Real-world observational study to capture demographic details of newly diagnosed type 2 diabetes mellitus

Background: To understand the demographic profile of newly diagnosed type 2 diabetes mellitus (T2DM) patients and to evaluate the glycaemic status and initial treatment choices in this subset of T2DM patients.Methods: The ROD-IT-2 study was a real-world, retrospective, cross-sectional, observational study conducted at various centres across India between April 2021 and March 2022. The study outcomes included epidemiology, comorbidities, and management strategies preferred by Indian clinicians in these patients.Results: Data from 29,550 newly diagnosed T2DM patients were analyzed. The mean age of patients was 53.3 years, and majority were males (65%). Majority of patients (63.85%) were aged 40 to 60 years. More than half (53.11%) of the patients were either overweight (36.65%) or obese (16.76%). The mean glycated hemoglobin (HbA1c) was high (8.4%). Most (88.5%) patients had cardio-renal comorbidities. Hypertension was the most common comorbidity (45.7%) followed by dyslipidemia (32.1%). Chronic kidney disease (CKD) was also present in 31.2% patients. In the present study, 9.2% patients presented with microvascular complications at the time of diagnosis. Majority of newly diagnosed patients (79.7%) were treated with combination therapy. In patients who were prescribed dual drug combination therapy, metformin + dipeptidyl peptidase-4 inhibitor (DPP4i) was the preferred combination (42.71%)  followed by metformin + sulfonylurea (31.37%).Conclusions: ROD-IT-2 study showed that mean HbA1c levels in T2DM patients still remain high in our population and cardio-renal comorbidities remain prevalent in newly diagnosed patients. Indian clinicians were found to prefer the combination therapy in newly diagnosed T2DM patients

Recent trends in the pattern and long-term management strategy of patients diagnosed with acute coronary syndrome in India: an observational study

Background: The understanding of demographic patterns and the real-world management practices for patients with acute coronary syndrome (ACS) will facilitate optimizing the management strategies for ACS based on the patient’s clinical profile and the associated risk factors in Indian patients. Hence, this study determined the demographic details and the treatment patterns in Indian patients with ACS.Methods: The RECent trends in the pattern and lOng-term management stRategy of patients Diagnosed with acute coronary syndrome in India (RECORD ACS-2) study was a real-world, retrospective, cross-sectional, observational study conducted at various centres across India between 2021 and 2022. The study outcomes included the demographic profile and therapeutic management in patients with ACS.Results: A total of 9945 patients with a mean age of 59 years were included. The ACS was commonly observed in the age group of 41-70 years with highest incidence in the age group of 51-60 years. The ST-elevation myocardial infarction (STEMI) was most common (53.2%) presentation. Hypertension (37.2%) and dyslipidemia (29.3%) followed by diabetes (21.3%) were the most common comorbidities. Single vessel disease was the most common angiographic feature (58%). Percutaneous coronary intervention was the most preferred management strategy (57%). Ticagrelor was the most preferred loading (68.3%) as well as maintenance (71.2%) P2Y12 inhibitor in ACS patients. Most of the patients (81.8%) had received high intensity statin therapy for the secondary prevention of the disease.Conclusions: The prevalence of ACS was high between 51-60 years of age, more so in males, smokers, and physically less active patients. Associated comorbidities were hypertension, dyslipidemia and diabetes. Incidence of STEMI was high, and more than half of the patients underwent PCI. Ticagrelor was the most preferred P2Y12 inhibitor in ACS patients for loading as well as maintenance therapy

Transfer or not to transfer? a medical dilemma

Morphological assessment predominantly determines the quality of embryos although, several methods are available for it. Dilemma to transfer arises when clinicians are left with mere poor grade embryos. This case report encompasses a case of 37 years primary infertile female managed with GnRH antagonist cycle for tubal factor infertility. Post ovarian stimulation and ovum pickup, only two 4 celled grade-C embryos were available for transfer. Reluctantly the embryo was transferred, but fortunately resulted in a healthy live intrauterine pregnancy. This case report questions the aptness of the current methods to determine embryo quality and also enlightens whether the ethical or medical conundrum holds true regarding relation between embryo quality and chances of a fruitful pregnancy

OPTIMIZATION OF BACOSIDE A LOADED SNEDDS USING D-OPTIMAL MIXTURE DESIGN FOR ENHANCEMENT INSOLUBILITY AND BIOAVAILABILITY

Objective: The objective of present study is to enhance solubility and bioavailability of poorly soluble bacoside A present in Bacopa monnieri extract using self nano emulsifying drug delivery system (SNEDDS) for the treatment of Alzheimer's disease.Methods: Solubility of the drug was assessed in various oils (edible as well as synthetic oil), surfactant and co-surfactant by saturation solubility study. Pseudo-ternary phase diagram was used to obtain appropriate concentration ranges of components include oil, surfactant and co-surfactant.Results: From the result of saturated solubility study and phase diagram, oleic acid, tween 20 and ethanol was selected as oil, surfactant and co-surfactant. The D-Optimal mixture design was used to optimize the formulation on the basis of solubility of drug and dilution potential. In vitro dissolution, study showed 89% of drug release from optimized SNEDDS formulation compared to untreated drug extract with 24% of drug release in 60 min. Ex vivo diffusion study showed more than 90% of drug diffused from optimized SNEDDS formulation compared to pure extract.Conclusion: In a nutshell, the developed SNEDDS formulation using the design of experimentation approach held great potential as a possible alternative to traditional oral formulations of poorly soluble Bacoside A to improve solubility and bioavailability

Clinical, biochemical and haematological changes in leptospirosis

Background: Leptospirosis is a globally important zoonotic disease caused by pathogenic leptospira. Leptospira species are spirochetes belonging to the order spirochetes and the family leptospiraceae. Present study is done to find out the incidence of thrombocytopenia in leptospirosis and to correlate it with other parameters like renal dysfunction, hepatic dysfunction and bleeding manifestation.Methods: Study includes 51 clinically suspected and diagnosed cases of leptospirosis, in Government hospital, South Gujarat, during a period from January 2017 to December 2017. Clinical signs and symptoms and complications, biochemical profile like bilirubin and creatinine, haematological profile like Hb, WBC count and platelet count were recorded. Thrombocytopenia was defined as a platelet count below 1,50,000/cmm.Results: The present study includes 51 cases of Leptospirosis. Age ranged from 16 years to 61 years (male-39 and Females-12) There were 38 (74.5%) cases with thrombocytopenia and 13 (25.4%) cases with normal platelet count. Out of 38 thrombocytopenic cases, 32 (84.2%) cases had renal dysfunction, 26 (68.4%) cases had hepatic dysfunction and 16 (42.1%) cases had pulmonary haemorrhage. Among 13 cases with normal platelet count, 8 (61.5%) cases had hepatic dysfunction and 7 (53.8%) cases had renal dysfunction and 3 (23%) cases had pulmonary haemorrhage.Conclusions: Thrombocytopenia is a frequent complication (present in more than half of the patient) in leptospirosis and associated with more frequent and more severe complications. Therefore, early recognition of thrombocytopenia is recommended to prevent complications and mortality in leptospirosis

Text-based Image Segmentation Methodology

AbstractIn computer vision, segmentation is the process of partitioning a digital image into multiple segments (sets of pixels). Image segmentation is thus inevitable. Segmentation used for text-based images aim in retrieval of specific information from the entire image. This information can be a line or a word or even a character. This paper proposes various methodologies to segment a text based image at various levels of segmentation. This material serves as a guide and update for readers working on the text based segmentation area of Computer Vision. First, the need for segmentation is justified in the context of text based information retrieval. Then, the various factors affecting the segmentation process are discussed. Followed by the levels of text segmentation are explored. Finally, the available techniques with their superiorities and weaknesses are reviewed, along with directions for quick referral are suggested. Special attention is given to the handwriting recognition since this area requires more advanced techniques for efficient information extraction and to reach the ultimate goal of machine simulation of human reading

Delayed Treatment Response in a Neonate with Multisystem Langerhans Cell Histiocytosis : Case report and review of literature

Langerhans cell histiocytosis (LCH) is a rare proliferative disorder of the Langerhans cells, which are part of the mononuclear phagocytic system. The disorder varies in terms of the extent of the disease, its natural course and patient outcomes. While skin rashes are a common presentation of neonatal LCH, other systems or organs may also be involved. Delays in the diagnosis of neonatal LCH may occur due to its non-specific presentation and a lack of awareness of the condition among doctors. We report a two-month-old male neonate who presented to the Chacha Nehru Bal Chikitsalya hospital, New Delhi, India, in 2016 after the onset of pulmonary symptoms. He had been noted to have a generalised rash which had progressively worsened from 15 days of age. Following a skin biopsy and chest imaging, he was diagnosed with multisystem LCH with risk organ involvement. There was a delayed response to combined chemotherapy with no major side-effects