Overlap Syndrome of Autoimmune Hepatitis and Primary Biliary Cirrhosis: A Clinical Enigma

“Overlap syndrome” is a term used to describe variant forms of autoimmune hepatitis (AIH) which present with characteristics of AIH and primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). Patients with overlap syndrome present with both hepatitic and cholestatic serum liver test and the clinical, biochemical, and histological features of these autoimmune diseases are overlapped. Thus, it is difficult to appreciate overlap syndrome as an actual diagnostic entity. AIH-PBC is the most common form of overlap syndrome, affecting almost 10% of adults with AIH or PBC. Transitions from PBC to AIH-PBC overlap syndrome have also been reported. Ursodeoxycholic acid is usually combined with immunosuppressive therapy but end-stage disease requires liver transplantation. We present a case of Overlap Syndrome (AIHPBC)in a 16 year old girl who presented to us with features of obstructive jaundice. She had six months history of generalised itching, yellow discoloration of skin and urine, decreased appetite and intermittent abdominal pain. Liver function test revealed conjugated hyperbilirubinemia, with moderate elevationof liver enzymes. Antinuclear, anti-muscle M2 and anti-glycoprotein 210 antibodies were positive. Liver biopsy showed features of primary biliary cirrhosis. The patient responded to ursodeoxycholic acid and immunosuppression

A case of Steroid Responsive Encephalopathy associated with Autoimmune Thyroiditis: A Diagnostic Dilemma

We present a case of 42 year-old female, who presented with generalized tonic-clonic seizures with altered sensorium, not responding to antiepileptic medications. She was a diagnosed case of hypothyroidism since last three years and was on replacement therapy. Her systemic examination including the neurological examination did not point to any specific diagnosis. Her routine investigations, brain imaging and CSF analysis were also within normal limits. Thyroid function test revealed raised thyroid stimulating hormone and anti-TPO antibody with normalT4 and T3 levels. Here we considered diagnosis of “Encephalopathy Associated with Autoimmune Thyroid Disease”. She was given intravenous methylprednisolone pulse to which she responded dramatically and seizures were controlled. She was discharged on oral anti-epileptics and steroids in a stable condition

Comparative assessment of air pollution tolerance index (APTI) in the industrial (Rourkela) and non industrial area (Aizawl) of India: An ecomanagement approach

Science for phyto-technologies has got immense application in air pollution science. The present study focuses on the determination of air pollution tolerance indices (APTI) from six common road side plant species growing along industrial (Rourkela) and non industrial area (Aizawl), India. The APTI was determined by synthesizing the four different physiological and biochemical parameters, that is, leaf relative water content (RWC), ascorbic acid content (AA), total leaf chlorophyll (TCh) and pH of leaf extract. The plant species selected for the study were Ficus bengalensis, Mangifera indica, Bougainvillea spectabilis, Psidium guajava, Hibiscus rosa-sinensis and Lantana camara. Reduction in total chlorophyll content and pH was found in the leaf samples of all selected plants collected from Industrial site (Rourkela) when compared with samples from non industrial site (Aizawl) whereas APTI, ascorbic acid and RWC were found to be higher in the plant samples of Industrial site (Rourkela) as compared to non industrial site (Aizawl). On the basis of APTI, F. bengalensis was found to be tolerant (8.64) in industrial site (Rourkela) and M. indica (7.95) in non industrial site (Aizawl). Plant species such as M. indica and B. spectabilis, showing minimum difference in their APTI values may be considered as tolerant for both (industrial and non industrial) sites.Key words: Air pollution tolerance indices (APTI), biochemical parameters, Ficus bengalensis, roadside plants

Inter-cluster Thread-to-core Mapping and DVFS on Heterogeneous Multi-cores

Heterogeneous multi-core platforms that contain different types of cores, organized as clusters, are emerging, e.g. ARM's big.LITTLE architecture. These platforms often need to deal with multiple applications, having different performance requirements, executing concurrently. This leads to generation of varying and mixed workloads (e.g. compute and memory intensive) due to resource sharing. Run-time management is required for adapting to such performance requirements and workload variabilities and to achieve energy efficiency. Moreover, the management becomes challenging when the applications are multi-threaded and the heterogeneity needs to be exploited. The existing run-time management approaches do not efficiently exploit cores situated in different clusters simultaneously (referred to as inter-cluster exploitation) and DVFS potential of cores, which is the aim of this paper. Such exploitation might help to satisfy the performance requirement while achieving energy savings at the same time. Therefore, in this paper, we propose a run-time management approach that first selects thread-to-core mapping based on the performance requirements and resource availability. Then, it applies online adaptation by adjusting the voltage-frequency (V-f) levels to achieve energy optimization, without trading-off application performance. For thread-to-core mapping, offline profiled results are used, which contain performance and energy characteristics of applications when executed on the heterogeneous platform by using different types of cores in various possible combinations. For an application, thread-to-core mapping process defines the number of used cores and their type, which are situated in different clusters. The online adaptation process classifies the inherent workload characteristics of concurrently executing applications, incurring a lower overhead than existing learning-based approaches as demonstrated in this paper. The classification of workload is performed using the metric Memory Reads Per Instruction (MRPI). The adaptation process pro-actively selects an appropriate V-f pair for a predicted workload. Subsequently, it monitors the workload prediction error and performance loss, quantified by instructions per second (IPS), and adjusts the chosen V-f to compensate. We validate the proposed run-time management approach on a hardware platform, the Odroid-XU3, with various combinations of multi-threaded applications from PARSEC and SPLASH benchmarks. Results show an average improvement in energy efficiency up to 33% compared to existing approaches while meeting the performance requirements

Bio-inspired Tensegrity Soft Modular Robots

In this paper, we introduce a design principle to develop novel soft modular robots based on tensegrity structures and inspired by the cytoskeleton of living cells. We describe a novel strategy to realize tensegrity structures using planar manufacturing techniques, such as 3D printing. We use this strategy to develop icosahedron tensegrity structures with programmable variable stiffness that can deform in a three-dimensional space. We also describe a tendon-driven contraction mechanism to actively control the deformation of the tensegrity mod-ules. Finally, we validate the approach in a modular locomotory worm as a proof of concept.Comment: 12 pages, 7 figures, submitted to Living Machine conference 201

Correlation between hematological parameters, blood urea level and mortality of COVID-19 patients.

Aim: Present study was aimed to analyze difference of hematological parameters and blood urea level between Recovered and Dead cases of COVID-19. Material & Methods: A hospital based study was undertaken wherein hematological parameters and blood urea level of 65 cases were analyzed. Results: Recovered patients, 16 (42.1%) showed higher levels of neutrophils with corresponding 22 (57.9%) patients showing normal level of lymphocytes, 25 (65.7%) with normal hemoglobin and 35 (92%) with normal blood urea. On other hand, among 27 Died cases, 26 (96.2%) showed higher counts of neutrophils, 1 patient showed normal lymphocytes (3.8%) and 26 (96.2%) with low count of lymphocytes. Conclusion: In majority of cases, recovered patients showed normal range of lymphocytes (20-45%), hemoglobin and blood urea levels, whereas mortality was observed associated with deficiency of lymphocytes (except one patient all belo

An assessment of the usefulness of a rapid immuno-chromatographic test, "Determine™ malaria pf" in evaluation of intervention measures in forest villages of central India

BACKGROUND: Plasmodium falciparum malaria, is a major health problem in forested tribal belt of central India. Rapid and accurate methods are needed for the diagnosis of P. falciparum. We performed a blinded evaluation of the recently introduced Determine™ malaria pf test (Abbott, Laboratories, Japan) compared with microscopy and splenomegaly in children in epidemic prone areas of district Mandla to assess the impact of intervention measures. METHODS: Children aged 2–10 yrs with and without fever were examined for spleen enlargement by medical specialist by establishing a mobile field clinic. From these children thick blood smears were prepared from finger prick and read by a technician. Simultaneously, rapid tests were performed by a field lab attendant. The figures for specificity, sensitivity and predictive values were calculated using microscopy as gold standard. RESULTS: In all 349 children were examined. The sensitivity and specificity for Determine rapid diagnostic test were 91 and 80% respectively. The positive predictive values (PPV), negative predictive values (NPV) and accuracy of the test were respectively 79, 91 and 85%. On the contrary, the sensitivity and specificity of spleen in detecting malaria infection were 57 and 74 % respectively with PPV of 73%, NPV 59 % and an accuracy of 65%. CONCLUSIONS: Determine™ malaria rapid diagnostic test is easier and quicker to perform and has other advantages over microscopy in not requiring prior training of personnel or quality control. Thus, highlighting the usefulness of a rapid antigen test in assessing prevailing malaria situation in remote areas

Long-term result of Memokath urethral sphincter stent in spinal cord injury patients

BACKGROUND: Memokath urethral sphincter stents are used to facilitate bladder emptying in patients with spinal cord injury, but long term follow-up has not been reported. METHODS: Case series of ten men with spinal cord injury who underwent insertion of Memokath stents and were followed for up to nine years. RESULTS: Within four years, the stent had to be removed in nine out of ten patients because of: extensive mucosal proliferation causing obstruction to the lumen of the stent; stone around the proximal end of the stent, incomplete bladder emptying, and recurrent urinary infections; migration of the stent into the bladder related to digital evacuation of bowels; large residual urine; concretions within the stent causing obstruction to flow of urine, and partial blockage of the stent causing frequent episodes of autonomic dysreflexia. In one patient the stent continued to function satisfactorily after nine years. CONCLUSIONS: The Memokath stent has a role as a temporary measure for treatment of detrusor-sphincter dyssynergia in selected SCI patients who do not get recurrent urinary infection and do not require manual evacuation of bowels

Association between major surgical admissions and the cognitive trajectory: 19 year follow-up of Whitehall II cohort study

Objective: To quantify the association between major surgery and the age related cognitive trajectory. / Design: Prospective longitudinal cohort study. / Setting: United Kingdom. / Participants: 7532 adults with as many as five cognitive assessments between 1997 and 2016 in the Whitehall II study, with linkage to hospital episode statistics. Exposures of interest included any major hospital admission, defined as requiring more than one overnight stay during follow-up. / Main outcomes measures: The primary outcome was the global cognitive score established from a battery of cognitive tests encompassing reasoning, memory, and phonemic and semantic fluency. Bayesian linear mixed effects models were used to calculate the change in the age related cognitive trajectory after hospital admission. The odds of substantial cognitive decline induced by surgery defined as more than 1.96 standard deviations from a predicted trajectory (based on the first three cognitive waves of data) was also calculated. / Results: After accounting for the age related cognitive trajectory, major surgery was associated with a small additional cognitive decline, equivalent on average to less than five months of aging (95% credible interval 0.01 to 0.73 years). In comparison, admissions for medical conditions and stroke were associated with 1.4 (1.0 to 1.8) and 13 (9.6 to 16) years of aging, respectively. Substantial cognitive decline occurred in 2.5% of participants with no admissions, 5.5% of surgical admissions, and 12.7% of medical admissions. Compared with participants with no major hospital admissions, those with surgical or medical events were more likely to have substantial decline from their predicted trajectory (surgical admissions odds ratio 2.3, 95% credible interval 1.4 to 3.9; medical admissions 6.2, 3.4 to 11.0). / Conclusions: Major surgery is associated with a small, long term change in the average cognitive trajectory that is less profound than for major medical admissions. The odds of substantial cognitive decline after surgery was about doubled, though lower than for medical admissions. During informed consent, this information should be weighed against the potential health benefits of surgery

Association between major surgical admissions and the cognitive trajectory: 19 year follow-up of Whitehall II cohort study

OBJECTIVE: To quantify the association between major surgery and the age related cognitive trajectory. // DESIGN: Prospective longitudinal cohort study. // SETTING: United Kingdom. // PARTICIPANTS: 7532 adults with as many as five cognitive assessments between 1997 and 2016 in the Whitehall II study, with linkage to hospital episode statistics. Exposures of interest included any major hospital admission, defined as requiring more than one overnight stay during follow-up. // MAIN OUTCOMES MEASURES: The primary outcome was the global cognitive score established from a battery of cognitive tests encompassing reasoning, memory, and phonemic and semantic fluency. Bayesian linear mixed effects models were used to calculate the change in the age related cognitive trajectory after hospital admission. The odds of substantial cognitive decline induced by surgery defined as more than 1.96 standard deviations from a predicted trajectory (based on the first three cognitive waves of data) was also calculated. // RESULTS: After accounting for the age related cognitive trajectory, major surgery was associated with a small additional cognitive decline, equivalent on average to less than five months of aging (95% credible interval 0.01 to 0.73 years). In comparison, admissions for medical conditions and stroke were associated with 1.4 (1.0 to 1.8) and 13 (9.6 to 16) years of aging, respectively. Substantial cognitive decline occurred in 2.5% of participants with no admissions, 5.5% of surgical admissions, and 12.7% of medical admissions. Compared with participants with no major hospital admissions, those with surgical or medical events were more likely to have substantial decline from their predicted trajectory (surgical admissions odds ratio 2.3, 95% credible interval 1.4 to 3.9; medical admissions 6.2, 3.4 to 11.0). // CONCLUSIONS: Major surgery is associated with a small, long term change in the average cognitive trajectory that is less profound than for major medical admissions. The odds of substantial cognitive decline after surgery was about doubled, though lower than for medical admissions. During informed consent, this information should be weighed against the potential health benefits of surgery