Hypothermia for moderate or severe neonatal encephalopathy in low-income and middle-income countries (HELIX): a randomised controlled trial in India, Sri Lanka, and Bangladesh

Background: Although therapeutic hypothermia reduces death or disability after neonatal encephalopathy in high-income countries, its safety and efficacy in low-income and middle-income countries is unclear. We aimed to examine whether therapeutic hypothermia alongside optimal supportive intensive care reduces death or moderate or severe disability after neonatal encephalopathy in south Asia. Methods: We did a multicountry open-label, randomised controlled trial in seven tertiary neonatal intensive care units in India, Sri Lanka, and Bangladesh. We enrolled infants born at or after 36 weeks of gestation with moderate or severe neonatal encephalopathy and a need for continued resuscitation at 5 min of age or an Apgar score of less than 6 at 5 min of age (for babies born in a hospital), or both, or an absence of crying by 5 min of age (for babies born at home). Using a web-based randomisation system, we allocated infants into a group receiving whole body hypothermia (33·5°C) for 72 h using a servo-controlled cooling device, or to usual care (control group), within 6 h of birth. All recruiting sites had facilities for invasive ventilation, cardiovascular support, and access to 3 Tesla MRI scanners and spectroscopy. Masking of the intervention was not possible, but those involved in the magnetic resonance biomarker analysis and neurodevelopmental outcome assessments were masked to the allocation. The primary outcome was a combined endpoint of death or moderate or severe disability at 18–22 months, assessed by the Bayley Scales of Infant and Toddler Development (third edition) and a detailed neurological examination. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02387385. Findings: We screened 2296 infants between Aug 15, 2015, and Feb 15, 2019, of whom 576 infants were eligible for inclusion. After exclusions, we recruited 408 eligible infants and we assigned 202 to the hypothermia group and 206 to the control group. Primary outcome data were available for 195 (97%) of the 202 infants in the hypothermia group and 199 (97%) of the 206 control group infants. 98 (50%) infants in the hypothermia group and 94 (47%) infants in the control group died or had a moderate or severe disability (risk ratio 1·06; 95% CI 0·87–1·30; p=0·55). 84 infants (42%) in the hypothermia group and 63 (31%; p=0·022) infants in the control group died, of whom 72 (36%) and 49 (24%; p=0·0087) died during neonatal hospitalisation. Five serious adverse events were reported: three in the hypothermia group (one hospital readmission relating to pneumonia, one septic arthritis, and one suspected venous thrombosis), and two in the control group (one related to desaturations during MRI and other because of endotracheal tube displacement during transport for MRI). No adverse events were considered causally related to the study intervention. Interpretation: Therapeutic hypothermia did not reduce the combined outcome of death or disability at 18 months after neonatal encephalopathy in low-income and middle-income countries, but significantly increased death alone. Therapeutic hypothermia should not be offered as treatment for neonatal encephalopathy in low-income and middle-income countries, even when tertiary neonatal intensive care facilities are available. Funding: National Institute for Health Research, Garfield Weston Foundation, and Bill & Melinda Gates Foundation. Translations: For the Hindi, Malayalam, Telugu, Kannada, Singhalese, Tamil, Marathi and Bangla translations of the abstract see Supplementary Materials section

Primary multicentric cutaneous epithelioid angiosarcoma

Cutaneous epithelioid angiosarcoma is a rare malignant vascular tumor, most commonly affecting elderly men, and is usually located on the extremities. We report a case of an 81-year-old lady who presented with two ulcerated plaques over the right temporal and parietal scalp of 1 year duration. The right submaxillary and submandibular lymph nodes were enlarged and tender. Computed tomography (CT) scan of the head showed soft tissue swelling over parietal and temporal areas and there was no intracranial extension. Ultrasonogram of the abdomen showed hyperechoic areas in liver suggestive of secondaries. Histopathology of the skin lesion showed the dermis and subcutis composed of clusters of atypical epithelioid cells with vesicular nuclei, prominent nucleoli and eosinophilic cytoplasm with increased mitotic figures. Immunohistochemical staining revealed CD-31, 33, 34 and vimentin positivity, while cytokeratin was negative confirming the diagnosis of epitheloid angiosarcoma. This case report highlights the unusual occurrence of multicentric epitheloid angiosarcoma on the scalp with secondaries in the liver

Estimation of photovoltaic models using an enhanced Henry gas solubility optimization algorithm with first-order adaptive damping Berndt-Hall-Hall-Hausman method

A reliable methodology is essential for accurately estimating the parameters of PV models, enabling reliable performance evaluations, effective control studies, accurate analysis of partial shading effects, and optimal optimization of Photovoltaic (PV) systems. It ensures that the obtained parameters reflect the true characteristics of the PV system, leading to more accurate and reliable results in various applications. The existing literature extensively explores the utilization of powerful Metaheuristic Algorithms (MAs) to address the complex constrained optimization problem in PV systems and achieve optimal solutions. However, it is important to note that a significant portion of these MAs primarily concentrates on the development of methodologies, often overlooking the design of the objective function tailored for PV systems. This oversight has created a theoretical gap in this research domain, underscoring the necessity for additional exploration and investigation to address this limitation. To address the existing theoretical gap, this study focused on developing an objective function that accurately estimates the initial root parameters of Photovoltaic (PV) models. This objective function was designed by incorporating the first-order Berndt-Hall-Hall-Hausman (BHHH) numerical method, along with the non-linear damping parameter of the Levenberg-Marquardt technique (LM). By implementing this approach, the study aimed to significantly improve the precision and reliability of estimating the initial root parameters in PV models, effectively filling the theoretical void in this specific research area. Then in terms of methodology, the Enhanced Henry Gas Solubility Optimization (EHGSO) algorithm is combined with the Sine-Cosine mutualism phase of Symbiotic Organisms Search (SOS) for efficiently estimating the unknown parameters of PV models. The keystone of EHGSO in terms of methodology enhances exploration at the beginning of optimization and intensifies exploitation in later iterations. The proposed EHGSO methodology based on the adaptive damping BHHH technique (EHGSOAdBHHH) is tested on Single Diode (SD), and Double Diode (DD) PV models using actual experimental data. EHGSOAdBHHH exhibits outstanding accordance with attained experimental data compared with other algorithms, and its superiority is validated using several statistical criteria

HLA – B association in psoriasis

Background: Psoriasis is a common skin disorder with prevalence varying from 0% to 11.8% in different population. HLA association with psoriasis is well established with very little information about Indian Population. Aim: To determine the HLA-B pattern and its association in psoriasis patients. Materials and Methods: Fifty cases and 50 controls were enrolled in the study. HLA-B typing was done by PCR-SSP method and the results was analyzed and interpreted. Results: The alleles that were found in higher frequency in the cases than in the controls were – HLA-B*35 (34%), HLA-B*15 (26%), HLA-B*40 (26%) and HLA-B*18(14%). Conclusion: HLA-B*18 and HLA-B*40 show a strong association with psoriasis