Multiple intracerebral lesions in a young male

Background: As the incidence of HIV infection has increased its neurological complications are being encountered in our clinical practice. Toxoplasmosis is a common cerebral opportunistic infection seen in HIV-infected patients, even though the incidence has declined with the use of antiretroviral therapy. Establishing a definitive diagnosis of cerebral toxoplasmosis is difficult in resource limited settings.Clinical case: A 20 year old gentleman was referred to our institute as a case of stroke. Magnetic  resonance imaging (MRI) of his brain showed multiple ill-defined and nodular enhancing lesions in bilateral supratentorial and infratentorial neuroparenchyma. Test for HIV-1 was reactive. Toxoplasma serology revealed raised IgG antibody levels. Based on the MRI features and positive toxoplasma serology a diagnosis of cerebral  toxoplasmosis was made. He was treated with trimethoprim/ sulfamethoxazole and pyrimethamine/ Sulfadoxine for 3 weeks. After 2 weeks of treatment, repeat MRI of brain was done which showed significant resolution of the lesions.Conclusion: We are presenting this case to highlight the fact that cerebral toxoplasmosis should be  considered in the differential diagnosis of multiple neuroparenchymal lesions in young individuals who present with neurological deficits.Keywords: Cerebral toxoplasmosis; HIV/AIDS; Tuberculoma; Neurocysticercosi

Efficacy of Autologous Platelet Rich Fibrin (PRF) Dressing Over Moist Saline/Povidone Iodine Dressing in Diabetic Foot Ulcers and the Influence of TLR 4 Receptors in their Healing: A Randomised Controlled Study

Diabetic foot ulcer is a devastating complication of diabetes mellitus. This condition is more common in old patients. The risk in a diabetic patient’s lifetime having this complication of diabetic foot ulcer is estimated to be about 15%. Majority of diabetic foot ulcers may heal whereas a smaller percentage will remain active and finally lead to amputation of the limb. With increasing duration of the ulcer and the increasing age of the patient, the risk of amputation also rises. Early prevention plays a vital role in betterment of the quality of life of the patient and also reduces the financial toll. Diabetic foot ulcer is one of the most demanding problems and it is recommended that a multi disciplinary team work is essential for management. Wound dressings constitute a major part of the management of diabetic foot ulceration. An ideal dressing will have to reduce the symptoms, give adequate protection of the wound and promote good healing. There are many types of dressings available for the treatment of foot ulcers. There is no particular dressing that fulfils all the requirements of the patient. Platelet rich fibrin prepared from patients own blood is under extensive research and is used in the fields of orthopaedics and dentistry to promote wound healing. Platelet rich fibrin transfers growth factors to the wound surface. The use of an autologous preparation reduces the risk of allergic reactions and promotes delivery of many growth factors when compared to conventional preparations. There are many studies on the use of platelet rich fibrin as a dressing alternative, but only very few studies compare the efficacy of PRF with other dressing materials. The normal wound healing process involves a series of stages namely acute inflammation, proliferation and remodeling. The innate immune system plays a major role in wound healing cascade and is usually mediated by toll like receptors. The down regulation of these receptors influence the normal healing pathway. The many chemokines and cytokines released have anti microbial effect. Toll Like Receptors were first discovered in 1985 by Christiane Nusslein- Volhard. The first discovered member of the TLR family was the toll like receptor 4 which is responsible for the release of a great range of cytokines. TLR 4 helps in immune-stimulation, inflammation, angiogenesis , tissue repair and regeneration and is recently under study for its major role in wound healing. Patients with down regulation of these receptors take longer time to heal. This also helps in expression of Vascular Endothelial Growth Factor. Therefore when there is differential expression of TLR 4 there is impaired wound healing. This study will compare the efficacy of PRF dressing with moist saline/povidone iodine dressing in diabetic patients having foot ulcers. Only a limited number of studies have been done to compare the efficacy of PRF dressing with other conventional methods. The molecular part of this study was done to determine the influence of TLR polymorphism in wound healing. The aim of this study was to compare the efficacy of autologous platelet rich fibrin (PRF) over moist sterile saline / povidone iodine dressing in diabetic foot ulcers and the influence of TLR 4 receptors in their healing. The objectives were to compare the mean reduction in ulcer area at the end of 4 weeks of dressings and to study the influence of expression of TLR 4 polymorphism in wound healing. 60 diabetic patients with foot ulcers from the department of general surgery, general medicine, endocrinology, and cardiology were prospectively studied. Detailed clinical history, evaluation of ulcer and presence of wound infection were assessed for all the patients. Patients were randomized into two groups of 30 patients each. While one group received PRF dressings, the other received saline/povidone iodine dressings. The wound healing was then compared in the two groups. Also the influence of TLR 4 receptor polymorphisms were studied in two different genes TLR 911 and TLR 914, in both saline and PRF treated groups. The efficacy of platelet rich fibrin dressing over moist saline/povidone iodine dressings was assessed by comparing the percentage reduction at the end of four weeks, using chi square test and ANOVA test. The influence of TLR 4 receptor polymorphism in wound healing was also studied in 13 patients who received PRF dressings and 13 patients who received moist saline/povidone iodine dressings and analyzed using chi square test and ANOVA test. Diabetic foot ulcers pose a real threat to diabetic patients in terms of morbidity and expense. Many dressing materials and techniques are available these days and the need for same should be tailored according to each patient. Platelet Rich Fibrin (PRF) when used for dressing in diabetic foot ulcers had better and faster healing when compared to saline/povidone iodine dressing. PRF is easy to prepare. Being an autologous preparation, it has the least adverse reactions. PRF has its best effect when left undisturbed for a week since it has the property of slow release of growth factors. Platelet Rich Fibrin dressing was found to be best suited for bed ridden patients. Toll like receptors 4 polymorphisms were found to influence wound healing in diabetic patients. It was found the expression of allele ‘A’ had better healing in diabetic foot ulcers treated with either saline/povidone iodine dressings or PRF dressings. However the molecular study did not show a statistically significant reduction the limitation being that it was done in a small sample size

BENEFICIAL OUTCOMES AFTER COMBINED THERAPY WITH AZATHIOPRINE AND PIOGLITAZONE IN PRECLINICAL ARTHRITIC MODELS

Objectives: The present study was designed to investigate the antioxidant and anti-arthritic activities of azathioprine-pioglitazone combination therapy to check whether it has an add on benefit over monotherapy with azathioprine or pioglitazone on disease activity in rodent models. Methods: The antioxidant activity of test drugs and their combination was screened by H2O2 and nitric oxide scavenging assays. They were further evaluated for anti-arthritic activity using in vitro models such as protein denaturation and membrane stabilization and in vivo methods such as formaldehyde and complete Freund’s adjuvant (CFA)-induced arthritis. Results: The combination of test drugs showed better inhibition of free radicals in both H2O2 and nitric oxide scavenging assay than individual counterparts revealing its potential antioxidant activity. They also showed significant inhibition of protein denaturation and proliferation of the red blood cell in in vitro models. The test drugs showed significant inhibition of the paw volume in both the formaldehyde and CFA-induced arthritis along with reverting the altered biochemical parameters. These findings were corroborated by radiological and histopathological studies. Conclusions: Combination of azathioprine and pioglitazone exhibited better antioxidant and anti-arthritic effect than the individual drugs showing synergistic interaction between them

YALE OBSERVATION SCALE AS A PREDICTOR OF BACTEREMIA AND FINAL OUTCOME IN 3-36 MONTHS OLD FEBRILE CHILDREN ADMITTED IN TERTIARY HEALTH CENTRES: A HOSPITAL-BASED CROSS-SECTIONAL STUDY

ABSTRACTObjectives: The objective of the study was to assess predictability of bacteremia in febrile children in the age group of 3-36 months by application ofYale observation scale (YOS) and to predict clinical course during hospital stay and final outcome by YOS.Methods: A hospital-based cross-sectional study was carried out at Kasturba Medical College, Mangalore, Karnataka, for a period of 2 years(September 2013-September, 2015) in 100 febrile children in the age group of 3-36 months with probable infectious etiology admitted in ward/PICU.Children with any non-infectious causes of fever (vaccination, autoimmune, and immunodeficiency disorder) were excluded from the study. Caseswere selected by simple random sampling. The primary study outcome was bacteremia based on positivity on blood culture and sensitivity sampledrawn at admission. Secondary outcomes are clinical course in the hospital, use of antibiotics, need for mechanical ventilation, hospital stay, andmortality.Results: 100 cases were included in the study out of which 18 cases were bacteremic with a mean YOS of 26 (non-bacteremic - 11), mean hospitalstay 19.5 days (non-bacteremic - 12 days). All 18 bacteremic children had YOS ≥20, but YOS ≥20 had 8 false positives cases. There was no significantinterobserver variability in YOS assessment (Cronbach's alpha - 0.993 showing good correlation with intraclass correlation coefficient - 0.986).Higher YOS scores had good sensitivity, specificity, positive and negative likelihood ratios, and area under curve for prediction of bacteremia atYOS >20 (100%, 90.2%, 10.2, 0.00, and 0.970), need for mechanical ventilation at YOS >21 (100%, 91.7%, 12.04, 0.00, and 0.969), need for scaling upantibiotics at YOS >21 (70.4%, 94.4%, 12.5, 0.31, and 0.822), and mortality at YOS >21 (90.9%, 85.4%, 6.2, 0.106, 0.878).Conclusion: YOS is a good tool to rule out bacteremia and to prognosticate the clinical course at the first visit. This simple scale can be of value inmonitoring admitted patients for deteriorating clinical state and for assessing the need for referral to higher centers for further management.Keywords: Yale observation scale, Bacteremia, Febrile patients

AVERTING THROUGHPUT OUTAGE LIKELIHOOD WITH RESTRICTED SHIELD

The goal of this paper would be to create a radio resource allocation strategy which allocates traffic channels based on users’ funnel conditions in addition to traffic patterns. There are many causes of this success of OFDMA as multiple access plans. To begin with, the proliferation of orthogonal frequency division multiplexing (OFDM) as favorable transmission plan for broadband wireless links makes OFDMA the “natural” option for multiple accesses. Within this paper we present a singular framework for admission control in OFDMA cells. The framework enables the conjecture of achievable rates given some sources along with a certain group of demands. An OFDMA system is understood to be one out of which each and every user occupies a subset of subcarriers, and every carrier is assigned solely to simply one user anytime. The TGM formula is dependent on greedy sensing, and it is transported out without iterations. It's optimal for that specific funnel that's being assigned. Particularly, the funnel is owned by the consumer that may boost the throughput to the most. The primary concept of the plan would be to first estimate the bandwidth allocation to fulfill the outage requirement from each user, and so the traffic throughput is maximized via a TGM formula coded in this paper. More to the point, these examples show how the value of queue versus. Funnel condition information varies using the traffic load. Maximizing the packets transmitted for every OFDM symbol transmission results in a maximum bound within the throughput

Developing a Measure of Safety Data Culture

Safety is a critical concern for many organizations, especially those in construction and manufacturing. A newer approach to improving an organization’s decision making involves the use of data analytics. In regard to safety, the use of data analytics would allow for detecting and tracking risk factors such as behaviors, environmental contingencies, production, procedures, and hazards that are associated with workplace injuries. However, many organizations do not have a culture involving the use and measurement of relevant variables on an ongoing basis. Accordingly, the purpose of the study is to develop a measure of safety culture with a specific emphasis on the extent to which data is being utilized for management of safety in an organization. This measure of safety culture and analytics will assist in determining the extent to which an organization is ready to utilize data analytics into their safety program

An investigation on the effects of psychological contract (PC) towards site safety in the south Indian construction industry

The construction sector is India\u27s second-largest industry, contributing to the country\u27s economy and providing many job opportunities. However, construction has been described as a hazardous industry with a high rate of injuries, accidents, and fatalities compared to other sectors worldwide. The psychological contract of safety (PCS) is one of the safety climate (SC) variables that influence worker safety behavior (WSB) actions on construction sites to improve safety. This research investigates the influence of SC factors on PCS and PCS on WSB in construction site safety. A quantitative research method has been adopted in this study, and the data is collected from the construction professionals working in South India. Statistical analyses were performed for the collected data; consisted of stepwise regression analysis and structural equation modelling (SEM) analysis to determine the significance of PCS. The findings disclose that in direct effect, four out of six SC factors contribute to enhancing PCS, namely supervisor safety behavior, co-worker safety behavior, worker involvement, and safety system, and it shows that PCS influences WSB. In indirect effect of SC factor on WSB two factors positively influence namely: supervisor safety behavior, co-worker safety behavior and remaining two negatively influences. The outcome of this study helps the construction professionals to improve safety performance by fulfilling their obligations and improving WSB in construction sites

Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries