A comparison of the efficacy and safety of daily inhaled budesonide/formoterol and as and when needed inhaled budesonide/formoterol combination in moderate persistent asthma

Background: To evaluate efficacy and safety of a fixed dose combination of budesonide/formoterol inhaler, when used as and when needed treatment approach in comparison with similar regimen daily.Methods: A prospective, open label, parallel group study design, in which, screened patients, having moderate persistent asthma, underwent a 2 week of run in period, underwent randomization in two treatment groups, in one group daily treatment with fixed dose combination of budesonide/formoterol inhaler and in another group as and when needed treatment with similar medication. The assessments after baseline were done at 2, 4 and 6 weeks. The primary outcomes were Asthma Control Questionnaire Score (ACQS), asthma free days, exacerbation frequency and severity. Other outcomes were, lung functions, need for rescue medication, Modified Borg dyspnea score and patient preference on VAS.Results: The mean age of 50 patients included in study was 40.24±2.38 years in group I, and 39.24±1.81 years in group II. Patients were followed up for 6 weeks after 2 weeks of run in period. Improvement of ACQS, exacerbation prevention and number of asthma free days were same with both the regimens. Though the drugs taken in as and when needed treatment group was almost half of daily regimen group. Adverse drug reactions (ADRs) were not found in any group. No association between adverse effects and dose was established.Conclusions: Both the treatment regimens improve the asthma control parameters, prevent exacerbations and prevent the decline in lung functions with the similar efficacy and safety. So as and when needed treatment approach can be an alternative to daily regimen for stable moderate persistent asthma patients

Bowel injury: a rare but dreaded complication of unsafe abortion

Unsafe abortions represent a preventable yet major cause of maternal mortality and morbidity in India. Intestinal perforation is a rare dreaded complication of unsafe abortion. It is commonly seen in countries in which abortions are performed by people without proper training and proper instruments. Bowel perforation occurs when the posterior vaginal wall or the uterine wall is perforated. The ileum and the sigmoid colon are the most commonly injured portion of the bowel. Here, we report a case of ileal perforation following induced unsafe abortion which was managed successfully

Class Imbalance Reduction and Centroid based Relevant Project Selection for Cross Project Defect Prediction

Cross-Project Defect Prediction (CPDP) is the process of predicting defects in a target project using information from other projects. This can assist developers in prioritizing their testing efforts and finding flaws. Transfer Learning (TL) has been frequently used at CPDP to improve prediction performance by reducing the disparity in data distribution between the source and target projects. Software Defect Prediction (SDP) is a common study topic in software engineering that plays a critical role in software quality assurance. To address the cross-project class imbalance problem, Centroid-based PF-SMOTE for Imbalanced data is used. In this paper, we used a Centroid-based PF-SMOTE to balance the datasets and Centroid based relevant data selection for Cross Project Defect Prediction. These methods use the mean of all attributes in a dataset and calculating the difference between mean of all datasets. For experimentation, the open source software defect datasets namely, AEEM, Re-Link, and NASA, are considered

Metronidazole Induced Liver Injury: A Rare Immune Mediated Drug Reaction

Drug induced liver injury (DILI) can result either from dose-dependent direct hepatotoxicity or from an unpredictable dose-independent idiosyncratic reaction. Incidence of idiosyncratic DILI is estimated to be approximately 10–15 per 100,000 patient years. Here we report an extremely rare case of metronidazole induced delayed immune-allergic hepatocellular liver injury masquerading as autoimmune hepatitis. A previously healthy 54-year-old Caucasian male, who was treated with metronidazole for Clostridium difficile associated diarrhea, presented 3 months later with right upper quadrant abdominal pain. Laboratory tests revealed total bilirubin level of 12.7 mg/dL, direct bilirubin of 7.2 mg/dL, alanine aminotransferase (ALT) of 973 IU/L, aspartate transaminase (AST) of 867 IU/L, alkaline phosphatase (AP) of 96 IU/L, and an INR of 1.9, suggestive of hepatocellular pattern of injury. A detailed workup for hepatitis revealed no other etiology. A clinical diagnosis of metronidazole induced liver injury was made. With a persistent rise in his bilirubin and transaminase levels, the patient was started on oral prednisone. At the 2-week posthospitalization follow-up visit, the patient reported a significant improvement in his overall sense of being well and liver functions tests trended down substantially (total bilirubin 7.2 mg/dL, ALT 420 IU/L, AST 276 IU/L, AP 183 IU/L, and INR 1.5)

Synthesis and in vitro antimicrobial activity of novel hydrazide-hydrazone derivatives of dodecanoic acid

Six new dodecanoic acid hydrazide-hydrazones (compounds 4a–f), unsubstituted or carrying hydroxy, methoxy, nitro and chloro groups on the benzene ring, were synthesized and tested, in vitro, for their antimicrobial activity against two Gram negative bacteria strains (Escherichia coli and Pseudomonas aeruginosa) and two Gram positive bacteria strains (Bacillus subtilis and Staphylococcus aureus) and two fungal strains (Candida albicans and Aspergillus niger). The microbial screening results indicated that compounds having chloro and nitro substituents were the most active ones. These hydrazone derivatives were characterized by CHN analysis, IR, and 1H NMR spectral data. All newly synthesized compounds exhibited promising results.Colegio de Farmacéuticos de la Provincia de Buenos Aire

LSTM Based Lip Reading Approach for Devanagiri Script

Speech Communication in a noisy environment is a difficult and challenging task. Many professionals work in noisy environments like aviation, constructions, or manufacturing, and find it difficult to communicate orally. Such noisy environments need an automated lip-reading system that could be helpful in communicating some instructions and commands. This paper proposes a novel lip-reading solution, which extracts the geometrical shape of lip movement from the video and predicts the words/sentences spoken. An Indian specific language data set is developed which consists of lip movement information captured from 50 persons. This includes students in the age group of 18 to 20 years and faculty in the age group of 25 to 40 years . All have spoken a paragraph of 58 words within 10 sentences in Hindi (Devanagari, spoken in India) language which was recorded under various conditions. The implementation consists of facial parts detection, along with Long short term memory’s. The proposed solution is able to predict the words spoken with 77% and 35% accuracy for data set of 3 and 10 words respectively. The sentences are predicted with 20% accuracy, which is encouraging

A study of serum lipid profile in normal pregnancy and pregnancy induced hypertensive disorders: a case-control study

Background: Pregnancy induced hypertensive disorders are one of the commonest complication of pregnancy which accounts for 12% of the maternal and perinatal mortality and morbidity. Dyslipidemias are associated with endothelial dysfunction that may result in proteinuria and hypertension which is a clinical hallmark of PIH. It affects both maternal health as well as fetal growth. Hence, this study was done to assess the role of altered lipid profile in the development of PIH.Methods: A Case Control study was conducted at the Department of Biochemistry, Kurnool Medical College and Govt General Hospital, Kurnool in collaboration with its Obstetrics Dept during the period of November 2015-2017. A total of 300 pregnant women, primigravida /multigravida with singleton pregnancy, in the age group of 18‐ 35 years with >20 weeks of gestation were included in the study. Subjects were divided into gestational hypertensives, n=39 (BP ≥140/80) and preeclamptic women, n=111 (≥140/80 and proteinuria) as cases. Age matched normotensive pregnant women, n=150 (BP 120/80) were recruited as Controls. Subjects with history of multiple pregnancies, pregnancy with congenital anomalies, chronic hypertension, diabetes mellitus, cardiac/thyroid/hepatic/renal disease, dyslipidemia were excluded. Total cholesterol, TG, HDL, LDL, VLDL were performed.Results: A comparison of these values between hypertensive and normotensive women showed a significant rise in TC, TG, LDL and VLDL. HDL-C showed a significant decrease in hypertensive women compared to normal pregnant women. LDL: HDL and TG:HDL ratios were higher in PIH group.Conclusions: The results of this study suggests an abnormal lipid metabolism, predominantly high TG concentrations and low HDL-C, which may add to the promotion of vascular dysfunction and oxidative stress seen in PIH. This association is significant in understanding the development of hypertension during pregnancy and is useful in early diagnosis and prevention of PIH

Financial Impact of Complex Cancer Surgery in India: A Study of Pancreatic Cancer.

PURPOSE: The rapidly increasing burden of cancer in India has profound impacts on health care costs for patients and their families. High out-of-pocket (OOP) expenditure, lack of insurance, and low government expenditure create a vicious cycle, leading to household impoverishment. Complex cancer surgery is now increasingly important for emerging countries; however, little is understood about the macro- and microeconomics of these procedures. After the Lancet Oncology Commission on Global Cancer Surgery, we evaluated the OOP expenditure for patients undergoing pancreatico-duodenectomy (PD) at a government tertiary cancer center in India. METHODS: Prospective data from 98 patients who underwent PD between January 2014 and June 2015 were collected and analyzed. The time frame for consideration of expenses, including all preoperative investigations, was from the first hospital visit to the day of discharge. Catastrophic expenditure was calculated by assessing the percentage of households in which OOP health payments exceeded 10% of the total household income. RESULTS: The mean expenditure for PD by patients was Rs.295,679.57 (US$74,420, purchasing power parity corrected). This amount was significantly higher among those admitted to a private ward and those with complications. Only 29.6% of the patients had insurance coverage. A total of 76.5% of the sample incurred catastrophic expenditure, and 38% of those with insurance underwent financial catastrophe compared with 93% of those without insurance. The percentage of patients facing catastrophic impact was highest among those in semiprivate wards, at 86.7%, followed by those in public and private wards. CONCLUSION: The cost of PD is high and is often unaffordable for a majority of India's population. A review of insurance coverage policies for better coverage must be considered

A Survey of Cybersecurity of Digital Manufacturing

The Industry 4.0 concept promotes a digital manufacturing (DM) paradigm that can enhance quality and productivity, which reduces inventory and the lead time for delivering custom, batch-of-one products based on achieving convergence of additive, subtractive, and hybrid manufacturing machines, automation and robotic systems, sensors, computing, and communication networks, artificial intelligence, and big data. A DM system consists of embedded electronics, sensors, actuators, control software, and interconnectivity to enable the machines and the components within them to exchange data with other machines, components therein, the plant operators, the inventory managers, and customers. This article presents the cybersecurity risks in the emerging DM context, assesses the impact on manufacturing, and identifies approaches to secure DM