Physiological tolerance of the early life history stages of fresh water prawn (Macrobrachium rosenbergii De Man, 1879) to environmental stress

382-389The present study examines the effect of temperature and salinity on the larval development and survival of Macrobrachium rosenbergii. The larvae showed 100 % mortality at higher temperature (33.5 ± 0.5 °C) in all the salinity conditions (12, 15, and 20 PPT). The survival rate varied between 76-96 % on exposure to lesser temperature conditions. Likewise, the post-embryonic yolk lasted for 4 days at ambient temperature (29 °C); whereas, at 33.5 ± 0.5 °C, it lasted only for 2-3 days. There was an increase in total length of larvae, when exposed to higher temperature and salinity. For the cardiac performance, larval heart beat (fH) significantly increased for higher temperature and salinity conditions (20 PPT; 33.5 °C) and lowered at ambient condition 12 PPT; 29 °C. Larval stroke volume Vs, Cardiac output (Qt) were higher in ambient conditions and lowest in higher temperature and salinity conditions. The larval activity decreased significantly at higher temperature and salinity conditions, compared to ambient conditions

Prevalence of hepatitis C in patients with chronic kidney disease at a tertiary care hospital in north India: a retrospective analysis

Background: Hepatitis C and chronic kidney disease (CKD) both present an unsolved public health problem Hepatitis C virus (HCV) is easily transmitted in haemodialysis units and by kidney transplantation. HCV leads to increased mortality and morbidity due to cirrhosis and hepatocellular carcinoma, while accelerating the progression of CKD. The aim of the  study was to describe the demographic, clinical/biochemical profile and prevalence of patients with CKD who have HCV infection.Methods: This was a retrospective analysis of patients with CKD who presented to out/in patient department of medicine in a tertiary care center in Jammu from a period of Feb 2016 to Nov 2018. Detailed clinical history along with previous lab reports were noted and tests for HCV infection were conducted in all patients. Diagnosis of HCV was made via HCV RNA(RT PCR) and positive  Anti HCV IgG serology.Results: Total 67 patients were included with median age of 54 years (range 43-72 years) with majority 76.1% being males, and 71.6% within 41-60 years age group. 31.4% were HCV positive out of which 81% were males. 7 patients were found to have co-infection with HIV and HBsAg. Genotype 1 (72%) was found to be more common than Genotype 3. Ultrasonography and Upper GI endoscopy showcased 57% with dilated spleenoportal axis  and oesophageal varices respectively.Conclusions: Prevalence of HCV infection in CKD patients is high with genotype 1 being commonest. False negative Anti HCV antibody is common hence screening with HCV RNA is recommended. Strict universal precautions should be employed in hospitals and dialysis units to prevent transmission

Thoracic empyema: clinical course and management in Trivandrum Medical College

Background: The incidence of empyema thoracis among adults is increasing steadily. It may be primary empyema (pleural infection developing without pneumonia) or secondary empyema. The common cause of secondary empyema being- community acquired pneumonia or hospital acquired pneumonia, empyema due to iatrogenic causes, secondary to trauma etc. With advancement in science and technology, early recognition of empyema in patients with symptoms is now possible. But the treatment guidelines are not unified so that each physician may treat this condition in a different way without referring to higher concerned specialties making it complicated. The objective of this study was to determine the clinical profile of thoracic empyema in Trivandrum Medical College a tertiary care centre in South Kerala.Methods: A total of 56 patients with empyema admitted to Government Medical College, Trivandrum, Kerala in 2018-2019 were reviewed retrospectively. The demographic details, clinical presentation, etiology, microbiological findings, and management were recorded in a planned proforma, and analysis was done.Results: The mean age was 49.1 years with peak incidence seen in 40-60 years of age. The male to female ratio was 4.6:1.0 and right pleura was more involved than left pleura. Risk factors were diabetes mellitus, chronic obstructive pulmonary disease, pulmonary tuberculosis, and smoking. Etiology of thoracic empyema was infective in 78.6% cases and traumatic in 21.4% cases. Only two cultures showed gram positive aerobe, rest of the culture was sterile. Only a few cases resolved with medical management. Decortication was needed for 52 patients (82.1%).Conclusions: A unified protocol need to be formulated and followed up in all centres for the management of empyema before its evolution and thus reducing the incidence of empyema and its associated complications.

MRI Kidney Tumor Image Classification with SMOTE Preprocessing and SIFT-tSNE Features using CNN

Kidney tumor detection is a challenging task due to the complexity of tumor characteristics and variability in imaging modalities. In this paper, we propose a deep learning-based approach for detecting kidney tumors with 98.5% accuracy. Our method addresses the issue of an imbalanced dataset by applying the Synthetic Minority Over-sampling Technique (SMOTE) to balance the distribution of images. SMOTE generates synthetic samples of the minority class to increase the number of samples, thus providing a balanced dataset. We utilize a convolutional neural network (CNN) architecture that is trained on this balanced dataset of kidney tumor images. The CNN can learn and extract relevant features from the images, resulting in precise tumor classification. We evaluated our approach on a separate dataset and compared it with state-of-the-art methods. The results demonstrate that our method not only outperforms other methods but also shows robustness in detecting kidney tumors with a high degree of accuracy. By enabling early detection and diagnosis of kidney tumors, our proposed method can potentially improve patient outcomes. Additionally, addressing the imbalance in the dataset using SMOTE demonstrates the usefulness of this technique in improving the performance of deep learning-based image classification systems

Role of Self Care Practices and Denture Maintenance in Oral Health

Background: Edentulous patients seek treatment to restore their oral function and esthetics, so that they can eat and speak more easily and feel better about themselves. The dental prosthesis helps replacement of teeth and restores oral function and esthetics. For the success of the treatment and acceptance ofthe prosthesis, maintenance of the prosthesis by the patient is very important. The authors’ objective in this study was to analyze how selfcare practices in terms of oral hygiene habits, maintenance of dentures, type of prosthesis are affected by age, gender and education level. Materials and methods: The authors developed a written oral health questionnaire and administered it to 586 individuals in dental care centres in Mangalore, South India. They ollected demographic information as well as data on oral hygiene practices and prosthetic status. The data was compared using Chi-squared test and the value of p < 0.05 was considered statistically significant. Results: The sample surveyed consisted of 586 participants (257 males and 329 females) of which 76 (13.0%) were with complete dentures, 312 (53.3%) with Fixed Prosthesis, 165 (28.2%) with Removable Partial dentures and 33 (5.5%) had a combination of the fixed and removable prosthesis. The study showed that denture cleansing habits, Oral hygiene habits, how prosthesis was worn, type of prosthesis were significantlyassociated with age and educational status of the subjects. Conclusion: Intensive population-directed strategies for oral health education should be developed in order to improve the oral hygiene practices, denture cleansing habits in the entire population

Budesonide/formoterol combination in COPD: a US perspective

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease of the lung caused primarily by exposure to cigarette smoke. Clinically, it presents with progressive cough, sputum production, dyspnea, reduced exercise capacity, and diminished quality of life. Physiologically, it is characterized by the presence of partially reversible expiratory airflow limitation and hyperinflation. Pathologically, COPD is a multicomponent disease characterized by bronchial submucosal mucous gland hypertrophy, bronchiolar mucosal hyperplasia, increased luminal inflammatory mucus, airway wall inflammation and scarring, and alveolar wall damage and destruction. Management of COPD involves both pharmacological and nonpharmacological approaches. Bronchodilators and inhaled corticosteroids are recommended medications for management of COPD especially in more severe disease. Combination therapies containing these medications are now available for the chronic management of stable COPD. The US Food and Drug Administration, recently, approved the combination of budesonide/formoterol (160/4.5 μg; Symbicort™, AstraZeneca, Sweden) delivered via a pressurized meter dose inhaler for maintenance management of stable COPD. The combination also is delivered via dry powder inhaler (Symbicort™ and Turbuhaler™, AstraZeneca, Sweden) but is not approved for use in the United States. In this review, we evaluate available data of the efficacy and safety of this combination in patients with COPD

Study to assess the changing pattern of clinical profile and determine the prognosis in hepatic encephalopathy

Background: Hepatic encephalopathy (HE) is a common complication of liver disease that requires intensive care management. The prevalence of HE is increasing during recent period. The most important factors of HE are alcohol consumption, chronic hepatitis, hepatotoxic drugs and unhealthy changes in life style. There were only relatively few studies from our region on the changing profile of hepatic encephalopathy under the background of life style changes. This study was conducted with the aim to detect the changing pattern of clinical profile, precipitants and to assess the prognosis of patients with hepatic encephalopathy.Methods: This was a prospective study for a period of 18 months since January 2012 at Academy of Medical Sciences, Pariyaram, Kannur, a tertiary care centre situated in the northern part of Kerala. Patients admitted in the medical and gastroenterology wards and intensive care units that fulfilled the inclusion criteria were enrolled in this study.Results: Among the 76 patients with HE, 60 were suffering from CLD and 16 due to acute liver failure. The common etiologies for HE in CLD patients were Alcoholic cirrhosis (63%), Cryptogenic cirrhosis (17%) and cirrhosis due to chronic HBV (10%) and HCV hepatitis (7%) respectively. Among the CLD patients at the start of observation majority were in Child Pugh class B and C. Based on West Haven grading most of them had Grade 2 and 3 HE. Majority with Grade 1, 2 and 3 improved where as those with Grade 4 and Grade 3 in Child Pugh class C worsened. The common precipitants of HE were GI bleed, dyselectrolemia, constipation and infections. Among these precipitants a statistically significant association for a worse outcome was present only with infection. Leptospirosis and deliberate self-harm due to ingestion of hepatotoxic rodenticide and paracetamol were the leading cause of hepatic encephalopathy in acute liver failureConclusions: In present study HE was most commonly seen in patients with alcoholic liver disease. Cryptogenic cirrhosis associated with other life style diseases was the second common condition. Among all precipitating factors infection appeared as a statistically significant factor predicting a worse outcome. Health education among alcoholic patients and life style modifications to prevent cryptogenic cirrhosis are of paramount importance in curtailing the increase in incidence of HE in this region