Patient Perspectives After Surgery-Related Complications Among Breast Cancer Patients from a LMIC.

Long-term quality of life in breast cancer patients has been studied and published regularly. However, the lived experiences of patients who develop complications after surgery are not well understood. Determining this experience of patients is challenging in most low- and middle-income countries where the majority of patients belong to poor strata of society and are uneducated. We aimed to explore the thoughts, feelings, and experiences of patients with surgery-related complications after breast cancer surgery. Purposive sampling was used to identify patients who developed any postoperative complication, and semi-structured interviews were conducted. Common patterns of patient experiences were identified and analyzed using descriptive thematic analysis. Twenty-eight patients out of 210 developing complications postoperatively were identified. The median age was 48 years (range 32-65 years). The majority (n = 26) were housewives, educated below the primary level (n = 11) and below the poverty line (n = 13). Complications included seroma (n = 17), flap necrosis and infection (n = 5), and hematoma (n = 1). Seven domains emerged from the interviews-knowledge of complications, psychological impact, burden, disruptiveness, social impact, relationship with the surgical team, and suggestions to improve the experience. The themes identified in the present study provide insights into the lived experiences and can inform the future development of patient-reported outcome measures and quality improvement programs, including more effective pre-operative counseling and consent. Supplementary Information: The online version contains supplementary material available at 10.1007/s13193-023-01721-z.

Implementation of Artificial Neural Network to Predict Diabetes with High-Quality Health System.

Patients with diabetes who are closely monitored have a higher overall quality of life than those who are not. Costs associated with healthcare can be decreased by utilising the Internet of Things (IoT), thanks to technological advancements. To satisfy the expectations of e-health applications, it is required for the development of the intelligent systems as well as increases the number of applications that are connected to the network. As a result, in order to achieve these goals, the cellular network should be capable of supporting intelligent healthcare applications that require high energy efficiency. In this paper, we model a neural network-based ensemble voting classifier to predict accurately the diabetes in the patients via online monitoring. The study consists of Internet of Things (IoT) devices to monitor the instances of the patients. While monitoring, the data are transferred from IoT devices to smartphones and then to the cloud, where the process of classification takes place. The simulation is conducted on the collected samples using the python tool. The results of the simulation show that the proposed method achieves a higher accuracy rate, higher precision, recall, and f-measure than existing state-of-art ensemble models.

Prediction of Noninvasive Ventilation Failure in a Mixed Population Visiting the Emergency Department in a Tertiary Care Center in India.

Background: Noninvasive ventilation (NIV) is an established first-line treatment of acute respiratory failure both in emergency departments (ED) and intensive care unit (ICU) settings. It is however not always successful. Materials and methods: Prospective, observational study was done among patients above 18 years presenting with acute respiratory failure initiated on NIV. Patients were placed in one of two groups covering successful NIV treatment and NIV failure. Two groups were compared on four variables: initial respiratory rate (RR), initial high-sensitivity C-reactive protein (hs-CRP), PaO2/FiO2 ratio (p/f ratio), and heart rate, acidosis, consciousness, oxygenation, and respiratory rate (HACOR) score at the end of 1 hour of initiation of NIV. Results: A total of 104 patients fulfilling the inclusion criteria were included in the study, of which 55 (52.88%) were exclusively treated with NIV (NIV success group), and 49 (47.11%) required endotracheal intubation and mechanical ventilation (NIV failure group). Noninvasive ventilation failure group had a higher mean initial RR compared with NIV success group (40.65 ± 3.88 vs 31.98 ± 3.15, p <0.001). Mean initial PaO2/FiO2 ratio was also significantly lower in the NIV failure group (184.57 ± 50.33 vs 277.29 ± 34.70, p <0.001). Odds ratio for successful NIV treatment with a high initial RR was 0.503 (95% confidence interval (CI), 0.390-0.649) and with a higher initial PaO2/FiO2 ratio was 1.053 (95% CI: 1.032-1.071 and with a HACOR score of >5 at the end of 1 hour of initiation of NIV was highly associated with NIV failure (p <0.001). A high initial level of hs-CRP was 0.949 (95% CI: 0.927-0.970). Conclusion: Noninvasive ventilation failure could be predicted with information available at presentation in ED, and unnecessary delay in endotracheal intubation could possibly be prevented. How to cite this article: Mathen PG, Kumar KPG, Mohan N, Sreekrishnan TP, Nair SB, Krishnan AK, et al. Prediction of Noninvasive Ventilation Failure in a Mixed Population Visiting the Emergency Department in a Tertiary Care Center in India. Indian J Crit Care Med 2022;26(10):1115-1119.

Resource management with kernel-based approaches for grid-connected solar photovoltaic systems.

The increasing penetration of photovoltaic (PV) power generation into the distribution grids has resulted in frequent reverse active power flows, rapid fluctuations in voltage magnitudes, and power loss. To overcome these challenges, this paper identifies the resource management of grid-connected PV systems with active and reactive power injection capabilities using smart inverters. This approach is aimed to minimize the voltage deviations and power losses in the grid-connected systems to accommodate the high penetration of PV systems. A kernel-based approach is proposed to learn policies and evaluate the reactive power injections with smart inverters for improving grid profile, minimizing power losses, and maintaining safe operating voltage limits. The proposed approach performs inverter coordination through nonlinear control policies using anticipated scenarios for load and generation. To assess the performance of the proposed approach, numerical simulations are performed with a single-phase grid-connected PV system connected to an IEEE bus system. The results show the effectiveness of the proposed approach in minimizing power losses and achieving a good voltage regulation.

Three-Dimensional Printed Lightweight Composite Foams.

The goal of this paper is to enable three-dimensional (3D) printed lightweight composite foams by blending hollow glass microballoons (GMBs) with high density polyethylene (HDPE). To that end, lightweight feedstock for printing syntactic foam composites is developed. The blend for this is prepared by varying the GMB content (20, 40, and 60 volume %) in HDPE for filament extrusion, which is subsequently used for 3D printing. The rheological properties and the melt flow index (MFI) of blends are investigated for identifying suitable printing parameters. It is observed that the storage and loss modulus, as well as complex viscosity, increase with increasing GMB content, whereas MFI decreases. Further, the coefficient of thermal expansion of HDPE and foam filaments decreases with increasing GMB content, thereby lowering the thermal stresses in prints, which promotes the reduction in warpage. The mechanical properties of filaments are determined by subjecting them to tensile tests, whereas 3D printed samples are tested under tensile and flexure tests. The tensile modulus of the filament increases with increasing GMB content (8-47%) as compared to HDPE and exhibit comparable filament strength. 3D printed foams show a higher specific tensile and flexural modulus as compared to neat HDPE, making them suitable candidate materials for weight-sensitive applications. HDPE having 60% by volume GMB exhibited the highest modulus and is 48.02% higher than the printed HDPE. Finally, the property map reveals a higher modulus and comparable strength against injection- and compression-molded foams. Printed foam registered 1.8 times higher modulus than the molded samples. Hence, 3D printed foams have the potential for replacing components processed through conventional manufacturing processes that have limitations on geometrically complex designs, lead time, and associated costs.

Optimization of Serum-Free Culture Conditions for Propagation of Putative Buffalo (Bubalus bubalis) Spermatogonial Stem Cells.

Spermatogonial stem cells (SSCs) self-renew and produce a large number of differentiated germ cells to maintain normal spermatogenesis. However, the growth factors crucial for SSC self-renewal and the mechanism underlying this process remain unclear. In the present study, a serum-free culture media was used to evaluate the effect of several growth factors on the expression of some SSC markers and self-renewal related genes. The putative SSCs were cultured on buffalo Sertoli cell feeder layer in KO-DMEM +10% KOSR. The colony formation was observed between 7 and 10 days. The putative SSC colonies also expressed markers specific for undifferentiated type A spermatogonia and pluripotency markers. After 15 days, relative mRNA expression study revealed that 20 ng/mL concentration of Glial cell line-derived neurotrophic factor (GDNF) upregulated the expression of PLZF, TAF4B, and THY1. Furthermore, supplementation of a combination of 20 ng/mL GDNF, 10 ng/mL basic fibroblast growth factor (bFGF), 1000 IU/mL leukemia inhibitory factor (LIF), and 1 ng/mL colony stimulating factor 1 (CSF1) upregulated the expression of PLZF, TAF4B, BCL6B, and ID4 genes. These results demonstrated that our defined culture media in combination with GDNF, bFGF, LIF, and CSF1 well supported SSC self-renewal.

Supplementation of Glial Cell Line-Derived Neurotrophic Factor, Fibroblast Growth Factor 2, and Epidermal Growth Factor Promotes Self-Renewal of Putative Buffalo (Bubalus bubalis) Spermatogonial Stem Cells by Upregulating the Expression of miR-20b, miR-21, and miR-106a.

In this study, we investigated the effect of glial cell line-derived neurotrophic factor (GDNF), fibroblast growth factor (FGF) 2, and epidermal growth factor (EGF) on the expression of some self-renewal-related microRNAs (miRs) in putative buffalo spermatogonial stem cells (SSCs). The SSCs were cultured on a buffalo Sertoli cell feeder layer, colony formation was observed between 7 and 10 days. The SSC colonies expressed markers specific for undifferentiated type A spermatogonia and pluripotency markers. After 15 days of initial culture, the colonies were subcultured as treatment (supplemented with 20 ng mL-1 GDNF +10 ng mL-1 FGF2 + 10 ng mL-1 EGF) and control groups. The number and area of SSC colonies were significantly (p < 0.05) higher in the treatment group than in the control group. The relative abundance of miR-20b, miR-21, and miR-106a in SSCs supplemented with growth factors was significantly higher (p < 0.001) than that in the control. The results indicate that supplementation of SSC culture medium with growth factors (GDNF, FGF2, and EGF) may promote the expression of miR-20b, miR-21, and miR-106a, which is essential for self-renewal and maintenance of SSCs.

The Eminence of Neutrophil-lymphocyte Count Ratio in Predicting Bacteremia for Community-acquired Infections at an Emergency Medicine Department in a Tertiary Care Setting.

INTRODUCTION: The changes in the white blood cells counts and other blood parameters are well-recognized feature in sepsis. A ratio between neutrophils and lymphocytes can be used as a screening marker in sepsis. Even though new markers such as Procalcitonin and adrenomedullin have been rolled out in the field, implementation of these markers has been hindered by cost, accessibility, and proper validation. We looked for the ability of simple neutrophil-lymphocyte count ratio (NLCR) when compared to the gold standard blood culture method in predicting bacteremia, on patients presented to emergency department (ED) with features of suspected community-acquired infections. MATERIALS AND METHODS: A comparative study done on 258 adult patients, admitted with suspected features of community-acquired infections. The study group included all patients who had positive blood culture results on index presentation at ED. Patients with hematological, chronic liver and retroviral diseases, patients receiving chemotherapy, and steroid medications were excluded from the study. The study group was compared with gender- and age-matched control group who were also admitted with a suspicion of the same, but in whom the blood culture results were negative. RESULTS: There was no statistically significant difference for predicting bacteremia by NLCR (>4.63) and culture positivity methods (P = 1.00). NLCR of > 4.63 predicts bacteremia with an accuracy of 84.9%. CONCLUSION: In our setting, NLCR performs equally well with culture positivity, in detecting severe infection at the early phase of disease. The NLCR may, therefore, be used as a suitable screening marker at ED for suspected community-acquired infections.

Effect of extended photoperiod during winter on growth and onset of puberty in Murrah buffalo heifers.

AIM: To investigate the effect of extended photoperiod on growth rate, hormonal levels, and puberty in Murrah heifers. MATERIALS AND METHODS: About 14 Murrah buffalo heifers were divided into normal day photoperiod (NDP; n=7) and extended NDP (ENDP; n=7) groups. The ENDP group was exposed to 4 h of extended photoperiod with artificial light (160 lux) after sunset for 3 months during winter. RESULTS: Group, age and group-by-age interaction effects on plasma glucose concentrations were non-significant (p>0.05). A significant effect of age on non-esterified fatty acids (p<0.05), cholesterol (p<0.01), and triglycerides (p<0.05) concentrations was observed. Group and group-by-age interaction effects on plasma T3, T4, leptin, 17 ß estradiol, prolactin and melatonin concentrations were non-significant (p>0.05) while significant (p<0.05) age effect on T4, leptin and melatonin concentrations was observed. With respect to the circadian pattern of melatonin and prolactin, the group, time and group-by-time interaction effects were non-significant (p>0.05). Average daily gain and dry matter intake of heifers were non-significant between the NDP and ENDP groups but were comparatively higher in ENDP group. By the end of the experiment, 6 out of 7 heifers attained puberty in ENDP group in comparison to 4 out of 7 in NDP group. CONCLUSION: Extending the photoperiod by artificial light for 4 h during winter season resulted in better growth rate and early onset of puberty in Murrah buffalo heifers.

Microencapsulation of Lactobacillus plantarum MTCC 5422 in fructooligosaccharide and whey protein wall systems and its impact on noodle quality.

Noodles are staple cereal food in many countries; however addition of encapsulated probiotics into noodle formulation, its effect on noodle quality and cell viability has not yet been reported. The aim of this study was to prepare microencapsulated Lactobacillus plantarum (MTCC 5422) by freeze drying with wall material combinations such as fructooligosaccharide (FOS), FOS + whey protein isolate (WPI), and FOS + denatured whey protein isolate (DWPI) to evaluate best wall system. Results showed that FOS + DWPI wall system provided better protection to cells after drying, during storage (60 days, 4 °C) and in simulated acidic and bile conditions. Further, FOS + DWPI encapsulates were incorporated into noodle formulation and evaluated the noodle quality and probiotic cell viability of cooked noodle obtained from two different production methods: (i) fresh and (ii) dried (room temperature dried - RTD, 28 °C and high temperature dried - HTD, 55 °C). The quality characteristics (cooking time, solid loss, texture, colour and sensory profiles) of FOS + DWPI encapsulates incorporated cooked noodles (both fresh and dried) were found to be acceptable. On evaluation of encapsulated probiotic bacteriaL. plantarum cell viability, 93.63 % and 62.42 % cell survival was obtained in fresh noodles before and after cooking respectively. However, 80.29 % (RTD) and 64.74 % (HTD) of encapsulated cells were viable in dried noodles, after cooking there was complete survival loss. This study suggested that fresh noodle was found to be a suitable carrier system to deliver viable cells. This is first report on influence of probiotic microcapsules in noodle processing.

Characteristics of microbial drug resistance and its correlates in chronic diabetic foot ulcer infections.

While virulence factors and the biofilm-forming capabilities of microbes are the key regulators of the wound healing process, the host immune response may also contribute in the events following wound closure or exacerbation of non-closure. We examined samples from diabetic and non-diabetic foot ulcers/wounds for microbial association and tested the microbes for their antibiotic susceptibility and ability to produce biofilms. A total of 1074 bacterial strains were obtained with staphylococci, Pseudomonas, Citrobacter and enterococci as major colonizers in diabetic samples. Though non-diabetic samples had a similar assemblage, the frequency of occurrence of different groups of bacteria was different. Gram-negative bacteria were found to be more prevalent in the diabetic wound environment while Gram-positive bacteria were predominant in non-diabetic ulcers. A higher frequency of monomicrobial infection was observed in samples from non-diabetic individuals when compared to samples from diabetic patients. The prevalence of different groups of bacteria varied when the samples were stratified according to age and sex of the individuals. Several multidrug-resistant strains were observed among the samples tested and most of these strains produced moderate to high levels of biofilms. The weakened immune response in diabetic individuals and synergism among pathogenic micro-organisms may be the critical factors that determine the delicate balance of the wound healing process.

Optimization of fruit punch using mixture design.

A highly acceptable dehydrated fruit punch was developed with selected fruits, namely lemon, orange, and mango, using a mixture design and optimization technique. The fruit juices were freeze dried, powdered, and used in the reconstitution studies. Fruit punches were prepared according to the experimental design combinations (total 10) based on a mixture design and then subjected to sensory evaluation for acceptability. Response surfaces of sensory attributes were also generated as a function of fruit juices. Analysis of data revealed that the fruit punch prepared using 66% of mango, 33% of orange, and 1% of lemon had highly desirable sensory scores for color (6.00), body (5.92), sweetness (5.68), and pleasantness (5.94). The aroma pattern of individual as well as combinations of fruit juices were also analyzed by electronic nose. The electronic nose could discriminate the aroma patterns of individual as well as fruit juice combinations by mixture design. The results provide information on the sensory quality of best fruit punch formulations liked by the consumer panel based on lemon, orange, and mango.

Hollow microspheres of diclofenac sodium - a gastroretentive controlled delivery system.

Most of the floating systems have an inherent drawback of high variability in the GI transit time, invariably affecting the bioavailability of drug. To overcome it, a multiple unit floating system with extended GI transit time, capable of distributing widely throughout the GIT for effective enteric release of the drug has been sought. Microballoons loaded with drug in their outer polymer shells were prepared by novel emulsion solvent diffusion method. The ethanol: dicloromethane solution of drug and Eudragit-S were poured into an aqueous solution of PVA that was thermally controlled at 40 degrees C. The gas phase generated in the dispersed polymer droplet by the evaporation of solvent formed an internal cavity in the microsphere of the polymer with the drug. The flowability of the resulting microballoons improved when compared to pure drug. The microballoons on floatation along with the surfactant, floated continuously for more than 12 hours in the acidic medium in-vitro conditions. The in-vitro drug release profile of the formulation in the simulated gastric buffer showed no drug release, which emphasizes the enteric release property and in simulated intestinal buffer, a slow and controlled drug release of 60 to 84% was obtained over a period of 8 hours. Drug release was significantly affected by increased drug to polymer concentration at pH 6.8. The formulation was found to be physically and chemically stable as per the ICH guidelines.