Evaluation of Cognitive and Functional Status Among Survivors of Sepsis in a Tertiary Care Hospital in South India (CAFDASS)

INTRODUCTION: Sepsis is a life-threatening state and continues to be a major challenge for health care institutions. Sepsis syndrome is a frequent cause of intensive care admissions and may even develop in patients admitted to the ICU for other reasons. There has been decrease in in-hospital mortality rate of patients admitted with sepsis from 27.8 percent during the period 1979 through 1984, to 17.9 percent during the period 1995 through 2000. Thus, despite favorable mortality outcomes, an accurate reflection of treatment success of a sepsis survivor depends on the person’s ability to get back to normal life and activity. This not only depends on his physical function but also mental alertness and cognitive capabilities. OBJECTIVES: Primary objective of this study is to measure the change in cognitive function and functional ability in survivors of Sepsis up to 3 months after discharge. Secondary objective of this study is to compare outcomes in both groups and identify factors which may have contributed to poorer outcome. METHODS: This was a prospective observational cohort study of patients admitted and discharged with a diagnosis of sepsis and survivors were followed up 3 months after discharge. Baseline physical and cognitive evaluation was assessed prior to discharge using WHODAS 2 and the RetroBCRS questionnaires and was reassessed withWHODAS-2 and BCRS questionnaire at 3 months follow up. 130 patients were included in the study and statistical analysis was done using paired t-test to evaluate cognitive and physical decline in sepsis survivors and bivariate analyses was done to assess variables that resulted in poorer outcome. RESULTS: Study showed significant decline in physical and cognitive function at 3 months follow up in patients following discharge, with 31.8% and 27.2% increase in scores of assessments as compared to baseline values respectively. Age above 60 years, underlying chronic obstructive airway disease, SOFA score of more than 2, moderate or higher grade of acute respiratory distress syndrome and developing in hospital critical illness polyneuropathy and bed sores were variables which were associated with greater decline in physical and cognitive functioning of patients at 3 months follow up

Coral reef ecosystem - Monitoring and assessment using satellite data sets

Remaining in splendid isolation, the Andaman and Nicobar Islands have a great relevance in the study of marine ecosystems. The islands, though remotely located in an ostensibly pristine environment have born witness to serious issues with regard to their ecosystem health. There are significant changes in the temperature and rain fall pattern in the islands and predictive modelling has forecasted further damage in the near future. The inundation of saline water into inland terrestrial ecosystems has created salinity stress to freshwater species while reducing the water available for domestic consumption. Terrestrial flora and fauna are vulnerable to the intruding saline waters. The marine ecosystem also faces grave challenges. There are issues of anthropogenic pollution resulting in damage of corals, regime shifts in community structure, water quality deterioration and other damage to marine fauna

Maintaining Mutual Consistency for Cached Web Objects

Existing web proxy caches employ cache consistency mechanisms to ensure that locally cached data is consistent with that at the server. In this paper, we argue that techniques for maintaining consistency of individual objects are not sufficient—a proxy should employ additional mechanisms to ensure that related web objects are mutually consistent with one another. We formally define the notion of mutual consistency and the semantics provided by a mutual consistency mechanism to end-users. We then present techniques for maintaining mutual consistency in the temporal and value domains. A novel aspect of our techniques is that they can adapt to the variations in the rate of change of the source data, resulting in judicious use of proxy and network resources. We evaluate our approaches using real-world web traces and show that (i) careful tuning can result in substantial savings in the network overhead incurred without any substantial loss in fidelity of the consistency guarantees, and (ii) the incremental cost of providing mutual consistency guarantees over mechanisms to provide individual consistency guarantees is small

Application of Information Communication Technology in Coastal Resilience through Income Improvement

Application of Information Communication Technology in Coastal Resilience through Income Improvemen

Effects of 12 Months of Vagus Nerve Stimulation in Treatment-Resistant Depression: A Naturalistic Study

Background: The need for effective, long-term treatment for recurrent or chronic, treatment-resistant depression is well established. Methods: This naturalistic follow-up describes outpatients with nonpsychotic major depressive (n = 185) or bipolar (I or II) disorder, depressed phase (n = 20) who initially received 10 weeks of active (n = 110) or sham vagus nerve stimulation (VNS) (n = 95). The initial active group received another 9 months, while the initial sham group received 12 months of VNS. Participants received antidepressant treatments and VNS, both of which could be adjusted. Results: The primary analysis (repeated measures linear regression) revealed a significant reduction in 24-item Hamilton Rating Scale for Depression (HRSD24) scores (average improvement, .45 points [SE = .05] per month (p \u3c .001). At exit, HRSD24 response rate was 27.2% (55/202); remission rate (HRSD24 ≤ 9) was 15.8% (32/202). Montgomery Asberg Depression Rating Scale (28.2% [57/202]) and Clinical Global Impression-Improvement (34.0% [68/200]) showed similar response rates. Voice alteration, dyspnea, and neck pain were the most frequently reported adverse events. Conclusions: These 1-year open trial data found VNS to be well tolerated, suggesting a potential long-term, growing benefit in treatment-resistant depression, albeit in the context of changes in depression treatments. Comparative long-term data are needed to determine whether these benefits can be attributed to VNS

Effects of 12 Months of Vagus Nerve Stimulation in Treatment-Resistant Depression: A Naturalistic Study

Background: The need for effective, long-term treatment for recurrent or chronic, treatment-resistant depression is well established. Methods: This naturalistic follow-up describes outpatients with nonpsychotic major depressive (n = 185) or bipolar (I or II) disorder, depressed phase (n = 20) who initially received 10 weeks of active (n = 110) or sham vagus nerve stimulation (VNS) (n = 95). The initial active group received another 9 months, while the initial sham group received 12 months of VNS. Participants received antidepressant treatments and VNS, both of which could be adjusted. Results: The primary analysis (repeated measures linear regression) revealed a significant reduction in 24-item Hamilton Rating Scale for Depression (HRSD24) scores (average improvement, .45 points [SE = .05] per month (p \u3c .001). At exit, HRSD24 response rate was 27.2% (55/202); remission rate (HRSD24 ≤ 9) was 15.8% (32/202). Montgomery Asberg Depression Rating Scale (28.2% [57/202]) and Clinical Global Impression-Improvement (34.0% [68/200]) showed similar response rates. Voice alteration, dyspnea, and neck pain were the most frequently reported adverse events. Conclusions: These 1-year open trial data found VNS to be well tolerated, suggesting a potential long-term, growing benefit in treatment-resistant depression, albeit in the context of changes in depression treatments. Comparative long-term data are needed to determine whether these benefits can be attributed to VNS

Whole genome analysis of Rhizopus species causing rhino-cerebral mucormycosis during the COVID-19 pandemic

IntroductionMucormycosis is an acute invasive fungal disease (IFD) seen mainly in immunocompromised hosts and in patients with uncontrolled diabetes. The incidence of mucormycosis increased exponentially in India during the SARS-CoV-2 (henceforth COVID-19) pandemic. Since there was a lack of data on molecular epidemiology of Mucorales causing IFD during and after the COVID-19 pandemic, whole genome analysis of the Rhizopus spp. isolated during this period was studied along with the detection of mutations that are associated with antifungal drug resistance.Materials and methodsA total of 50 isolates of Rhizopus spp. were included in this prospective study, which included 28 from patients with active COVID-19 disease, 9 from patients during the recovery phase, and 13 isolates from COVID-19-negative patients. Whole genome sequencing (WGS) was performed for the isolates, and the de novo assembly was done with the Spades assembler. Species identification was done by extracting the ITS gene sequence from each isolate followed by searching Nucleotide BLAST. The phylogenetic trees were made with extracted ITS gene sequences and 12 eukaryotic core marker gene sequences, respectively, to assess the genetic distance between our isolates. Mutations associated with intrinsic drug resistance to fluconazole and voriconazole were analyzed.ResultsAll 50 patients presented to the hospital with acute fungal rhinosinusitis. These patients had a mean HbA1c of 11.2%, and a serum ferritin of 546.8 ng/mL. Twenty-five patients had received steroids. By WGS analysis, 62% of the Rhizopus species were identified as R. delemar. Bayesian analysis of population structure (BAPS) clustering categorized these isolates into five different groups, of which 28 belong to group 3, 9 to group 5, and 8 to group 1. Mutational analysis revealed that in the CYP51A gene, 50% of our isolates had frameshift mutations along with 7 synonymous mutations and 46% had only synonymous mutations, whereas in the CYP51B gene, 68% had only synonymous mutations and 26% did not have any mutations.ConclusionWGS analysis of Mucorales identified during and after the COVID-19 pandemic gives insight into the molecular epidemiology of these isolates in our community and establishes newer mechanisms for intrinsic azole resistance

NEID Rossiter–McLaughlin Measurement of TOI-1268b: A Young Warm Saturn Aligned with Its Cool Host Star

Close-in gas giants present a surprising range of stellar obliquity, the angle between a planet's orbital axis and its host star's spin axis. It is unclear whether the obliquities reflect the planets' dynamical history (e.g., aligned for in situ formation or disk migration versus misaligned for high-eccentricity tidal migration) or whether other mechanisms (e.g., primordial misalignment or planet-star interactions) are more important in sculpting the obliquity distribution. Here we present the stellar obliquity measurement of TOI-1268 (TIC-142394656, V mag ∼10.9), a young K-type dwarf hosting an 8.2 day period, Saturn-sized planet. TOI-1268's lithium abundance and rotation period suggest the system age between the ages of the Pleiades cluster (∼120 Myr) and the Prasepe cluster (∼670 Myr). Using the newly commissioned NEID spectrograph, we constrain the stellar obliquity of TOI-1268 via the Rossiter-McLaughlin effect from both radial velocity and Doppler tomography signals. The 3σ upper bounds of the projected stellar obliquity λ from both models are below 60°. The large host star separation (a/R ∗ ∼17), combined with the system's young age, makes it unlikely that the planet has realigned its host star. The stellar obliquity measurement of TOI-1268 probes the architecture of a young gas giant beyond the reach of tidal realignment (a/R ∗ ≲10) and reveals an aligned or slightly misaligned system

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome