Ayurvedic Management of Presbycusis (Project TOPMAC): Protocol for an Exploratory Randomized Controlled Trial.

BACKGROUND: Presbycusis is characterized by sensorineural hearing loss in both ears at high frequencies, which affects more than half of the older adults by the age of 75 years and is often accompanied by tinnitus and cognitive deterioration. Unfortunately, there are no treatments available to restore hearing loss. Treatment mainly focuses on improving the quality of life and communication with hearing aids. Traditional medicine like Ayurveda also explains ailments of a similar nature as Badhirya and advises using drugs with antiaging and neuroprotective activity for treatment. In Ayurveda, Badhirya and Karnanada (senile deafness with tinnitus) are due to vitiation of Vata Dosha. Treatments such as topical oil pooling (Karnapurana) are usually advised to counter Vata, improve hearing capacity, and reduce tinnitus. Kshirabala Taila, a medicated oil formulation prepared with Sida cordifolia Linnaeus, is one of the most preferred oils for topical oil pooling in such conditions, as it has a definitive indication for sensory dysfunctions. Drugs like Withania somnifera (L.) Dunal (Ashwagandha) are also used, as they ameliorate neurodegeneration and help to improve cognitive dysfunction. OBJECTIVE: We propose an exploratory randomized controlled trial study for evaluating the efficacy of TOPMAC (Topical Oil Pooling with Kshirabala Taila and Supplementation of Ashwagandha Churna) in tinnitus suppression and hearing and cognitive function protection in patients aged 60-75 years with mild to moderate presbycusis. METHODS: A parallel, 2-group, exploratory randomized controlled trial will be conducted in an Indian Ayurvedic research center at its outpatient service. Participants (N=60) with mild to moderate presbycusis will be recruited by screening. Participants will be randomized (computer-generated 1:1) to receive either basic treatment and health education (BTHE) or BTHE+TOPMAC for 24 weeks. The primary objective is to compare the efficacy of TOPMAC with that of BTHE in the protection of hearing function. The secondary objective is to compare the efficacy of TOPMAC with that of BTHE in tinnitus suppression and cognitive function protection. RESULTS: This project was funded in January 2023. The institutional ethics committees at National Ayurveda Research Institute for Panchakarma (3/1/2020/NARIP/Tech/2036) and Institute for Communicative and Cognitive Neuro Sciences (IEC006) approved this study. The first patient was enrolled in September 2023; 22 participants were enrolled as of August 2024. The data analysis is yet to start, and the results are expected to be published by January 2025. CONCLUSIONS: If this exploratory trial is proven effective, it will steer the setting of a definitive randomized controlled trial to test whether the TOPMAC intervention can be incorporated as a cost-effective integrative approach for managing presbycusis. The Indian government has already launched a National Program for Prevention and Control of Deafness to benefit the deaf population. TOPMAC may later be considered for integration with the national program. TRIAL REGISTRATION: Clinical Trials Registry India CTRI/2023/04/051485; https://tinyurl.com/2h2hry3n. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55089.

Smart City IoT System Network Level Routing Analysis and Blockchain Security Based Implementation.

This paper demonstrates, network-level performance analysis and implementation of smart city Internet of Things (IoT) system with Infrastructure as a Service (IaaS) level cloud computing architecture. The smart city IoT network topology performance is analyzed at the simulation level using the NS3 simulator by extracting most of the performance-deciding parameters. The performance-enhanced smart city topology is practically implemented in IaaS level architecture. The intended smart city IoT system can monitor the principal parameters like video surveillance with a thermal camera (to identify the virus-like COVID-19 infected people), transport, water quality, solar radiation, sound pollution, air quality (O3, NO2, CO, Particles), parking zones, iconic places, E-suggestions, PRO information over low power wide area network in 61.88 km × 61.88 km range. Primarily we have addressed the IoT network-level routing and quality of service (QoS) challenges and implementation level security challenges. The simulation level network topology analysis is performed to improve the routing and QoS. Blockchain technology-based decentralization is adopted to enrich the IoT system performance in terms of security.

A comparative analysis of risk scoring systems in predicting clinical outcomes in upper gastrointestinal bleed.

Upper gastrointestinal bleed (UGIB) is a life threatening condition which presents as hematemesis, coffee-ground vomiting or melena. There are multiple scoring systems which have been developed for the same, which predict different outcomes, are important in the management of UGIB and are essential to determine high and low risk patients. AIMS AND OBJECTIVES: To compare the sensitivity and specificity for various risk scoring systems for UGIB and to determine the optimum cut-off values of various risk scoring systems in assessment of patients with UGIB. MATERIAL: 81 patients presenting with acute UGIB to M. S. Ramaiah hospitals between October 2018 to July 2020 were evaluated and Glasgow Blatchford score (GBS), AIMS65, pre-rockall and full- rockall scores were calculated for risk assessment in predicting clinical outcomes such as need for ICU care, blood transfusion, in-hospital mortality or discharge and endoscopic intervention. OBSERVATION: The GBS was the best at predicting mortality with the cut off of >14 (p 0.01, sensitivity 80%, NPV 98.6%) and blood transfusion at a cut-off >6 (sensitivity 97.6%, NPV 94.6%). The GBS and AIMS65 scores of more than 8 (p 0.000) and 1 (p 0.032) respectively were good predictors of need for ICU care. AIMS65 was the best at predicting duration of hospitalisation (p 0.032). CONCLUSION: The GBS was superior in predicting clinical outcomes, categorisation into high risk and low risk and need for blood transfusion. GBS and AIMS65 scores help in predicting the need for ICU care; AIMS65 being a simple score will reduce the cost burden of unnecessary ICU admissions.