Consensus statement on the management of invasive candidiasis in Indian scenario

Invasive fungal infections in critically ill patients are associated with increased morbidity and mortality. Candida species are among the most common causes of nosocomial bloodstream infections and of invasive infections in intensive care units (ICUs). The high mortality mandates early identification of invasive candidiasis which is vital to initiate appropriate and timely treatment and improve outcomes. Delaying the initiation of treatment could result in an increase in mortality which can be avoided by usage of more rapid diagnostic techniques. There are multiple diagnostic tests including culture and non-culture tests like 1,3-β-D-glucan and newer techniques like MALDI-TOF which are available to diagnose candidemia but each with their drawbacks. Additionally, there are various guidelines like IDSA and ESCMID on treatment which aim to minimize death, late complications from deep-seated candidiasis and rise of drug- resistant Candida strains. Through this consensus statement prepared by a panel of experts, all of whom are senior intensivists, infectious disease specialists and microbiologists, we aim to address the major aspects of management of invasive candidiasis in the Indian population as per the authors opinions, backed by published evidence and supported by the latest clinical guidelines

Predictors of restenosis: a morphometric and quantitative evaluation by intravascular ultrasound

Despite advances in catheter-based interventional techniques, restenosis remains a major complication of angioplasty. Recently, intravascular ultrasound imaging (IVUS) has provided new insight into plaque composition and geometric distribution inside the vessel. To investigate if : : IVUS-defined parameters can predict restenosis in patients after coronary angioplasty, we performed IVUS in 33 patients (33 lesions) after balloon angioplasty (n= 25) or directional : atherectomy (n = 8). Qualitative analysis included assessment of plaque composition, plaque eccentricity, plaque fracture, and presence of dissection. In addition, minimal luminal diameter, percent diameter stenosis, percent area stenosis, plaque burden, and elastic recoil were quantitatively analyzed. Follow-up data were obtained 1, 2, and 6 months after angioplasty and were available for 30 patients. Angiographic restenosis occurred in 11 patients (group 1), and no restenosis occurred in 19 patients (group 2) by clinical (n=10) or angiographic (n = 9) assessment. Plaque fracture was noted in 30% of group 1 patients and 74% of group 2 patients (p = 0.04). Major dissections were more frequent in group I than in group II (78% vs 10%, p = 0.009). Of the quantitative parameters analyzed, plaque burden was significantly higher in group 1 than in group 2 (0.50 ± 0.05 vs 0.34 ± 0.05, p = 0.0001). In 78% of the patients with plaque burden of >0.40, restenosis developed. Thus, of the various parameters analyzed, the absence of plaque fracture, the existence of a major dissection, and greater plaque burden were associated with increased incidence of restenosis. Our results indicate that IVUS can identify a : subset of patients in whom restenosis is likely to develop. lnformation about the morphologic. features of the atheroma and its composition may be used to modify the interventional strategy and thus optimize lumen size and possibly reduce the chance of restenosis

Percutaneous angioscopy of saphenous vein coronary bypass grafts

AbstractObjectives. We compared the results of percutaneous angioscopy and angiography for detecting critical elements of surface lesion morphology in 21 patients undergoing balloon angioplasty of saphenous vein coronary bypass grafts.Background. Angiography remains the standard for diagnosing and treating intravascular pathology associated with atherosclerotic coronary artery disease. It has been demonstrated that coronary angioscopy is more sensitive for identifying more complex atherosclerotic plaques and intracoronary thrombi in native coronary arteries.Methods. Angioscopy and angiography were performed before and after angioplasty of “culprit lesions” in bypass grafts. All but one of the patients had unstable angina. The mean age of the saphenous vein coronary bypass grafts was 10.1 ± 2.4 years (range 5 to 15).Results. Restesosis at a prior angioptasty site was present in seven patients. Intravascalar thrombi were seen by angioscopy in 15 (71%) of 21 versus 4 (19%) of 21 grafts by angiography (p < 0.001). Dissection was identified by angioscony in 14 (66%) of 21 versus 2 (9.5%) of 21 grafts by angiograpay (p < 0.01). The presence of friable plaque liung the Iumen surface of the vein graft was detected by angioscopy in 11 (52%) of 21 versus 4 (19%) of 21 grafts by angiography (p < 0.05). There was no correlation between age of the bypass graft and the finding of friable plaque.Conclusions. We conclude that angioscopy is superior to angiography for detecting complex lesion merphology ta bypass grafts and that the presence of friable plaque does not preclude an uncomplicated angioplasty procedure

An automated hyperparameter tuned deep learning model enabled facial emotion recognition for autonomous vehicle drivers

The progress of autonomous driving cars is a difficult movement that causes problems regarding safety, ethics, social acceptance, and cybersecurity. Currently, the automotive industry is utilizing these technologies to assist drivers with advanced driver assistance systems. This system helps different functions to careful driving and predict drivers' ability of stable driving behavior and road safety. A great number of researches have shown that the driver's emotion is the major factor that handles the emotions, resulting in serious vehicle collisions. As a result, continuous monitoring of drivers' behavior could assist to evaluate their behavior to prevent accidents. The study proposes a new Squirrel Search Optimization with Deep Learning Enabled Facial Emotion Recognition (SSO-DLFER) technique for Autonomous Vehicle Drivers. The proposed SSO-DLFER technique focuses mainly on the identification of driver facial emotions in the AVs. The proposed SSO-DLFER technique follows two major processes namely face detection and emotion recognition. The RetinaNet model is employed at the initial phase of the face detection process. For emotion recognition, the SSO-DLFER technique applied the Neural Architectural Search (NASNet) Large feature extractor with a gated recurrent unit (GRU) model as a classifier. For improving the emotion recognition performance, the SSO-based hyperparameter tuning procedure is performed. The simulation analysis of the SSO-DLFER technique is tested under benchmark datasets and the experimental outcome was investigated under various aspects. The comparative analysis reported the enhanced performance of the SSO-DLFER algorithm on recent approaches

Assessment of intracoronary morphology in cardiac transplant recipients by angioscopy and intravascular ultrasound

Percutaneous coronary angioscopy and intravascular ultrasound are sensitive intravascular imaging methods for detecting early changes in coronary morphology in cardiac transplant recipients. To compare the 2 imaging modalities, 29 consecutive cardiac transplant recipients underwent percutaneous coronary angioscopy and intravascular ultrasound during annual coronary angiography. Surface morphology, presence of plaque, and percent area stenosis were determined with each procedure. Percutaneous coronary angioscopy was more sensitive in detecting the presence of plaque and stenosis than was coronary angiography (plaque: 79 vs 10% [

A Model Sea Urchin Spicule Matrix Protein Self-Associates To Form Mineral-Modifying Protein Hydrogels

In the purple sea urchin <i>Strongylocentrotus purpuratus</i>, the formation and mineralization of fracture-resistant skeletal elements such as the embryonic spicule require the combinatorial participation of numerous spicule matrix proteins such as the SpSM30A–F isoforms. However, because of limited abundance, it has been difficult to pursue extensive biochemical studies of the SpSM30 proteins and deduce their role in spicule formation and mineralization. To circumvent these problems, we expressed a model recombinant spicule matrix protein, rSpSM30B/C, which possesses the key sequence attributes of isoforms “B” and “C”. Our findings indicate that rSpSM30B/C is expressed in insect cells as a single polypeptide containing variations in glycosylation that create microheterogeneity in rSpSM30B/C molecular masses. These post-translational modifications incorporate O- and N-glycans and anionic mono- and bisialylated and mono- and bisulfated monosaccharides on the protein molecules and enhance its aggregation propensity. Bioinformatics and biophysical experiments confirm that rSpSM30B/C is an intrinsically disordered, aggregation-prone protein that forms porous protein hydrogels that control the <i>in vitro</i> mineralization process in three ways: (1) increase the time interval for prenucleation cluster formation and transiently stabilize an ACC polymorph, (2) promote and organize single-crystal calcite nanoparticles, and (3) promote faceted growth and create surface texturing of calcite crystals. These features are also common to mollusk shell nacre proteins, and we conclude that rSpSM30B/C is a spiculogenesis protein that exhibits traits found in other calcium carbonate mineral modification proteins