Universal Fingerprint Generation: Controllable Diffusion Model with Multimodal Conditions.

The utilization of synthetic data for fingerprint recognition has garnered increased attention due to its potential to alleviate privacy concerns surrounding sensitive biometric data. However, current methods for generating fingerprints have limitations in creating impressions of the same finger with useful intra-class variations. To tackle this challenge, we present GenPrint, a framework to produce fingerprint images of various types while maintaining identity and offering humanly understandable control over different appearance factors such as fingerprint class, acquisition type, sensor device, and quality level. Unlike previous fingerprint generation approaches, GenPrint is not confined to replicating style characteristics from the training dataset alone: it enables the generation of novel styles from unseen devices without requiring additional fine-tuning. To accomplish these objectives, we developed GenPrint using latent diffusion models with multimodal conditions (text and image) for consistent generation of style and identity. Our experiments leverage a variety of publicly available datasets for training and evaluation. Results demonstrate the benefits of GenPrint in terms of identity preservation, explainable control, and universality of generated images. Importantly, the GenPrint-generated images yield comparable or even superior accuracy to models trained solely on real data and further enhances performance when augmenting the diversity of existing real fingerprint datasets.

Efficacy and Safety of Terlipressin Infusion in Hepatorenal Syndrome-Acute Kidney Injury (HRS-AKI): A Retrospective Observational Study.

Background Hepatorenal syndrome-acute kidney injury (HRS-AKI) is an event that occurs in chronic liver disease (CLD) and is associated with high morbidity and mortality. Terlipressin, a vasopressin analog, is used for the treatment of portal hypertension-related gastrointestinal (GI) bleeding and is found to be effective in the management of HRS-AKI. Continuous infusion of terlipressin maintains a high mean arterial pressure while reducing adverse events. It is better tolerated and equally effective at lower doses than intravenous boluses in patients with HRS-AKI. Aim of the study This study aimed to evaluate the safety and efficacy of terlipressin infusion at the rate of 4 mg/day in the treatment of HRS-AKI. Methods This retrospective study included patients who had HRS-AKI according to the modified International Club of Ascites (ICA) definition. Patients were started on a continuous intravenous infusion. The included patients received terlipressin 1 mg stat followed by a 4 mg infusion over 24 hours, and the infusion was continued until specific response criteria were met or for a maximum of seven days. Results In total, 136 patients were included in this study. The mean age of the study group was 45 years, the mean Child-Turcotte-Pugh (CTP) score was 11, the mean model for end-stage liver disease (MELD) score was 30, and the mean serum creatinine was 2.46 mg/dl. A response to treatment in the form of reduction of serum creatinine was observed in 94 (69.1%) patients, 30 (22%) patients showed no response, and worsening of creatinine was seen in 12 (8.8%) patients. The mean duration of hospital stay was 7.6 days, the mean serum creatinine was 1.17 mg/dl at the end of treatment, and the mean CTP and MELD scores in treatment responders were nine and 27, respectively. A total of 29 (21.3%) of 136 patients had adverse events during the terlipressin infusion therapy.  Conclusion Terlipressin infusion has sustained effects on splanchnic hemodynamics with fewer and less severe adverse events than intravenous bolus doses. Terlipressin infusion at a dose of 4 mg/day appeared to be well tolerated, with similar outcomes to that of 2 mg/day with a significantly lower albumin dose. These findings emphasize the importance of optimizing treatment protocols, particularly those favoring infusion methods, to enhance efficacy and minimize adverse effects.

Assessment of change in antimicrobial susceptibility pattern of bacteria causing orthopaedic infections by sequential sampling: A prospective cohort study.

Background: Management of Orthopaedic wound infections often depend on isolation of bacteria species (spp.) and its subsequent antimicrobial susceptibility testing (AST). However, the susceptibility to antibiotics may change over time in the same bacterial spp. particularly after initiation of antibiotic therapy. Repeating AST through sequential sampling can be used for the early detection of changes in antimicrobial susceptibility pattern. However, the recommendations about the optimal frequency of repeat AST for same bacterial spp. isolates from same patient to detect the changes in susceptibility patterns are still not established. Furthermore, no prospective research is available to address the crucial issue. Thus, we aimed this study to evaluate the need of repeat AST through sequential samples from the same site. Methods: AST was performed on same bacterial spp. isolates from three sequential samples using Kirby-Bauer disc diffusion method. Considering day 1 as control/baseline, changes in antimicrobial susceptibility pattern was interpreted on two sequential instances (on day 3 and day5). Changes were categorized into favorable & unfavorable and major & minor change categories. Results: The overall change in antimicrobial susceptibility pattern was 28 % on instance 1(on day3) and 36.1 % at instance 2 (on day 5). Susceptible to resistance phenotypic change was 14.9 % at instance 1 and 9.2 % at instance 2.A higher percentage change per case in antimicrobial susceptibility pattern was observed at instance 2. Predominant changes were towards the direction of favorable antimicrobial susceptibility pattern. Conclusion: The risk of change in antimicrobial susceptibility potential was over 10 % at both the instances. Furthermore, it was higher at instance 2 i.e., at day5, therefore a repeat sequential antimicrobial susceptibility testing would be recommended at later instance.

Chemical pressure induced spin reorientation in the magnetic structure ofCa3Mn2-xSnxO7(x=0,0.03,0.05).

The effect of partially substituting Tin (Sn) at the Manganese (Mn) site ofCa3Mn2O7, viz.Ca3Mn2-xSnxO7withx=0.03,0.05, on its structural and magnetic properties have been investigated using synchrotron diffraction, neutron diffraction, and bulk magnetization measurements. It is observed that with a substitution ofx=0.03, the minor (≈8%) tetragonal (I4/mmm) structural phase that is present in the predominantly orthorhombic (Cmc21) undopedCa3Mn2O7, completely disappears. The compounds order antiferromagnetically, the ordering temperature decreases with increasing Sn-content, indicating a weakening of the antiferromagnetic exchange interactions. Interestingly, in the ordered state, the spin magnetic moments which were aligned along thea-axis of the unit cell in the undoped compound, are observed to have reoriented with their major components lying in theb - cplane in the Sn-doped compounds. The above influence of Sn-doping is seen to be stemming from a significant modification of the octahedral rotation and tilt mode geometry in the unit cell, that is known to be responsible for driving ferroelectricity in these compounds.

Three-year outcomes of surgical valve replacement with Dafodil™ pericardial bioprosthesis: Dafodil™-1 trial.

Background: The Dafodil™-1 trial was designed to evaluate the clinical safety and performance of Dafodil™ pericardial bioprosthesis for replacing diseased native or prosthetic aortic or mitral valves in patients with advanced valvular heart disease (VHD). Methods: The Dafodil™-1 trial was a prospective, multicenter, first-in-human clinical trial. Patients were enrolled if they had advanced VHD requiring aortic valve replacement (AVR) or mitral valve replacement (MVR) with or without concomitant valve surgery and having surgical risk scores <4%. Major adverse cardiac events (MACE), including all-cause death, myocardial infarction (MI), and stroke; and hemodynamics were analyzed. Results: A total of 136 patients (aortic: 67 and mitral: 69) were enrolled in the trial (with mean age-AVR group: 60.2 ± 8.3 years and MVR group: 49.7 ± 14.4 years). A total of 134 patients (aortic: 66 and mitral: 68) completed the 3-year follow-up (total 300 per 100 patient-years of follow-up). The AVR group demonstrated a significant reduction in the mean pressure gradients from 51.2 ± 24.1 mmHg at baseline to 11.1 ± 6.0 mmHg at the 3-year follow-up (p < 0.0001). The mean effective orifice area (EOA) improved from baseline (0.9 ± 0.6 cm2) to 3-year follow-up (1.8 ± 0.4 cm2) (p < 0.0001). In the MVR group, the mean indexed EOA (iEOA) increased significantly from baseline (0.7 ± 0.4 cm2/m2) to 3-year follow-up (1.1 ± 0.4 cm2/m2) (p < 0.001). There was significant improvement in New York Heart Association functional class and mean SF-12 scores in both groups. At 3-year follow-up, the MACE incidence was 2.3% per 100 patient-years (1.3% strokes per 100 patient-years and 1.3% deaths per 100 patient-years) for AVR group and 4.7% per 100 patient-years (0.6% strokes per 100 patient-years and 4.0% deaths per 100 patient-years) for MVR group. No cases of MI, structural valve deterioration and prosthetic valve endocarditis were reported. The AVR and MVR groups achieved 89.6% and 79.7% MACE-free survival, respectively at 3-year follow-up. Conclusions: The Dafodil™-1 trial demonstrated satisfactory outcomes of clinical safety, hemodynamic performance, and quality-of-life metrics. Additionally, no incidence of structural valve deterioration and very low rates of valve thrombosis during the 3-year follow-up period of Dafodil™-1 first-in-human trial indicated acceptable valve durability up to three years and similar outcomes are warranted for longer follow-ups as a primary goal. Clinical Trial Registration Number: https://www.ctri.nic.in/Clinicaltrials/showallp.php?mid1=18377&EncHid=&userName=CTRI/2017/07/009008, CTRI/2017/07/009008.

Cervicodorsal spine tuberculosis-- surgical approach.

Background: Tuberculosis (TB) of CT junction is uncommon (5 % of all spinal TB), and difficult to approach surgically in view of its deep location with sternum in front and scapula in the back. We present 7 consecutively treated cases of cervico-thoraccic TB for outcome of treatment and discuss rationale of choosing surgical approach. Methods: Present study includes 7 freshly diagnosed cases of CT junction TB. Plain radiographs, sagittal reconstruction of CT spine that included sternum on CT/MRI was performed in all cases. Disc space below the distal healthy vertebrae was identified and a line parallel to disc space was drawn. If this line passes above suprasternal notch, it was inferred that this VB can be accessed by anterior cervical approach. If disease focus was at or below suprasternal notch level, manubriotomy/sternotomy was added for better visualization of the lesion. Results: All seven cases were female, with mean age of 20 years (9-45 years). The vertebral lesion involved 2VB (n = 3), 3VB (n = 2) and >3 VB (n = 2). The average Cervico-thoracic kyphosis was 15° (range 10-25°). All 7 cases were operated for anterior decompression, kyphotic deformity correction and instrumented stabilization. Anterior cervical approach and manubriotomy/sternotomy approach was performed in three cases each. In two pan-vertebral cases we performed 360° procedure. Six cases have shown first sign of neural recovery within 3 weeks of surgery and almost complete neural recovery at 3 months follow-up while one case showed partial recovery. ATT was stopped after 12 months once healed stage was demonstrated on contrast MRI in all. Conclusions: CT junction TB usually presents with severe kyphotic deformity/neural deficit. These cases require anterior decompression/corpectomy, deformity correction, gap grafting and instrumented stabilization with anterior cervical plate. Lesion with pan-vertebral disease is stabilized 360°. These lesions can be decompressed by lower anterior cervical approach with/without manubriotomy. The Karikari method was useful in deciding the need for manubriotomy to decompress the lesion.

Drug-Resistant Bone, Joint and Spine Tuberculosis: Evolution of Diagnosis and Treatment.

Background: Drug resistant (DR) osteoarticular TB (OATB) is a challenge in view of it being deep seated lesion and paucibacillary disease. Case definition, investigation protocol, treatment of proven DR and those cases where DR could not be demonstrated lacks clarity and evidence. Hence, a series of studies were conducted to develop an algorithm to investigate and treat therapeutically refractory disease (TRD) or presumptive drug resistance (PDR) cases of OATB. Patients and methods: 6 studies were conducted. Study one and two evaluated criteria to label TRD/PDR. Three subsequent studies were conducted where TDR/PDR or fresh cases of OATB cases were investigated by AFB smear, Bactec/liquid culture, histology and genotypic DST by CBNAAT & LPA. Sixth study was a retrospective evaluation of all DR cases treated for proven or clinical drug resistance (CDR). Results: Patient of bone/spine TB on ATT for 5 months or more show poor clinico-radiological treatment response as worsening of lesion, increased spinal deformity, persistent discharging sinus/ulcer, appearance of fresh lesion, recurrence of previous lesion, wound dehiscence of post-operative surgical scar cab labelled as PDR cases. These cases on histology ascertained TB and were proven DR on genotypic and phenotypic DST and are treated successfully. The patients of histologically ascertained TB and no/indeterminate phenotypic and genotypic DST were successfully treated as clinical drug resistance on MDR protocol. Conclusions: We described an algorithm. We must suspect PDR(TRD) based on criteria described. The tissue must be procured and submitted for AFB smear, histology and phenotypic and genotypic DST for diagnosis of TB. Genotypic and phenotypic DST will be useful to prove (90% instances) type of drug resistance. Remaining on strong clinical suspicion of DR and yet inconclusive on phenotypic/genotypic DST (<10%), may be treated as CDR as MDR. The adverse drug reactions and hepatic side-effects should be monitored diligently and these cases to be treated till healed status is demonstrated.

Tubercular Osteomyelitis of Navicular Bone: A Rare Site for Bone Tuberculosis.

Introduction: Tuberculosis (TB) is a global public health problem, endemic to India. Osteoarticular TB uncommonly presents in the foot, navicular osteomyelitis is an extremely rare entity. Case Report: We report a rare case of navicular osteomyelitis caused by TB in a 37-year-old man who presented to OPD with swelling and dull aching pain over the dorsum of his left foot. A radiograph of the foot showed a lytic lesion in the navicular bone. Further investigations in the form of aspiration cytology, cartridge-based nucleic acid amplification test, and acid-fast bacilli culture confirmed TB. Category-1 anti-tubercular therapy was started immediately and the patient was treated conservatively. Four drugs (HRZE) were given for 2 months and 3 drugs (HRE) for 9 months, after which the patient stopped his medications on his own. Radiographs and CEMRI at 14-month follow-up showed a healed lesion. Conclusion: This case illustrates an exceptional location of osteoarticular TB and shows that Navicular TB can be treated conservatively with near-complete function and recovery if diagnosed early.

Treatment Outcome of Drug-Resistant Skeletal Tuberculosis: A Retrospective Analysis.

Background: Management outcomes of drug-resistant (DR) osteoarticular tuberculosis (OATB) is dismal as in pre-ATT era (1905). The studies documenting treatment outcome of DR-OATB are scarce; hence, present retrospective analysis was conducted to evaluate outcome of consecutive cases of DR-OATB. Methods: 45 consecutive patients of suspected DR-OATB were treated from 2010 onwards. Tissue samples were submitted for AFB smear, cytology/histology, liquid culture, CBNAAT/LPA besides gram's staining and aerobic/anaerobic culture. Patients were treated by individualized second-line ATT till documenting healed status by contrast MRI/PET. The changes in neurological deficit, deformities, and drug-induced adverse events were documented. Results: 37/45 patients, 15 males and 22 females, mean age 26.89 years were followed. DR was suspected observing poor clinico-radiological response/appearance of fresh lesions on ATT. All showed no growth on aerobic/anaerobic pyogenic culture. 29 (78%) had microbiologically proven drug resistance and 8 (22%) were labeled as clinical drug resistance (CDR). 18/29 had multi-drug resistance. Mean prior ATT intake was 12.03 months 15 (40%) underwent surgical decompression. Mean duration of second-line ATT was 22.5 months (9-36 months). All patients achieved healed status with 8 (21%) developed side effects, most commonly hepatotoxicity, ototoxicity, and psychiatric disturbances. Average follow-up after completion of ATT was 40.5 months. Conclusion: We report a large series where patients of DR-OATB were suspected on clinical criteria, investigated by DST, and treated. Patients with proven drug resistance were treated by individualized second-line ATT. CDR cases were treated by MDR protocol. Genotypic DST (CBNAAT/LPA) improved demonstration of DR. We demonstrated healed status on MRI/PET with no recurrence at minimum 2-year follow-up.

Intertwining of Localized (d) and Delocalized (π) Spins in Magnetically Frustrated Two-Dimensional Metal-Organic Frameworks.

Two-dimensional metal-organic frameworks (2D MOFs) are emerging as a new class of multifunctional materials for diversified applications, although magnetic properties have not been widely explored. The metal ions and organic ligands in some of the 2D MOFs are arranged in the well-known Kagome lattice, leading to geometric spin frustration. Hence, such systems could be the potential candidates to exhibit an exotic quantum spin liquid (QSL) state, as was observed in Cu3(HHTP)2 (HHTP = hexahydroxytriphenylene), with no magnetic transition down to 38 mK. Hereto, we have investigated the spin intertwining in a bimetallic 2D MOF system, M3(HHTP)2 (M = Cu/Zn), arising from the localized (d-electron) and delocalized (π-electron) S = 1/2 spins from the Cu(II) ions and the HHTP radicals, respectively. The origin of the spin frustration (down to 5K) was critically examined by varying the metal composition in bimetallic systems, CuxZn3-x(HHTP)2 (x = 1, 1.5, 2), containing both S = 1/2 and S = 0 spins. Additionally, to gain a deeper understanding, we studied the spin interaction in the pristine Zn3(HHTP)2 system containing only S = 0 Zn(II) ions. In view of the quantitative estimate of the localized and delocalized spins, the d-π spin correlation appears essential in understanding the unusual magnetic and/or other physical properties of such hybrid organic-inorganic 2D crystalline solids.

Walking speeds are lower for short distance and turning locomotion: Experiments and modeling in low-cost prosthesis users.

Preferred walking speed is a widely-used performance measure for people with mobility issues, but is usually measured in straight line walking for fixed distances or durations, and without explicitly accounting for turning. However, daily walking involves walking for bouts of different distances and walking with turning, with prior studies showing that short bouts with at most 10 steps could be 40% of all bouts and turning steps could be 8-50% of all steps. Here, we studied walking in a straight line for short distances (4 m to 23 m) and walking in circles (1 m to 3 m turning radii) in people with transtibial amputation or transfemoral amputation using a passive ankle-foot prosthesis (Jaipur Foot). We found that the study participants' preferred walking speeds are lower for shorter straight-line walking distances and lower for circles of smaller radii, which is analogous to earlier results in subjects without amputation. Using inverse optimization, we estimated the cost of changing speeds and turning such that the observed preferred walking speeds in our experiments minimizes the total cost of walking. The inferred costs of changing speeds and turning were larger for subjects with amputation compared to subjects without amputation in a previous study, specifically, being 4x to 8x larger for the turning cost and being highest for subjects with transfemoral amputation. Such high costs inferred by inverse optimization could potentially include non-energetic costs such as due to joint or interfacial stress or stability concerns, as inverse optimization cannot distinguish such terms from true metabolic cost. These experimental findings and models capturing the experimental trends could inform prosthesis design and rehabilitation therapy to better assist changing speeds and turning tasks. Further, measuring the preferred speed for a range of distances and radii could be a more comprehensive subject-specific measure of walking performance than commonly used straight line walking metrics.

Robust Spin Liquidity in 2D Metal-Organic Framework Cu3 (HHTP)2 with S=1 /2 Kagome Lattice.

On one hand electron or hole doping of quantum spin liquid (QSL) may unlock high-temperature superconductivity and on the other hand it can disrupt the spin liquidity, giving rise to a magnetically ordered ground state. Recently, a 2D MOF, Cu3 (HHTP)2 (HHTP - 2,3,6,7,10,11-hexahydroxytriphenylene), containing Cu(II) S= 1 / 2 ${{ 1/2 }}$ frustrated spins in the Kagome lattice is emerging as a promising QSL candidate. Herein, we present an elegant in situ redox-chemistry strategy of anchoring Cu3 (HHTP)2 crystallites onto diamagnetic reduced graphene oxide (rGO) sheets, resulting in the formation of electron-doped Cu3 (HHTP)2 -rGO composite which exhibited a characteristic semiconducting behavior (5 K to 300 K) with high electrical conductivity of 70 S ⋅ m-1 and a carrier density of ~1.1×1018  cm-3 at 300 K. Remarkably, no magnetic transition in the Cu3 (HHTP)2 -rGO composite was observed down to 1.5 K endorsing the robust spin liquidity of the 2D MOF Cu3 (HHTP)2 . Specific heat capacity measurements led to the estimation of the residual entropy values of 28 % and 34 % of the theoretically expected value for the pristine Cu3 (HHTP)2 and Cu3 (HHTP)2 -rGO composite, establishing the presence of strong quantum fluctuations down to 1.5 K (two times smaller than the value of the exchange interaction J).

Outcomes of coronary artery bypass grafting based on myocardial perfusion imaging.

Introduction: Coronary artery disease (CAD) is the foremost single cause of mortality and loss of disability-adjusted life years globally and a large percentage of this burden is found in low and middle income countries, with the treatment strategies based on revascularisation, based on studies that have shown that on revascularisation of viable myocardium there is an improvement of function over a period of time. Aim: To evaluate the utilization of myocardial perfusion imaging (MPI) for identifying viable myocardium and assessing the improvement. Material and methods: This prospective observational study was conducted in patients having CAD planned for coronary artery bypass grafting. The patients were evaluated using 2D ECHO and MPI preoperatively and postoperatively after 1 year. Results: Mean ejection fraction preoperatively was 40.6 ±9.72% and postoperatively it improved to 41.32 ±10.64% and ejection fraction was calculated using MPI and an average improvement from 35.98 ±12.72% to 45.51 ±12.61% (p ≤ 0.0001). Summed rest score was calculated and an improvement was noted from 24.28 ±8.47 to 18.02 ±8.75 (p ≤ 0.0001). Total perfusion deficit was calculated and was found to have reduced from 32.44 ±11.98 to 25.61 ±12.23 (p ≤ 0.0001). Conclusions: MPI was able to accurately assess the improvement, which correlated not only with the 2D echocardiography data but also with the clinical wellbeing of the patients. Being a non-invasive, quick procedure, it should be added to the arsenal of the cardiac surgeon for evaluation of patients with diffuse diseases, low ejection fractions, patients who might generally be considered inoperable.

Incidence and Patterns of Drug Resistance in Patients with Spinal Tuberculosis: a Prospective, Single-Center Study from a Tuberculosis-Endemic Country.

Background: There is paucity of data on incidence and pattern of drug resistance in spinal TB. This prospective observational study was conducted to document the incidence and drug-resistance pattern among primary and presumptive resistant cases. Methods: 59 consecutive cases diagnosed clinico-radiologically (imaging) were grouped into Group A (n = 51, primary cases) and Group B (n = 8, presumptive resistant cases) based on pre-defined criteria (INDEX-TB guidelines). Tissue samples obtained percutaneously (37.29%, 22/59) and on surgery (62.71%, 37/59) were subjected to genotypic DST (CBNAAT, LPA) and phenotypic DST (BACTEC MGIT 960 culture and sensitivity using fixed critical concentration of drugs). Results: Etiological diagnosis was ascertained in all. 13/51 (25.49%) in Group A, while 3/8 (37.5%) in Group B and 16/59 (27.12%) overall demonstrated drug resistance. 12/16 (75%) had no prior history of ATT intake. 4 demonstrated INH (Isoniazid) mono-resistance. 12 polydrug resistance demonstrated: 5MDR, 3pre-XDR, while RIF + FQ (fluoroquinolones), FQ + Lz (linezolid), only SLID (second-line injectable drugs), and only FQ resistance observed in 1 case each. Isolated RIF (Rifampicin) resistance and XDR pattern were not observed. Overall frequency of RIF resistance was 16.4% (9/55) and INH was 25% (12/48) with low-(n-2) and high-level INH resistance (n-10). Among second-line drugs, FQ resistance was more than SLID resistance and within FQ, levofloxacin resistance was more frequent than moxifloxacin. MGIT demonstrated positive growth in 16/59 samples, out of which 1 sample was positive for nontuberculous mycobacteria (M. chelonae) but on genotypic testing demonstrated MTB resistant to RIF and FQ. Conclusion: This is the first report on incidence and drug-resistant pattern in culture-positive/negative cases. High (25.49%) primary drug resistance is worrisome. This being the first study in  spinal TB cases which document prevalent drug-resistant pattern as evaluated for consecutive culture-positive/negative cases. The tissue obtained must be submitted for AFB culture and molecular tests to ascertain drug resistance in culture-positive/negative cases. However, in the presence of insufficient tissue sample histology and CBNAAT can ascertain etiological diagnosis in 100% cases. INH resistance is more than RIF with isolated RIF resistance unreported.

Effect of COVID-19 on the Burden and Profile of Orthopaedic Patients Admitted Post-Resumption of Routine Services in a Tertiary Care Hospital in Delhi.

Purpose On resumption of routine services post-lockdown during coronavirus disease 2019 (COVID-19), we expected a backlog of orthopaedic patients who could not get appropriate and timely care and would now present with complications due to missed or delayed treatment. This study aimed to quantify the effect of COVID-19 on the burden and profile of orthopaedic patients admitted post-resumption of routine services. Materials and methods Data on all the patients admitted to the orthopaedic department were collected using an interviewer-administered schedule for a complete one-year period after the resumption of routine orthopaedic services in a tertiary care hospital in Delhi. For comparison of the burden of trauma patients with that during the pre-COVID-19 period, data were obtained from a similar study done on trauma patients in 2017 at the same institution. For patients with non-traumatic conditions, previous hospital records were used. Results A total of 1585 patients were admitted during the one-year period post-resumption of routine services following COVID-19 restrictions, which was 41% less than that compared to the corresponding pre-COVID-19 data. The proportion of patients from other neighbouring states showed a decline from 52% in the pre-COVID-19 period to 41.55% when healthcare services resumed during the COVID-19 period. Out of all admitted trauma patients in 2021, 12.7% presented with a missed or complication of treatment as compared to 3.1% in the pre-COVID period. Around half of them (52.5%) attributed their complications to a COVID-19-related lockdown. Conclusion There was a significant decline in the number of patients post-resumption of routine orthopaedic care services. Converting whole tertiary care teaching hospitals to COVID-19-dedicated hospitals must not be done as it leads to an increase in missed or complication of orthopaedic treatment.

Drug Resistance in Osteoarticular Tuberculosis: A Study From an Endemic Zone.

BACKGROUND: The present study was undertaken to determine the incidence of drug resistance against anti-tubercular drugs among patients from an endemic zone.  Methodology: Forty consecutive clinico-radiologically diagnosed patients of osteoarticular tuberculosis (29: spine, 11: extraspinal) were enrolled. Pus from needle aspiration was taken in 31 cases, tissue following spinal decompression in seven, synovial in one, and sinus edge biopsy in one. The pus/tissue was subjected to acid-fast bacilli (AFB) staining and liquid culture, sensitivity to 13 anti-tubercular drugs (Isoniazid (INH), rifampicin (RIF), kanamycin (KAN), amikacin (AMK,) capreomycin (CAP), ethionamide (ETH), levofloxacin (LEV), moxifloxacin (MOX), linezolid (LNZ), para-amino-salicylic acid (PAS), bedaquiline (BDQ), delamanid (DLM), and clofazimine (CFO)) were checked, and histopathological/cytopathological examination and molecular tests were performed.   Results: The mean age of patients was 29.07(9-65) years; 21 were female and 19 were male. The diagnostic accuracy for tuberculosis was 20% by AFB smear, 65% by liquid culture, 82.5% by histopathology, and 90% by cartridge-based nucleic acid amplification testing (CBNAAT). All culture-positive isolates were identified as Mycobacterium tuberculosis with no non-tubercular Mycobacterium. The drug resistance detected on CBNAAT was 11.1%, line probe assay (LPA) first line was 15.4%, LPA second line was 4%, and liquid drug susceptibility testing (DST) 11.5%. We detected 15.4% INH resistance, 11.1% RIF, 7.6% LEV, 3.8% MOX and PAS. No resistance was detected against second-line injectable drugs (SLID), ETH, LNZ, BDQ, DLM, and CFO.    Conclusions: No single laboratory modality can ascertain the diagnosis in all cases; hence, samples should be sent for all tests in tandem. In the presence of insufficient samples, tissue may be subjected to CBNAAT and histopathology to arrive at tissue diagnosis. In this subset, overall drug resistance incidence was 12.5% (5/40) with one patient each of isolated INH and RIF resistance, one of multidrug-resistance (MDR), and two of pre-extensively drug-resistant (pre-XDR). Primary drug resistance came out to be 11.1% (4/36) with one patient each of isolated INH and RIF resistance, one of MDR, and one Pre-XDR.

Prevalence of lumbosacral transitional vertebra in patients with chronic low back pain: a descriptive cross-sectional study.

BACKGROUND: Numerous causes of low back pain have been identified like spondylosis, spondylolysis, spondylolisthesis, facet lesions, discal abnormalities, vertebral instability, degenerative osteoarthritis, etc., These causes of low back pain are seen commonly in >50 years of age. Lumbosacral transitional vertebra (LSTV) is a common congenital anomaly with multitude of intermediate morphologic manifestations between the typical sacral and lumbar vertebra reported by some authors as a cause of low back pain. There are racial differences reported in the literature on the prevalence of LSTV. There is no common consensus in literature about the association between LSTV and low back pain. There is a paucity of literature on the subject in the Indian population, hence the current study was conducted. MATERIAL AND METHODS: 60 cases of low back pain and 60 controls were included in the study. Patients between 18-50 years of age with low back pain of >12 weeks duration who were fulfilling the inclusion criteria were included in the study. The plain radiographs were screened by two observers (one Orthopaedician and one Radiologist) for the presence or absence of lumbosacral transitional vertebra (LSTV) and classification was determined by consensus. The incidence of LSTV was calculated in both the groups (cases and controls) and evaluated for statistical significance. RESULTS: Prevalence of lumbosacral transitional vertebra (LSTV) was found to be 38.33% in cases group as compared to control group (21.66%) and was statistically significant (p value <0.05). Prevalence of lumbarisation was higher in case group (10%) in comparison to control group (5.0%) but not found to be statistically significant. Prevalence of sacralisation was also found to be higher in case group (28.33%) as compared to control group (16.67%). This was not found to be statistically significant. CONCLUSION: The present study showed a higher prevalence of lumbosacral transitional vertebra (LSTV) in case group (38.33%) as compared to control group (21.66%) which was found to be statistically significant. Prevalence of lumbarisation and sacralisation were both found to be higher in the case group in comparison to control group, but the difference was not statistically significant. However, further studies with larger sample would be needed to conclusively determine any association between low back pain and subtypes of LSTV.

Transfer Learning in Deep Reinforcement Learning: A Survey.

Reinforcement learning is a learning paradigm for solving sequential decision-making problems. Recent years have witnessed remarkable progress in reinforcement learning upon the fast development of deep neural networks. Along with the promising prospects of reinforcement learning in numerous domains such as robotics and game-playing, transfer learning has arisen to tackle various challenges faced by reinforcement learning, by transferring knowledge from external expertise to facilitate the efficiency and effectiveness of the learning process. In this survey, we systematically investigate the recent progress of transfer learning approaches in the context of deep reinforcement learning. Specifically, we provide a framework for categorizing the state-of-the-art transfer learning approaches, under which we analyze their goals, methodologies, compatible reinforcement learning backbones, and practical applications. We also draw connections between transfer learning and other relevant topics from the reinforcement learning perspective and explore their potential challenges that await future research progress.

Automated Closed-Loop Propofol Anesthesia Versus Desflurane Inhalation Anesthesia in Obese Patients Undergoing Bariatric Surgery: A Comparative Randomized Analysis of Recovery Profile.

INTRODUCTION: Precision general anesthesia (GA) techniques that minimize the presence of residual anesthetic and facilitate recovery, are desirable in patients with morbid obesity. Automated administration of propofol total intravenous anesthesia (TIVA), which facilitates precision propofol delivery by factoring in continuous patient input variable (bispectral index) to establish a closed feedback loop system, may help mitigate concerns related to propofol's lipid solubility and adverse accumulation kinetics in patients with morbid obesity. This randomized study evaluated the recovery of patients with morbid obesity undergoing bariatric surgery under propofol TIVA automated by a closed-loop anesthesia delivery system (CLADS) versus desflurane GA. METHODS: Forty patients, randomly allocated to receive propofol TIVA (CLADS group) or desflurane GA (desflurane group), were evaluated for postoperative recovery (early and intermediate) (primary objective); they were evaluated for intraoperative hemodynamics, anesthesia depth consistency, anesthesia delivery performance characteristics, patient satisfaction, and incidence of adverse events (sedation, pain, postoperative nausea, and vomiting) (secondary objective). RESULTS: No difference was found for the time-to-eye-opening (CLADS group: 4.7 [3.0, 6.7] min vs. desflurane group: 5.6 [4.0, 6.9] min, P = 0.576), time-to-tracheal-extubation (CLADS group: 6.7 [4.7, 9.3] min vs. desflurane group: 7.0 [5.8, 9.2] min, P = 0.528), ability-to-shift score from operating room table to the transport bed (CLADS group: 3 [3.0, 3.5] vs. desflurane group: 3 [3.0, 4.0], P = 0.703), and time to achieve a modified Aldrete score 9/10 (CLADS group: 15 [15.0, 37.5] min vs. desflurane group: 15 [15.0, 43.7] min, P = 0.867). CONCLUSION: Automated propofol TIVA as administered by CLADS, which matched desflurane GA with respect to depth of anesthesia consistency and postanesthesia recovery profile, can be explored further as an alternative anesthesia technique in patients with morbid obesity.

Assessment of inter and intra-observer variation of Leonetti and Tigani CT bases classification of tibial pilon fractures.

INTRODUCTION: tibial pilon fracture constitutes 5-7% of all tibial fractures. The treatment of choice is an open reduction with anatomical articular reconstruction and stable fixation. A relievable fracture classification is needed for the preoperative planning the surgical management of these fractures. Hence, we assessed the inter- and intra-observer variation of Leonetti and Tigani CT bases classification of tibial pilon fractures. MATERIALS AND METHODS: In this prospective study, 37 patients aged between 18-65 years with an ankle fracture were included. All these patients underwent a CT scan for the ankle fracture, and the CT scan was further evaluated by 5 independent observers (Orthopaedic surgeon). A kappa value was determined for inter and intra-observer variation. RESULTS: Leonetti and Tigani's CT-based classification of the kappa values was 0.657 to 0.751, with a mean value of 0.700. The range of values for the intra-observer variation using Leonetti and Tigani CT-based classification on the kappa values was 0.658 to 0.875 with a mean value of 0.755. The P-value < 0.001 states that there was a significant agreement between the inter-observer and intra-observer classification. CONCLUSION: Leonetti and Tigani Classification have shown substantial inter- and intra-observer agreement, and the "4B" subclass of Leonetti and Tigani CT-based classification showed a predominance in the present study.