Empyema Thoracis- the role of open thoracotomy with decortication in the era of video-assisted thoracoscopic surgery

Background: Empyema Thoracis, a condition in which purulent fluid accumulates within the pleural cavity, is commonly caused by bacterial infection (both Gram- positive and Gram-negative), such as Mycobacterium tuberculosis, and rarely by fungal infection. Timely intervention significantly reduces morbidity and mortality. Surgical intervention is needed in advanced disease. This study aimed evaluate decortications performed through video-assisted thoracoscopic surgery (VATS) and open thoracotomy. Methods: This retrospective study included 47 patients who underwent decortications by either VATS or open thoracotomy for empyema Thoracis at the Department of Surgery of, BLDE DU Shri B M Patil Medical College from May 2015 to August 2020. Results: Tuberculosis was the most common etiological factor for empyema Thoracis. In 19 patients who underwent VATS decortications, VATS was converted to open thoracotomy in 11 patients. Only 8 patients achieved successful decortication with VATS. Thirty- nine patients (including 11 whose VATS was converted to open thoracotomy) underwent successful open thoracotomy decortications. Thirty-two patients had postoperative bronchopleural fistula, and all cases were successfully managed conservatively. The timing of the surgical intervention is critical in reducing morbidity and mortality. The more advanced the disease, the higher the failure rate of VATS in attaining complete decortications. Conclusion: Open thoracotomy decortication remains the gold standard in attaining complete decortications in advanced empyema Thoracis

Oral Pemphigus treated with minipulse therapy.

Pemphigus is a chronic potentially fatal autoimmune disorder that causes blisters and erosions of the skin and oral mucous membrane. Most of the cases present oral manifestations as the first clinical sign along with dermal lesions. Only 0.5 to 3.2 of cases are reported each year per 1,000,000 population with oral manifestations without dermal participation, and is at times difficult to diagnose. We report a case of oral pemphigus vulgaris in a 20 year old female patient without dermal manifestations treated with oral mini pulse therapy. Pénfigo oral tratado con terapia minipulse.Resumen: El pénfigo es un trastorno autoinmune crónico potencialmente fatal que causa ampollas y erosiones de la piel y la membrana mucosa oral. La mayoría de los casos presentan manifestaciones orales como el primer signo clínico junto con lesiones dérmicas. Solo se reportan de 0.5 a 3.2 casos cada año por cada 1,000,000 de personas con manifestaciones orales sin afectación de la piel, y algunas veces es difícil de diagnosticar. Presentamos un caso de pénfigo vulgar oral en un paciente de 20 años, sin manifestaciones cutáneas tratadas con mini terapia del pulso oral

Vehicle Tracking And Accident Detection Using IoT

With the advent of modern technology has made our life simple, comfortable luxurious compared to the previous years. Now a day’s people are more habituated to vehicles for travelling purpose because of its ease and time consumption. Thus there is 31increase in usage of vehicles leading to increase in traffic causing many people to die due to road accidents. This paper is about a system that prevents the accident of vehicles which gives more likely to lower the accidents takes place daily on roads and at the same time if any accident occurs the system will locate the vehicles location and informs to local emergency authorities automatically helps to take immediate and appropriate actions. This system is based on Arduino developed with Global Positioning System (GPS) to identify the vehicle's location and Global System for Mobile Communication (GSM) technologies. A motion sensor gyroscope with 3-axis gyroscope and 3-axis accelerometer is used that measures the vehicles velocity and tilting position when the vehicle hits by something. When the vehicle velocity is more than the defined maximum for the particular location a warning will be given automatically and if any accident occurs the geographical coordinates of place are located by GPS and sends an SMS to the authorities nearby

In-silico analysis of PtpA - an antigenic protein of Mycobacterium tuberculosis

PtpA, a low-molecular weight tyrosine phosphatase, is a secreted protein of Mycobacterium tuberculosis (Mtb). Many secretory proteins of Mtb are known to be the prominent targets of host immune response. It plays an important role in host-pathogen interaction and it interferes with the passing of the protein from one endosomal vesicle to the next endosomal vesicle in the infected macrophage. It inhibits host phagolysosomal fusion in the infected macrophages and thus allows the bacteria to survive within macrophages. Analysis of primary and secondary structure of the protein was done by ProtParam and GOR IV respectively. Since the number of negatively charged residues are higher than the positively charged residues, PtpA is an acidic protein. Immunity against Mtb is T-cell mediated Thus an important criterion in seeking protective antigens should be that they induce T-cell- mediated immunity. The characterization of PtpA inducing CD4+ T-cell responses could critically contribute to the development of subunit vaccines for Mtb.  Here we performed computational analysis by using Proped, T-cell epitope prediction program. In-silico antigenicity prediction of PtpA was done using VaxiJen. Owing to the  resistance of this protein to the natural immune response, in-silico antigenicity and T-cell epitope prediction will be helpful to design better subunit vaccines to develop effective acquired immune response to Mtb

Toxicity of Neurons Treated with Herbicides and Neuroprotection by Mitochondria-Targeted Antioxidant SS31

The purpose of this study was to determine the neurotoxicity of two commonly used herbicides: picloram and triclopyr and the neuroprotective effects of the mitochondria-targeted antioxidant, SS31. Using mouse neuroblastoma (N2a) cells and primary neurons from C57BL/6 mice, we investigated the toxicity of these herbicides, and protective effects of SS1 peptide against picloram and triclopyr toxicity. We measured total RNA content, cell viability and mRNA expression of peroxiredoxins, neuroprotective genes, mitochondrial-encoded electron transport chain (ETC) genes in N2a cells treated with herbicides and SS31. Using primary neurons from C57BL/6 mice, neuronal survival was studied in neurons treated with herbicides, in neurons pretreated with SS31 plus treated with herbicides, neurons treated with SS31 alone, and untreated neurons. Significantly decreased total RNA content, and cell viability in N2a cells treated with picloram and triclopyr were found compared to untreated N2a cells. Decreased mRNA expression of neuroprotective genes, and ETC genes in cells treated with herbicides was found compared to untreated cells. Decreased mRNA expression of peroxiredoxins 1–6 in N2a cells treated with picloram was found, suggesting that picloram affects the antioxidant enzymes in N2a cells. Immunofluorescence analysis of primary neurons revealed that decreased neuronal branching and degenerating neurons in neurons treated with picloram and triclopyr. However, neurons pretreated with SS31 prevented degenerative process caused by herbicides. Based on these results, we propose that herbicides—picloram and triclopyr appear to damage neurons, and the SS31 peptide appears to protect neurons from herbicide toxicity

Assessment of patient perceptions of technology and the use of machine-based learning in a clinical encounter

Background: Electronic health records (EHR) were implemented to improve patient care, reduce healthcare disparities, engage patients and families, improve care coordination, and maintain privacy and security. Unfortunately, the mandated use of EHR has also resulted in significantly increased clerical and administrative burden, with physicians spending an estimated three-fourths of their daily time interacting with the EHR, which negatively affects within-clinic processes and contributes to burnout. In-room scribes are associated with improvement in all aspects of physician satisfaction and increased productivity, though less is known about the use of other technologies such as Google Glass (GG), Natural Language Processing (NLP) and Machine-Based Learning (MBL) systems. Given the need to decrease administrative burden on clinicians, particularly in the utilization of the EHR, there is a need to explore the intersection between varying degrees of technology in the clinical encounter and their ability to meet the aforementioned goals of the EHR. Aims: The primary aim is to determine predictors of overall perception of care dependent on varying mechanisms used for documentation and medical decision-making in a routine clinical encounter. Secondary aims include comparing the perception of individual vignettes based on demographics of the participants and investigating any differences in perception questions by demographics of the participants. Methods: Video vignettes were shown to 498 OhioHealth Physician Group patients and to ResearchMatch volunteers during a 15-month period following IRB approval. Data included a baseline survey to gather demographic and background characteristics and then a perceptual survey where patients rated the physician in the video on 5 facets using a 1 to 5 Likert scale. The analysis included summarizing data of all continuous and categorical variables as well as overall perceptions analyzed using multivariate linear regression with perception score as the outcome variable. Results: Univariate modeling identified sex, education, and type of technology as three factors that were statistically significantly related to the overall perception score. Males had higher scores than females (p = 0.03) and those with lower education had higher scores (p \u3c 0.001). In addition, the physician documenting outside of the room encounter had statistically significantly higher overall perception scores (mean = 22.2, p \u3c 0.001) and the physician documenting in the room encounter had statistically significantly lower overall perception scores (mean = 15.3, p \u3c 0.001) when compared to the other vignettes. Multivariable modeling identified all three of the univariably significant factors as independent factors related to overall perception score. Specifically, high school education had higher scores than associate/bachelor education (LSM = 21.6 vs. 19.9, p = 0.0002) and higher scores than master/higher education (LSM = 21.6 vs. 19.5, p \u3c 0.0001). No differences between age groups were found on the individual perception scores. Males had higher scores than females on ‘The doctor clearly explained the diagnosis and treatment to the patient’ and ‘The doctor was sincere and trustworthy’. High school education had higher scores than associate/bachelor and master/higher on all five individual perception scores. Conclusion: The study found sex, education, and type of technology were significant indicators for overall perception of varying technologies used for documentation and medical decision-making in a routine clinical encounter. Importantly, the vignette depicting the least interaction with the EHR received the most positive overall perception score, while the vignette depicting the physician utilizing the EHR during the interaction received the least positive overall perception score. This suggests patients most value having the full attention of the physician and feel less strongly about differentiating the logistics of data transcription and medical decision-making, provided they feel engaged during the interaction. Therefore, the authors suggest maximizing face-to-face time in the integration of technology into the clinical encounter, allowing for increased perceptions of personal attention in the patient-physician interaction

Utility of Cell-Free DNA Detection in Transplant Oncology

Transplant oncology is an emerging field in cancer treatment that applies transplant medicine, surgery, and oncology to improve cancer patient survival and quality of life. A critical concept that must be addressed to ensure the successful application of transplant oncology to patient care is efficient monitoring of tumor burden pre-and post-transplant and transplant rejection. Cell-free DNA (cfDNA) detection has emerged as a vital tool in revolutionizing the management of cancer patients who undergo organ transplantation. The advances in cfDNA technology have provided options to perform a pre-transplant evaluation of minimal residual disease (MRD) and post-transplant evaluation of cancer recurrence and transplant rejection. This review aims to provide a comprehensive overview of the history and emergence of cfDNA technology, its applications to specifically monitor tumor burden at pre-and post-transplant stages, and evaluate transplant rejection

Prevalence and patterns of depression among post myocardial infarction patients attending a tertiary care hospital

Background: Depression often affects the clinical outcome of Myocardial Infarction. Depression reduces the recovery rate of the individual and often deteriorates the condition. Knowledge regarding the prevalence of depression after myocardial infarction is necessary for treatment purposes. The present study is aimed to know prevalence and patterns of depression among post myocardial infarction patients.Materials and methods: A cross sectional study was done on 50 patients who suffered from myocardial infarction at tertiary care hospital, Guntur. A socio demographic chart along with Zung’s depression inventory was used to collect the data from the individual patient.Results: In our study, sample comprised of 27 (54%) male patients and 23 (46%) female patients. Symptoms for depression was observed 18 (36%) of the patients. Out of 50 patients 16 (32%) were in the group of mild depression and 2 (4%) patients were in the group of moderate depression, according to Zung’s Self Rating Depression Scale.Conclusion: Depression is common among post myocardial infarction patients. Identifying the symptoms of depression and proper treatment will help the patient to improve the treatment outcome of Myocardial Infarction. So it will help in overall improvement of their quality of life.Keywords: Depression, Myocardial infarction, Tertiary care hospital, Zung’s Self Rating Depression Scale