Toxicoepidemiology of acute poisoning cases in a secondary care hospital in rural South India: A five-year analysis.

OBJECTIVE: To ascertain the trend of poisoning cases admitted to the Government District Headquarters Hospital, a secondary care center in Udhagamandalam, Nilgiris District, Tamil Nadu, India, over a five-year period. MATERIALS AND METHODS: The number of cases that presented to the hospital annually (incidence, mortality, and case fatality rates), socio-demographic pattern, and the nature of the poison were noted. RESULTS: A total of 1860 poisoning cases (80 deaths) were reported during the period from October 2008 to September 2013. The incidence of poisoning was found to increase every year. The average incidence was 1.60 per 1000 population, while the average case fatality rate and mortality rates were 40.51 and 0.07, respectively. A total of 1148 (62%) were males. The majority of cases were seen in the 21-30 age group (41.24%). The poisonings were largely deliberate self-harm (n = 1,755; 94.35%), followed by accidental (n = 85; 4.57%). Agrochemicals were the main choice of poisoning agents and among these, organophosphates were the major cause. CONCLUSION: The data generated can help policy makers take decisions on the sale and availability of pesticides in this region.

Meningioma brain tumor detection and classification using hybrid CNN method and RIDGELET transform.

The detection of meningioma tumors is the most crucial task compared with other tumors because of their lower pixel intensity. Modern medical platforms require a fully automated system for meningioma detection. Hence, this study proposes a novel and highly efficient hybrid Convolutional neural network (HCNN) classifier to distinguish meningioma brain images from non-meningioma brain images. The HCNN classification technique consists of the Ridgelet transform, feature computations, classifier module, and segmentation algorithm. Pixel stability during the decomposition process was improved by the Ridgelet transform, and the features were computed from the coefficient of the Ridgelet. These features were classified using the HCNN classification approach, and tumor pixels were detected using the segmentation algorithm. The experimental results were analyzed for meningioma tumor images by applying the proposed method to the BRATS 2019 and Nanfang dataset. The proposed HCNN-based meningioma detection system achieved 99.31% sensitivity, 99.37% specificity, and 99.24% segmentation accuracy for the BRATS 2019 dataset. The proposed HCNN technique achieved99.35% sensitivity, 99.22% specificity, and 99.04% segmentation accuracy on brain Magnetic Resonance Imaging (MRI) in the Nanfang dataset. The proposed system obtains 99.81% classification accuracy, 99.2% sensitivity, 99.7% specificity and 99.8% segmentation accuracy on BRATS 2022 dataset. The experimental results of the proposed HCNN algorithm were compared with those of the state-of-the-art meningioma detection algorithms in this study.

Molecular epidemiology of measles in India, 2005-2010.

Measles is a childhood disease that causes great morbidity and mortality in India and worldwide. Because measles surveillance in India is in its infancy, there is a paucity of countrywide data on circulating Measles virus genotypes. This study was conducted in 21 of 28 States and 2 of 7 Union Territories of India by MeaslesNetIndia, a national network of 27 centers and sentinel practitioners. MeaslesNetIndia investigated 52 measles outbreaks in geographically representative areas from 2005 through June 2010. All outbreaks were serologically confirmed by detection of antimeasles virus immunoglobulin M (IgM) antibodies in serum or oral fluid samples. Molecular studies, using World Health Organization (WHO)-recommended protocols obtained 203 N-gene, 40 H-gene, and 4 M-gene sequences during this period. Measles genotypes D4, D7, and D8 were found to be circulating in various parts of India during the study period. Further phylogenetic analysis revealed 4 lineages of Indian D8 genotypes: D8a, D8b, D8c, and D8d. This study generated a large, countrywide sequence database that can form the baseline for future molecular studies on measles virus transmission pathways in India. This study has created support and capabilities for countrywide measles molecular surveillance that must be carried forward.

Communication of Autonomous Vehicles in Road Accidents for Emergency Help in Healthcare Industries.

Autonomous cars like driverless motors are considered solely in science fiction films; however, in 2019, they are turning into a veracity and reality. People all around the world are excited to see the driverless automobile in reality. Selfless vehicles do not want human intervention. A completely driverless car is nonetheless at a superior trying out stage; however, in part due to computerized technological know-how, it has been around for the last few years. A partly computerized car has points such as lane keeping, automatic braking, and adaptive cruise control. With a self-sustaining automobile device, the vehicle has to feel the environment and discover objects, and with the assistance of GPS, it should run on the right navigation course even while obeying site visitors and transportation rules. In addition to that, the safety of passengers and pedestrians is also very important. This capability to keep away from collisions with barriers and accidents during assemble is important. To forestall the self-sufficient vehicle, this autonomous system helps a lot. The sensor used in this gadget identifies the objects in front of the car and stops the car, directing it to go on a specific course to keep away from accidents and communicate with each other. This accident-avoidance gadget and communication system help the self-sustaining car to attain the vacation spot via coaching the vehicle with synthetic intelligence. By making the motors smartest the lifestyles fashion additionally turns into smartest.

Impact of prediabetes education program on Knowledge, attitude and practice among prediabetic population of south India.

Education plays a vital role not only in the management of diabetes but also for the effective prevention of diabetes and its complications. Prediabetes awareness and knowledge is grossly inadequate in India and massive prediabetic screening and management programs are urgently needed. This study was an initiative to conduct education program among the prediabetic subjects after assessment of their knowledge attitude and practice using a newly developed and validated prediabetes questionnaire. A total of 308 prediabetic participants were recruited through prediabetes screening camps conducted in the selected districts of Kerala and Tamilnadu. A newly developed and validated KAP-PAQ Questionnaire was used to analyze the Knowledge Attitude and Practice among the prediabetic population. The impact of Prediabetes Education Program was assessed by administration of questionnaire before and after PEP with an interval period of 30 days. Baseline assessment of knowledge among prediabetics shown that 90% had poor knowledge but after PEP program 43% had average knowledge and 44% could score good knowledge. Baseline assessment of attitude exhibited 30% with negative attitude but after counseling 68% shown positive attitude. Regarding practice assessment 35% had very poor and 52% shown poor practice but after PEP 71% shown good practice and 15% shown very good practice. Baseline KAP survey shows the need for health literacy among the newly diagnosed prediabetics. Prediabetes education program could bring significant improvement in knowledge attitude and practice and KAP-PAQ was found to be an efficient tool to conduct survey among the newly diagnosed prediabetics of south India.

Post tsunami changes in soil properties of Andaman Islands, India.

A post tsunami study was conducted to assess the changes in soil properties in the Andaman Island, in India. The present study reported tsunami led conversion of acid soils to saline acid soils and acid sodic soils to acid saline sodic soils in the areas South Andaman inundated during tsunami and permanently receded later and in the low-lying area submerged during high tides. Upon intense leaching acid saline soils and acid saline sodic may further develop typical characteristics of acidic soils and acidic sodic soil, respectively. The soil at Guptapara inundated almost due to tsunami with minimal pyrite oxidation has potential to develop into highly acidic soils upon drainage. The tsunami by and large has modified some depositional layer affecting the salt accumulation to a greater extent and iron to a lesser extent and least to sodicity.

Triangulating the ledge: radiographic study of the floor of orbit and derivation of a novel template.

In orbital floor reconstruction, the need for the orbital implant to reach the exact position of the posteromedial ledge is essential, but owing to the complex anatomy of the region, visualisation of the ledge may be difficult. Several morphometric studies, both radiographic and cadaveric, have calculated a mean length from the orbital rim to the ledge. However, those linear measurements are unreliable and possess a higher margin of error for intraoperative guidance. This study attempts to triangulate the position of the posterior ledge from three easily accessible and reproducible points on the orbit and tries to provide a better guideline. A total of 50 patients (25 male and 25 female) with no history of orbital trauma or orbital surgery were selected randomly for this study. Computed tomography (CT) of both orbits, was done from three anatomically consistent and reproducible points: the infraorbital rim just above the infraorbital foramen (point A), hamulus lacrimalis (point B), and the most anterior point of the inferior orbital fissure (point C). The distance from these landmarks to the posterior ledge was measured using DICOM imaging software. A polygonal template was fabricated using the data obtained, which was used for intraoperative guidance. The mean (SD) distance to the posterior ledge from point A was 32.99 (1.35) mm, from point B was 31.36 (1.31) mm, and from point C was 20.19 (1.40) mm. There were no significant differences between left and right orbit or between male and female subjects. The template guides the shape, size, and direction of the orbital implant, reducing the risk of undersized or misplaced implants.

Serosurvey of rubella in five blocks of Tamil Nadu.

BACKGROUND & OBJECTIVE: Rubella, normally a mild, self-limiting disease characterized by rash, fever and lymphadenopathy, is a vaccine preventable disease. It carries little morbidity and apparently only minor complications in children. Infection during early pregnancy may lead to congenital rubella infection. Presence of rubella specific IgG in an unvaccinated population is a long term marker of previous rubella infection, which helps to assess the immune status of that population. Though many seroprevalence studies on rebella have been reported earlier from India, no study has been conducted in recent years. We undertook this study in 2003 in five blocks identified by the Integrated Child Development Scheme (ICDS), in the five districts of Tamil Nadu to assess the immune status to rubella in two age groups (1-5 yr boys and girls and 10-16 yr adolescent girls) before vaccination and draw strategies for future vaccination programme. METHODS: A total of 300 blood samples were collected by vein puncture from girls and boys of 1-5 yr age and adolescent girls of 10-16 yr age. Samples were tested for the presence of rubella specific IgG antibody by ELISA. RESULTS: Of the 300 samples tested, 145 (48.3%) were negative for rubella IgG antibodies. The seronegativity was 82.2 per cent in 1-5 yr and 13.5 per cent in the 10-16 yr age groups, the difference was statistically significant (P<0.001). INTERPRETATION & CONCLUSION: Large percentage of children, 82.2 per cent in the 1-5 yr age group and 13.5 per cent in 10-16 yr population were susceptible to rubella infection highlighting the fact that there was a risk of congenital rubella syndrome. There is a need to implement routine measles, mumps, rubella (MMR) immunization programme for under five children and mass scale one time immunization with monovalent rubella vaccine for adolescent girls.

Automatic detection of blood vessels in retinal images for diabetic retinopathy diagnosis.

Diabetic retinopathy (DR) is a leading cause of vision loss in diabetic patients. DR is mainly caused due to the damage of retinal blood vessels in the diabetic patients. It is essential to detect and segment the retinal blood vessels for DR detection and diagnosis, which prevents earlier vision loss in diabetic patients. The computer aided automatic detection and segmentation of blood vessels through the elimination of optic disc (OD) region in retina are proposed in this paper. The OD region is segmented using anisotropic diffusion filter and subsequentially the retinal blood vessels are detected using mathematical binary morphological operations. The proposed methodology is tested on two different publicly available datasets and achieved 93.99% sensitivity, 98.37% specificity, 98.08% accuracy in DRIVE dataset and 93.6% sensitivity, 98.96% specificity, and 95.94% accuracy in STARE dataset, respectively.

Buprenorphine added to the local anesthetic for brachial plexus block to provide postoperative analgesia in outpatients.

BACKGROUND AND OBJECTIVES: Over the past 10 years, several studies have suggested that the addition of certain opiates to the local anesthetic used for brachial block may provide effective, long-lasting postoperative analgesia. One of these studies indicated that the agonist-antagonist, buprenorphine, added to bupivacaine provided a longer period of postoperative analgesia than the traditional opiates, but in this study, it is impossible to determine the relative contributions of the local anesthetic and the opiate to the postoperative analgesia because of the extremely long duration of the anesthesia provided by the local anesthetic, bupivacaine. By repeating the study using a local anesthetic of a shorter duration, the present study delineates more clearly the contribution of the buprenorphine to postoperative analgesia when added to a shorter-acting local anesthetic. METHODS: Forty, healthy, consenting adult patients scheduled for upper extremity surgery were enrolled in the study. Premedication was provided by intravenous midazolam 2 mg/70 kg and anesthesia by a subclavian perivascular brachial plexus block. The patients were assigned randomly to 1 of 2 equal groups based on the agents used for the blocks. The patients in group I received 40 mL of a local anesthetic alone, while those in group II received the same local anesthetic plus buprenorphine 0.3 mg. The study was kept double-blind by having 1 anesthesiologist prepare the solutions, a second anesthesiologist perform the blocks, and a third anesthesiologist monitor the anesthesia and analgesia thereafter, up to and including the time of the first request for an analgesic medication. The data were reported as means (+/- SEM), and differences between groups were determined using repeated measures of analysis of variance (ANOVA) and chi(2), followed by the Fisher exact test for post hoc comparison. A P value of less than.05 was considered to be statistically significant. RESULTS: The mean duration of postoperative pain relief following the injection of the local anesthetic alone was 5.3 (+/- 0.15) hours as compared with 17.4 (+/- 1.26) hours when buprenorphine was added, a difference that was statistically (and clinically) significant (P <.0001). CONCLUSIONS: The addition of buprenorphine to the local anesthetic used for brachial plexus block in the present study provided a 3-fold increase in the duration of postoperative analgesia, with complete analgesia persisting 30 hours beyond the duration provided by the local anesthetic alone in 75% of the patients. This practice can be of particular benefit to patients undergoing ambulatory upper extremity surgery by providing prolonged analgesia after discharge from the hospital.

Contribution to the knowledge of the pharmaceutical ethnobotany of La Segarra region (Catalonia, Iberian Peninsula).

An ethnobotanical survey was carried out in the region known as La Segarra, situated at the north east of the Iberian Peninsula, in the inner plains of Catalonia, with an area of 720 km2 and a population of 17000. Working with 29 people, data on uses of 142 species belonging to 54 botanical families were obtained and presented, of which 13 uses corresponding to nine plant species were previously unreported.

Preliminary screening of ethnomedicinal plants from India.

Antibacterial activity of aqueous residues of 16 different ethnomedicinal plants have been studied. The effect of the aqueous extract at two different weights of plant residues, 30 and 40 mg, were tested against three gram positive bacteria and seven gram negative bacteria by the filter paper disc diffusion method. Among the tested plants, Cleome gynandropsis and Ageratum conyzoides showed a significant control of the growth of Alkaligens viscolactis, Klebsiella aerogenas, Bacillus cerues and Streptococcus pyogens. The maximum inhibitions were observed in Tridax procumbens, Cleome viscosa, Acalypha indica and Boerhaavia erecta against Aeromonas hydrophilla and Bacillus cerues.

Three cases of subungual glomus tumours of the fingers - a case series.

Subungual glomus tumours are rare tumours (2% of all hand tumours) presenting with excruciating pin point pain under the nail which is often misdiagnosed. Diagnosis is often always clinical. Here, we report the case of three patients who had subungual glomus tumour not diagnosed earlier for many years.

Donor site analgesia after anterior iliac bone grafting in paediatric population: a prospective, triple-blind, randomized clinical trial.

The aim of this study was to compare the efficacy of femoral nerve block with indwelling catheter-based multiple infiltrations of bupivacaine for postoperative pain management after iliac bone harvesting. Sixty paediatric patients undergoing iliac harvesting were randomized into three groups: group A, preoperative femoral nerve block; group B, multiple bolus infiltration of 0.5% bupivacaine via indwelling catheter at the donor site; group C, controls--single dose of 0.5% bupivacaine infiltration given subcutaneously. The primary outcome measure was postoperative pain intensity at rest and at function. The time to maximum pain score, time to ambulation, duration of analgesia, and length of hospital stay were also assessed. Group B patients had the best pain relief and return to function, however the duration of pain relief was longer in group A. Subjects in group A had concomitant motor blockade causing delayed ambulation. Group C showed the worst outcomes. Indwelling catheter-based infiltration of bupivacaine was the most efficient method for providing enhanced pain relief after iliac bone graft harvesting. There was no increase in operating time or hospital stay. Femoral nerve block provided the next best results, but had the significant disadvantage of motor nerve blockade.

Clinical and radiological spectrum of Japanese encephalitis.

INTRODUCTION: Japanese encephalitis (JE) is mosquito-borne flaviviral encephalitis that remains to be a major health problem in India--it still continues to cause havoc in many parts of the country. We undertook the study to analyze the clinical and radiological spectrum of JE in adults and children. METHOD: This prospective study consists of 148 patients with JE. The diagnosis of JE was based on clinical, epidemiological, radiological features and demonstration of JE virus specific IgM in CSF and serum by JE virus immunoglobulin M capture enzyme-linked immunosorbent assay (MAC ELISA). All patients underwent a detailed neurological examination, CSF study & neuroimaging of brain (either CT or MRI or both). All patients were followed-up at regular interval. RESULT: Seizures were present in adults (52.88%) and in children (43.18%). Dystonia was more common in children 19 (43.18%) compared to adults 19 (18.2%), and Parkinsonian features were observed in both groups 47 (45.19%) of the adults and 20 (45.45%) of the children. JE-specific IgM antibody was detected in both CSF and serum in 81.7%. In neuroimaging, apart from classical involvement of thalami, basal ganglia & midbrain, prominent involvement of hippocampus and other areas of the cortex was also found in 27 (45.6%) patients. Presence of thalamic lesion in CT/MRI showed significant relationship to the development of dystonia. However, no correlation was found between the neuroimaging features and poor clinical outcome. Twenty three patients (15.5%) died during acute phase of illness. On multivariate logistic regression analysis age, prolonged fever, Glasgow coma scale, recurrent seizures and reflex changes were found to be the predictors of outcome at the time of discharge. CONCLUSION: A trend of severe and frequent involvement in younger patients with dystonia and other movement disorders was observed. It should be emphasized that presence of atypical cranial CT/MRI features in JE was not unknown and they need to be differentiated from herpes simplex encephalitis in appropriate clinical setting.

Outcomes of Endovascular Coiling in Patients with Intracranial Aneurysms Presenting with Poor Clinical and SAH Grade.

Although the treatment of intracranial aneurysms has made significant advances, prediction of outcomes in poor grades has always been difficult. We present our findings of patients in poor clinical and SAH grade treated with endovascular coiling. We aimed to evaluate the clinical outcomes in patients presenting with poorer neurological and SAH grades treated by endovascular techniques. Of 190 patients who presented with SAH over a period of nine years, 34 were of poorer clinical grade (Hunt & Hess Grades 4 and 5), of whom 30 presented with H&H grade 4 and four with grade 5. 44.1% of the 34 patients belonged to Fischer grade 4. We assessed the technical success and final outcomes based on the Glasgow outcome scale. Of the 30 patients with grade 4, 81.4% had a good outcome. Two out of four patients with grade 5 had a poor outcome. 82.5% of the patients with Fischer grade 4 had a good outcome. None of the poor outcomes were procedure-related. Endovascular treatment with its higher rates of technical success, lower complication rates and better outcomes should be recommended as the treatment of choice in patients with intracranial aneurysms even in patients with poorer clinical and SAH grades.