Antihypertensive and Antioxidant Action of Amlodipine and Vitamin C in Patients of Essential Hypertension

The etiology of essential hypertension includes increased oxidative stress. The role of antihypertensive drug amlodipine as an antioxidant and the benefit of addition of vitamin C, an antioxidant to antihypertensive therapy were studied. Forty male patients of essential hypertension were randomly divided into two groups and treated with 5 mg amlodipine. In addition one group also received 1000 mg vitamin C (as two 500 mg tablets) once daily for three months. Although blood pressure decreased in both groups, the systolic blood pressure in patients given vitamin C was less (126.4 ± 7.47) compared to the other group (130.9 ± 7.27). A decrease in malondialdehyde, an increase in erythrocyte sodium-potassium adenosine triphosphatase (Na+ K+ ATPase) and an increase in the superoxide dismutase levels were observed in both groups. The increase in SOD was statistically more in the patients given vitamin C in addition to amlodipine (0.1717 ± 0.0150 compared to 0.152 ± 0.0219 units/100 ml assay). In spite of the known antihypertensive, antioxidant activity, similarity in correcting endothelial dysfunction independently, giving the two drugs together and early introduction of vitamin C perhaps decreases oxidative stress and augments the antioxidant status. This may prevent further vascular damage due to oxidative stress, leading to a better prognosis in essential hypertension patients

Rare Case of Nasal Vault Oncocytic Cystadenoma

Background: Oncocytic Cystadenomas are a rare benign pathology often found to arise from the salivary glands, reported more commonly in minor salivary glands, but even more rarely in major salivary glands and the larynx. This is the first known report of a nasal vault oncocytic cystadenoma in a pediatric patient. Methods: Case Report and Literature Review. Case presentation: A 10-year-old female presented with a mass involving the left nasal vestibule that caused nasal obstruction and a visible external abnormality. MRI imaging revealed a cystic lesion in the anterior nasal cavity that was rim enhancing with a bright T2 signal that appeared to arise from the nasal mucosa. She was taken to the operating room for endoscopic-assisted removal of the lesion. Pathology showed an oncocytic cystadenoma. On follow-up clinic visit, she is doing well with no signs or symptoms of recurrence. Conclusion: The authors present the first reported case of a pediatric patient with nasal vault oncocytic cystadenoma. In other head and neck locations, these cysts are generally benign and only cause symptoms related to their location and proximity to other vital structures. Surgical endoscopic management was effective for resection

RecD: Deduplication for End-to-End Deep Learning Recommendation Model Training Infrastructure

We present RecD (Recommendation Deduplication), a suite of end-to-end infrastructure optimizations across the Deep Learning Recommendation Model (DLRM) training pipeline. RecD addresses immense storage, preprocessing, and training overheads caused by feature duplication inherent in industry-scale DLRM training datasets. Feature duplication arises because DLRM datasets are generated from interactions. While each user session can generate multiple training samples, many features' values do not change across these samples. We demonstrate how RecD exploits this property, end-to-end, across a deployed training pipeline. RecD optimizes data generation pipelines to decrease dataset storage and preprocessing resource demands and to maximize duplication within a training batch. RecD introduces a new tensor format, InverseKeyedJaggedTensors (IKJTs), to deduplicate feature values in each batch. We show how DLRM model architectures can leverage IKJTs to drastically increase training throughput. RecD improves the training and preprocessing throughput and storage efficiency by up to 2.48x, 1.79x, and 3.71x, respectively, in an industry-scale DLRM training system.Comment: Published in the Proceedings of the Sixth Conference on Machine Learning and Systems (MLSys 2023

Nebulized Recombinant Tissue Plasminogen Activator (rt-PA) for Acute COVID-19-Induced Respiratory Failure : An Exploratory Proof-of-Concept Trial

Acknowledgments We would like to extend our sincerest gratitude to all the colleagues and hospital staff who worked tirelessly throughout the pandemic and without whom this work would not have been possible. Firstly, we would like to thank our colleagues in the intensive care unit (ICU), in particular the matrons, Sean Carroll and Sinead Hanton, and research nurses, Filipe Helder and Amitaa Maharajh for their support, and bedside nurses who bore the responsibility of drug administration. We would also like to extend our thanks to ICU consultants who acted as professional legal consultees on behalf of critical care patients. Equally, we would like to thank colleagues within the respiratory team. Their expertise was instrumental to our role in treating patients on 8N and 8E wards. A special mention to lead Nurse Mary Emerson; we were grateful for her knowledge, support and for facilitating the training for the nebulizer and drug administration on the wards. We would like to thank Aarti Nandani and all the staff in the Royal Free clinical trials pharmacy for their immense support throughout the whole pandemic, especially considering their ever-increasing workload at the time. Thanks also to the HSL coagulation laboratory, the Trust R&D department and all the staff working to cover during a very challenging time. We are also very grateful to the Royal Free charity for funding this study. Finally, we would like to thank all the clinical nurses, physiotherapists, research data managers and healthcare professionals within the Haemophilia department (and wider hospital) for all their many efforts in supporting this study. This trial was overseen by an independent data monitoring committee, chaired by Najib Rahman, Director of the Oxford Respiratory Trials Unit, University of Oxford and comprises the following committee members: Mike Makris, Jonathan Silversides and Henry Watson. Funding Royal Free Charity Trust Fund 35 provided funding for this study. The study drug was provided by Boehringer Ingelheim (BI). BI had no role in the design, analysis, or interpretation of the results. They were given the opportunity to review the manuscript for medical and scientific accuracy since it relates to BI substances and intellectual property considerations.Peer reviewedPublisher PD

Study of Central Corneal Thickness (CCT) bBefore and aAfter Small-Incision Cataract Surgery (SICS) and phacoemulsification surgery

Purpose: To highlight the importance of measurement of central corneal thickness (CCT) which is an indirect indicator of corneal endothelial dysfunction after cataract surgery. Materials and Methods: This was a randomised control trial involving 101 patients who presented with cataract. Cataracts were graded using Lens Opacities Classification system grading. Fifty-one patients underwent small incision cataract surgery (SICS) and 50 underwent phacoemulsification (PHACO). Patients with any other ocular pathology were excluded. Results: There was significant improvement in the best corrected visual acuity (BCVA) comparable in both groups. There was a statistically  significant increase in central corneal thickness on day 7th and 30th post op. The change in the CCT and BCVA was comparable between SICS and PHACO on day 30th post op. Conclusion: The increase in CCT suggests that there was some endothelial cell loss leading to change in corneal thickness but not to the extent of causing visual impairment. SICS and phacoemulsification surgery are  comparable in respect to visual rehabilitation. Manual SICS is still a safe and cost-effective option in the developing world. Proper case selection, diligent surgery, and adequate postoperative care are essential to maintain a clear cornea.Keywords: Cataract, CCT, phacoemulsification, SIC

Vintage meets contemporary: Use of rigid TBNA in the era of real-time imaging – first report from India

In the modern era, real-time imaging-guided transbronchial needle aspiration (TBNA) has completely replaced the traditional surgical approaches to sample the mediastinal lesions for diagnosis and cancer staging. However, there is a limited role of these innovations in the presence of critical airway narrowing due to a further decrease in cross-sectional area of the airway proportionate to the outer diameters of the scope. Rigid TBNA with airway control by rigid bronchoscopy is one alternative which can be used for mediastinal sampling when modern technique is impracticable. Herein, we report the use of rigid TBNA, an underutilized old method to sample the mediastinal lesion in a patient with severe orthopnea secondary to tracheal compression by mediastinal mass

Syphilis D′ Emblee

A 28-year-old male patient presented to Skin, V.D. and Leprosy outpatient with a single gray white plaque on the left side of the lower lip for last 8 months and multiple papulosquamous lesions all over the body for last 6 months. There was history of blood transfusion for anemia 1 year back. Histopathology of lip lesion and reactive VDRL and TPHA tests confirmed the diagnosis as syphilis. We report this rare case of Syphilis d′ emblee

Ultrasound guided internal jugular vein cannulation in infants: Comparative evaluation of novel modified short axis out of plane approach with conventional short axis out of plane approach

Background and Aims: Central venous cannulation (CVC) through right internal jugular vein (IJV) route is routinely performed in paediatric patients undergoing major surgery and in those admitted to intensive care units. A novel technique (modified short-axis out-of-plane [MSA-OOP]) to improve first pass success rate of ultrasound-guided IJV CVC in neonates and infants is being compared with conventional SA-OOP method. Methods: A total of 120 patients were enroled in the study over a period of 6 months. All paediatric patients with age <1 year and weight <10 kg who underwent a major surgery requiring CVC were included. Patients were randomised to either of the two approaches of ultrasound-guided IJV cannulation; SA-OOP and modified SA-OOP (MSA-OOP). In modified approach, the midline of probe footprint was marked with a radio-opaque barium wire that casted a central acoustic shadow on ultrasound screen. Results: In MSA-OOP group, 83.1% of patients were cannulated in the first attempt as compared to 49.2% patients in group SA-OOP. Patients in MSA-OOP group required significantly fewer attempts for successful CVC as compared to patients in the SA-OOP group ( MSA-OOP: median = 1, interquartile range [1-1]; SAOOP: median = 2, interquartile range [1-2], P < 0.001, Mann–Whitney U-test). Conclusion: The use of MSA-OOP ultrasound technique for IJV CVC cannulation results in a higher first-attempt success rate and reduces the number of cannulation attempts