade-from estimated or incident cases to numbers successfully treated or disease-free survival-has long been characterised by sharp declines at each step in the cascade. The losses along the cascade vary across different settings, and the reasons why some countries have a higher burden of DR-TB are complex and multifactorial; broadly, weak health systems, inadequate financing and poverty all impact differential access to DR-TB care. Within a human rights framework that mandates the right to health and the right to benefit from scientific progress, the aim of this review is to focus on describing inequities in access to DR-TB care at critical points in the cascade.

Interventional radiofrequency ablation: A promising therapeutic modality in the management of malignant biliary and pancreatic duct obstruction.

Background: Malignant biliary and/or pancreatic obstruction has often encountered in the advanced stages of periampullary and cholangicarcinomas. HabibTM Radiofrequency (RF) ablation has been successfully used in the management of various cancers of liver and pancreas. Percutaneous HPB probe (EMcision Ltd, London, UK) is a new addition to this class of tools. It is an endoluminal Radiofrequency (RF) catheter which works on the principle of ablation and induces coagulative necrosis to recanalize the obstructed duct. The aim of this study is to address the technical details of canalization, feasibilities and outcomes of percutaneous endo-luminal Radiofrequency (RF) catheter in patients with unresectable malignancy with obstructed bile and pancreatic duct (PD). Material and Method: A total of 134 patients with inoperable malignant obstruction of biliary and PD underwent RF based percutaneous endoluminal RF ablation in a tertiary referral centre between December 15th, 2010 to August 7th, 2015. This device was used in a sequential manner with an intent to recanalize the obstructed. Following the initial catheter drainage of the duct, subsequent percutaneous endobiliary RF ablation, the metallic stent was placed to recanalize the obstructed bile and PD secondary to unresectable malignancy under real-time fluoroscopic guidance. Results: The percutaneous RF based ablation of obstructed bile duct and PD with metallic stent placement was successfully achieved in 130 (97.01%) cases. The three failures were noted in cases of biliary obstruction whilst, one with PD obstruction. The patency restored in 124 and patients, where the procedure was successfully completed and revealed clinical improvement reported. Conclusion: The percutaneous endoluminal RF based ablation of obstructed duct with metallic stent placement appeared to be a safe, effective procedure and may improve survival in patients with advanced stage cancer presenting with biliary and PD obstruction. Considering the above mentioned evidence, this modality may stand ahead of stenting alone. This could be considered as viable modality in management of such patients where very limited treatment options are available.

Relationship between vancomycin exposure and outcomes among patients with MRSA bloodstream infections with vancomycin Etest® MIC values of 1.5mg/L: A pilot study.

Data suggest that vancomycin is less effective for methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) with vancomycin Etest® MIC (MICEtest) ≥1.5 mg/L. No published studies have evaluated the relationship between vancomycin exposure and outcomes among patients with MRSA BSIs vancomycin MICEtest ≥1.5 mg/L. This study was a retrospective cohort of 71 hospitalized, adult, non-dialysis patients with MRSA BSIs treated with vancomycin. All but three patients had a vancomycin MICEtest of 1.5 mg/L. Achievement of CART-derived AUC24-48h of at least 550 mg*h/L (AUC24-48h/MIC of 366 mg*h/L) was associated with a lower incidence of treatment failure. In multivariate analyses, the risk ratio was 0.45 for the CART-derived AUC24-48h threshold, indicating that achievement of the CART-derived AUC24-48h threshold of 550 was associated with a 2-fold decrease in treatment failure. These findings suggest a potential association between vancomycin exposure and outcomes in patients with MRSA BSIs with MICEtest ≥1.5 mg/L. As this study was retrospective, these findings provide the basis for a future large-scale, multi-center prospective study.

Group O RBCs: where is universal donor blood being used.

BACKGROUND: There have been recurrent shortages of group O blood due to insufficient inventory and use of group O blood in ABO non-identical recipients. We performed a 12-year retrospective study to determine utilization of group O Rh-positive and Rh-negative red blood cells (RBCs) by recipient ABO group. Reasons for transfusing group O blood to ABO non-identical recipients were also assessed. METHODS: Utilization data from all group O Rh-positive and Rh-negative RBCs transfused at three academic hospitals between April 2002 and March 2014 were included. Data were extracted from Transfusion Registry for Utilization Surveillance and Tracking, a comprehensive database with inventory information on all blood products received at the hospitals. Extracted data included product type, ABO and Rh, final disposition (transfused, wasted, outdated), and demographic and clinical data on all patients admitted to hospital. Descriptive statistics were performed using sas 9.3. RESULTS: There were 314 968 RBC transfusions: 151 645 (48·1%) were group O, of which 138 136 (91·1%) RBC units were transfused to group O individuals. ABO non-identical recipients received 13 509 group O RBCs (8·9%). The percentage of group O RBCs transfused to ABO non-identical recipients by fiscal year varied from 7·8% to 11·1% with a steady increase from 2011 to 2013. Reasons for this included: trauma, outdating, outpatient usage and shortages. CONCLUSION: The practice of transfusing O RBCs to non-O individuals has been increasing. Specific hospital and blood supplier policies could be targeted to change practice, leading to a more sustainable group O red blood cell supply.