Neurocognitive effects of proanthocyanidin in Alzheimer's disease: a systematic review of preclinical evidence.

Cognitive disorders and dementia largely influence individual independence and orientation. Based on the Alzheimer's Disease International (ADI) estimation, approximately 75% of individuals with dementia are undiagnosed. In fact, in some low- and middle-income countries, the percentage is as high as 90%. In this systematic review, which is based on PRISMA guidelines, we aim to identify the mechanism of action of proanthocyanidin. Finding a natural product alternative as a potential nootropic can help increase the number of armamentariums against dementia and other cognitive impairments. In this preclinical research, we determined the effect of proanthocyanidins on Alzheimer's disease (AD) by searching electronic bibliographic databases like Scopus, Proquest, ScienceDirect, PubMed, and Google. There was no imposed time limit. However, the search was limited to only English articles. The review protocol is registered on PROSPERO as CRD42022356301. A population, intervention, control, and outcomes (PICO) technique was utilized for report inclusion, and all reports were assessed for risk of bias by using the SYRCLE's RoB tool. The article's bibliographic information, induction model, type of proanthocyanidins, animal strain/weight/age, and outcome measurements were acquired from ten papers and are reported here. Further analysis was validated and determined for the review. The included studies met the review's inclusion criteria and suggested that proanthocyanidins have a neurocognitive effect against AD. Additionally, the effectiveness of proanthocyanidins in reducing oxidative stress, acetylcholinesterase activity, amyloid beta, its efficacy in alleviating superoxide dismutase, cognitive properties, and in facilitating cholinergic transmission in various models of AD has been collectively observed in ten studies.

Risk factors of urolithiasis: A hospital-based retrospective study.

Aim: Urolithiasis is the most prevalent urinary tract disease, posing a global public health concern. The escalating prevalence and recurrence rates of urolithiasis are attributed to lifestyle modifications, such as reduced physical activity and dietary habits. This retrospective study aims to explore the risk factors associated with urolithiasis among individuals diagnosed with this condition. Method: A retrospective hospital-based study involving 60 participants meeting the inclusion criteria was conducted. The participants were selected through convenience sampling from the urology, nephrology, and medical wards at Saveetha Medical College and Hospital. Demographic variables were collected, and the risk factors were assessed using a checklist on one-to-one interviews. Results: The study unveiled that most participants (68%) were male. Eighty percent of participants had the risk factor of decreased water intake, 74% consumed excess tomatoes, 56% had a history of recurrent urinary tract infections, 64% consumed an excessive amount of salt daily, 72% experienced a decreased urine output, 53% had a habit of alcohol consumption, and 45% included milk and milk products in their daily diet. A small percentage (5%) had a family history of urolithiasis. Additionally, 6% were undergoing Siddha treatment. Conclusion: The findings from this study underscore the significant factors contributing to urolithiasis. They can inform public health campaigns to raise awareness about lifestyle modifications, dietary changes, and hydration protocols contributing to kidney stone formation.

Monomelittoside and Dichotomoside D from bark extract of Alstonia scholaris (L.) R. Br. inhibits dental caries pathogen Streptococcus mutans.

Dental caries advances to be a significant global health concern, primarily attributed to the virulent actions of Streptococcus mutans. The antibacterial property of the bark extract of Alstonia scholaris was assessed using standard disc diffusion assays, which revealed significant inhibition of S. mutans. Subsequently, we determined the Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) revealed potent antibacterial activity of bark extract against S. mutans, at MIC and MBC values 62.5 and 125 µg/mL, respectively and antibiofilm activity at 125 µg/mL. Furthermore, cytotoxicity assays showed no adverse effects on mammalian cells. Moreover, we employed liquid chromatography-mass spectrometry to identify bioactive compounds in the bark extract and revealed the presence of major active compounds as Monomelittoside and Dichotomoside D effective in targeting the S. mutans. These findings showed that, the promising antibacterial efficacy of Monomelittoside and Dichotomoside D, highlighting their potential as natural therapeutics for combating dental caries.

TopoGeoFusion: Integrating object topology based feature computation methods into geometrical feature analysis to enhance classification performance.

This study used smartphone captured RGB images of gooseberries to automatically sort into standard, premium, or rejected categories based on topology. Main challenges addressed include, separation of touching or overlapping fruits into individual entities and new method called 'TopoGeoFusion' that combines basic geometrical features with topology aware features computed from the fruits to assess the grade or maturity. Quality assessment helps in grading the fruit to determine market suitability and intelligent camera applications. Computer Vision-based techniques have been applied to automatically grade the quality of gooseberries as standard, premium, or rejected according to fruit maturity. Smartphone-captured images of 1697 Indian Star Gooseberries are contributed to the study. This work acquired images consisting multiple fruits with overlapping and non-overlapping boundaries for concurrent quality assessment. Multiple classifiers such as Random Forest, SVM, Naive Bayes, Decision Tree, and KNN were applied to grade the gooseberry fruit. Random Forest classification with a fusion feature model resulted in an accuracy of 100 % towards reject, standard, and premium classes for test sets with four training strategies. The proposed segmentation model proves reliable in fruit detection & extraction with an average mAP of 0.56, resulting in an acceptable model for grade assessment.•The study highlights the effectiveness of TopoGeoFusion in automating the grading process of gooseberry fruits using topologically computed features.•The developed models exhibit high accuracy and reliability, even in challenging scenarios such as overlapping and touching fruits.•The method provides the technique to detect and extract the occluded objects and compute the features based on the partial object's topology.

CFTR mutations and phenotypic correlations in people with cystic fibrosis: a retrospective study from a single centre in south India.

Background: Emerging data reveal higher-than-expected prevalence of cystic fibrosis (CF) among non-European populations worldwide including in the Indian subcontinent. Systematic analyses of the CFTR mutation profile, and genotype-phenotype correlations among people with CF from south, east, or northeast India have not been reported before. We wanted to identify CFTR mutations in people with CF, and highlight novel variants, selective phenotypic correlations, and regional variances within India. Methods: A retrospective study was conducted at Christian Medical College, Vellore, India (single tertiary referral hospital) from September 2010 to August 2022, involving 120 people with CF from (i) four south Indian states (Tamil Nadu, Andhra Pradesh, Kerala, Karnataka), (ii) in and nearby regions of West Bengal, India and (iii) Bangladesh. Comprehensive CFTR mutation analyses were done by Next-Generation Sequencing, and variants were categorized per American College of Medical Genetics guidelines and compared with validated Locus-specific databases. Demographic characteristics, mutation profile, novel mutations, selective phenotype correlations, and regional variances were assessed. Findings: In 120 people with CF, 55 CFTR variants were identified, including six novel variants. F508del was the predominant mutation, yet with a lower allele frequency than reported among European populations (27% versus 70%). Phenotypic correlations suggested high mutational pathogenicity causing severe multi-organ morbidity, and death in 27%. Milder variants associated with pancreatic sufficiency were also evident in 23% of people with CF. Statistically significant regional variances were noted in genotype frequency, and clinical phenotype among people with CF from the two regions. Hotspot exons and introns that could potentially help create targeted mutation panels were identified. Interpretation: The identification of 55 different CFTR variants among 120 people with CF describes the diversity of mutations noted in India, while also revealing the challenges that providers may encounter in timely diagnosis and treatment of CF. However, these single-centre data have specific limitations and cannot be generalised to all people with CF from India or to those of non-European origin. Our data on regional CFTR mutations contribute to the emerging national registry on CF epidemiology in India, help formulate diagnostic and newborn screening algorithms, help optimise clinical care, and highlight urgency to improve access to life-changing modulator therapy. Funding: Cystic Fibrosis Foundation, USA (towards the CF-India Demonstration Project) and Christian Medical College, Vellore, India.

Stochastic calculus-guided reinforcement learning: A probabilistic framework for optimal decision-making.

Stochastic Calculus-guided Reinforcement learning (SCRL) is a new way to make decisions in situations where things are uncertain. It uses mathematical principles to make better choices and improve decision-making in complex situations. SCRL works better than traditional Stochastic Reinforcement Learning (SRL) methods. In tests, SCRL showed that it can adapt and perform well. It was better than the SRL methods. SCRL had a lower dispersion value of 63.49 compared to SRL's 65.96. This means SCRL had less variation in its results. SCRL also had lower risks than SRL in the short- and long-term. SCRL's short-term risk value was 0.64, and its long-term risk value was 0.78. SRL's short-term risk value was much higher at 18.64, and its long-term risk value was 10.41. Lower risk values are better because they mean less chance of something going wrong. Overall, SCRL is a better way to make decisions when things are uncertain. It uses math to make smarter choices and has less risk than other methods. Also, different metrics, viz training rewards, learning progress, and rolling averages between SRL and SCRL, were assessed, and the study found that SCRL outperforms well compared to SRL. This makes SCRL very useful for real-world situations where decisions must be made carefully.•By leveraging mathematical principles derived from stochastic calculus, SCRL offers a robust framework for making informed choices and enhancing performance in complex scenarios.•In comparison to traditional SRL methods, SCRL demonstrates superior adaptability and efficacy, as evidenced by empirical tests.

A focus on melorheostosis disease: a literature review and case report of femoral-acetabular impingement due to melorheostosis treated with surgical hip osteoplasty.

OBJECTIVE: Melorheostosis is a rare, non-hereditary, benign bone disease characterized by abnormal bone growth. Generally, melorheostosis develops during childhood or adolescence and progresses gradually over time. This disease represents a true challenge to the physician because of its variability due to location, extension of the affected bone, and involvement of associated soft tissue. Pain management, physical therapy, and surgery may be recommended, depending on the individual case. This review aims to get an overview of the latest evidence relating to epidemiology, clinical and radiographic characteristics, diagnosis, and possible therapeutic strategies for melorheostosis and describe our experience through a clinical case. METHODS: We designed a comprehensive literature search on melorheostosis in MEDLINE (via Pubmed) up to April 2023 and reviewed reports published in international journals. RESULTS: The purpose is to highlight the importance of a multidisciplinary approach in the management of a rare disease such as melorheostosis. We discuss the role of different physicians, including genetists, rheumatologists, physiatrists, physical therapists, and orthopedic surgeons, in providing accurate diagnoses and effective treatments. We conducted a comprehensive review of the literature on the treatment of melorheostosis to support these findings. In addition, the article presents a case study of a patient suffering from melorheostosis, focusing on difficulties in reaching a correct diagnosis and attempts towards conservative and surgical interventions. The patient underwent hip arthroplasty, and the final result was an improvement in function and a reduction in pain. CONCLUSIONS: Managing melorheostosis can be challenging, and there is no standardized treatment for this condition at the moment.

Outcomes of etonogestrel subdermal contraceptive implants: A single center cross-sectional study.

OBJECTIVES: To examine the prevalence of menstrual irregularities, side effects, and discontinuation rates of etonogestrel subdermal implants (ESI) in women attending King Abdulaziz Medical City, Jeddah, Saudi Arabia. METHODS: This cross-sectional was carried out based on electronic medical records and a phone-based questionnaire administered to women who underwent ESI insertion in a single tertiary care hospital in Jeddah, Saudi Arabia, between 2019 and 2022. The primary objective was the prevalence of menstrual abnormalities. The secondary study objective included the discontinuation rate, reasons for discontinuation, and ESI side effects. RESULTS: In total, 345 women with ESI were included in this study. The prevalence of any type of menstrual abnormalities was 88%. Other side effects included skin and mood changes, arm pain, and numbness. The discontinuation rate was 11% in the first year and 22% before the completion of 36 months. CONCLUSION: Although menstrual abnormalities are a common side effect of ESI, only 22% of users discontinued this method of contraception.

Mutation of conserved histidine residues of dengue virus envelope protein impairs viral like particle maturation and secretion.

Dengue virus (DENV) envelope protein plays crucial role in virus entry and maturation of virus during infection. Maturation of DENV occurs in the trans Golgi network at slightly acidic pH which is close to pKa of histidine. When exposed to the acidic environment of the late secretory pathway, dengue virus particles go through a significant conformational change, whereby interactions of structural proteins envelope (E) and prM proteins are reorganised and enable furin protease to cleave prM resulting in mature virus. In order to study the role of histidine of E protein in DENV maturation, we mutated 7 conserved histidine residues of envelope protein and assessed the percent of budding using viral like particle (VLP) system. Histidine mutants; H144A, H244A, H261A and H282A severely disrupted VLP formation without any significant change in expression in cell and its oligomerization ability. Treatment with acidotropic amine reversed the defect for all 4 mutants suggesting that these histidines could be involved in maturation and release. Over expression of capsid protein slightly enhanced VLP release of H244A and H261A. Similarly, furin over expression increased VLP release of these mutants. Co-immunoprecipitation studies revealed that prM and E interaction is lost for H244A, H261A and H282A mutants at acidic pH but not at neutral pH indicating that they could be involved in histidine switch during maturation at acidic pH. Detailed analysis of the mutants could provide novel insights on the interplay of envelop protein during maturation and aid in target for drug development.

AMDPWE: Alphonso Mango Dataset for Precision Weight Estimation.

Alphonso Mango (Mangifera indica L.), is popularly known as king of mangoes in India. India is one of the leading countries in mango production. Automatic visual inspection systems for quality assessment using weight are intelligent interventions designed to evaluate fruit maturity based on various parameters. Automated systems utilize a combination of image analysis, computer vision, and artificial intelligence algorithms to estimate the weight of fruits precisely. One of the crucial quality parameters is weight, which measures the fruit's overall mass and potential quality. Integration of precision weighing mechanisms in fruit quality estimation leads to a quick and accurate method of measuring fruit weight in the marketplace. Furthermore, the fruit's demand in the market is directly connected to its size as it influences consumer preferences. Automatic precision weight estimation systems equipped with intelligent high-resolution assists in ensuring consistency in size across batches of fruits. The dataset samples consist of images of 71 Alphonso cultivars of mango fruit. The fruit is collected from the College of Horticulture Yalachahalli, Mysuru, India. The fruits were harvested in April/May 2022. The digital images of these fruits are captured using the acquisition setup with a controlled environment. Each image has a resolution of 2048×1536. The images include two orientations of each sample. The physical parameters such as the weight, fruit diameter, and width across the shoulder are also maintained. The digital images undergo pre-processing, and further, the vision-based features such as area, convex area, and minor axis for both orientations are captured.

Evaluation of Salivary Interleukin-6 in Patients with Oral Squamous Cell Carcinoma, Oral Potentially Malignant Disorders, Chronic Periodontitis and in Healthy Controls - A Cross-Sectional Comparative Study.

Introduction: Oral squamous cell carcinoma (OSCC) accounts for 95% among all head and neck cancers. Literature reveals saliva as a predictive, diagnostic and prognostic tool in carcinoma, inflammatory and genetic disorders. Expression of salivary interleukin-6 (IL-6) has been reported in patients with OSCC and in oral potentially malignant disorders (OPMDs). This study aims at the following objectives: • To evaluate the changes in the salivary levels of IL-6 in healthy individuals and those with chronic periodontitis (CP), OPMD and OSCC. • To compare the estimated levels of salivary IL-6 individually in healthy individuals and those with CP, OPMD and OSCC. • To assess the estimated levels of salivary IL-6 individually within histopathologically differentiated OSCC. • To analyse salivary IL-6 as a reliable biomarker in the diagnosis of OSCC. Materials and Methods: Totally, 60 patients were divided into four groups consisting of 15 patients in each group. Salivary samples were collected by simple drooling method. The concentration of IL-6 is to be determined by using Quantitative sandwich ELISA technique. All analyses were carried out using Statistical Package for Social Sciences (SPSS). Results: The concentration values of IL-6 were found to be more in OSCC group in comparison with the other three groups and the concentration values of OPMD were found to be more than in the CP and control group and was statistically significant. Discussion: We attempted a study to evaluate the salivary IL-6 in patients with OSCC, OPMDs and CP in comparison with the healthy controls. We achieved a pragmatic result showed that salivary IL-6 can be a reliable biomarker in the detection of OSCC. Saliva, due its wide array of functional characteristics, is an upcoming diagnostic fluid in the field of medicine and salivary IL-6 can be one such biomarker in the diagnosis of OSCC.

DIMPSAR: Dataset for Indian medicinal plant species analysis and recognition.

Mobile-captured images of medicinal plants are widely used in various research investigations. Machine vision-based tasks such as the identification of plant species types for intelligent imaging device applications take a significant part in it. Botanists, farmers and researchers can reliably identify medicinal plants with the help of images captured using smartphones.  Mobile captured images can be used for quality control to make sure that the right plant species are being used in pharmaceutical products. In the field of education, pictures of medicinal plants and their usage can be used to educate learners, medical professionals, and the general public. Further, various research investigations in the area of chemistry, pharmacology, the therapeutic potential of medicinal plants, images can be employed. In this paper, we contribute a dataset of Indian medicinal plant species. The dataset is collected from different regions of Karnataka and Kerala. Datasets include characteristics such as multiple resolutions, varying illuminations, varying backgrounds, and seasons in the year. The datasets consist of 5900 images of forty plant species and single leaf images of eighty plant species consisting of 6900 samples obtained from real-time conditions using smartphones. The datasets contributed would be useful to researchers to investigate on development of algorithmic models based on image processing, machine learning, and deep learning concepts to educate about medicinal plants. The dataset can be accessed by anybody, without charge, at DOI:10.17632/748f8jkphb.2, 10.17632/748f8jkphb.3.

Efficient generation and characterization of chimeric dengue viral-like particles.

Viral-like particles (VLPs) because of their non-infectious and high immunogenic properties have important applications in diagnostics, drug delivery, and vaccine production. They also serve as an attractive model system to study virus assembly and fusion processes. Unlike other flaviviruses, Dengue virus (DENV) is not very efficient in the production of VLPs on the expression of DENV structural proteins. On the other hand, the stem region and transmembrane region (TM) of G protein of Vesicular Stomatitis virus (VSV) alone are sufficient for budding. Here we generated chimeric VLPs replacing regions of stem and transmembrane domain (STEM) or only transmembrane domain (TM) of E protein of DENV-2 with corresponding regions of VSV G protein. Both chimeric proteins secreted VLPs at higher levels than the wild type (2-4 folds) without any significant change in the expression in the cell. Chimeric VLPs could be recognized by a conformational monoclonal antibody, 4G2. They were also found to interact with dengue-infected patient sera effectively thus implying that their antigenic determinants are preserved. In addition, they were able to bind to its putative receptor, heparin with similar affinity as the parent counterpart thus retaining its functional property. However, cell-cell fusion revealed that there is no significant increase in the fusion ability of chimeras as compared to the parent clone, whereas VSV G protein displayed high cell-cell fusion activity. Overall, this study suggests that chimeric dengue VLPs can be taken forward for their likely potential as vaccine production and serodiagnosis.

HMPLMD: Handwritten Malayalam palm leaf manuscript dataset.

The realization of high recognition rates of degraded documents such as palm leaf manuscripts primarily relies on document enhancement. Advancement of deep learning models in the process of document enhancement plays a major role among non-deep learning models or thresholding methods. Preparation of readily available ground truth data for creation of deep learning models is of paramount importance as it is highly time consuming task. The ground truth dataset preparation involves greater complexities as ancient documents are affected with degradations such as fungi, humidity, uneven illumination, discoloration, holes, cracks, and other damages. We propose a Handwritten Malayalam Palm Leaf Manuscript Dataset (HMPLMD) and its ground truth data aspiring for advancements in the field of palm leaf image analysis. We employ the palm leaf manuscripts of Kambaramayanam and Jathakas for the sake of experimentations. The proposed ground truth samples of degraded palm leaves plays a crucial role in creation of specialized deep/transfer learning models to handle challenges related to binarization.

Adaptive dewarping of severely warped camera-captured document images based on document map generation.

Automated dewarping of camera-captured handwritten documents is a challenging research problem in Computer Vision and Pattern Recognition. Most available systems assume the shape of the camera-captured image boundaries to be anywhere between trapezoidal and octahedral, with linear distortion in areas between the boundaries for dewarping. The majority of the state-of-the-art applications successfully dewarp the simple-to-medium range geometrical distortions with partial selection of control points by a user. The proposed work implements a fully automated technique for control point detection from simple-to-complex geometrical distortions in camera-captured document images. The input image is subject to preprocessing, corner point detection, document map generation, and rendering of the de-warped document image. The proposed algorithm has been tested on five different camera-captured document datasets (one internal and four external publicly available) consisting of 958 images. Both quantitative and qualitative evaluations have been performed to test the efficacy of the proposed system. On the quantitative front, an Intersection Over Union (IoU) score of 0.92, 0.88, and 0.80 for document map generation for low-, medium-, and high-complexity datasets, respectively. Additionally, accuracies of the recognized texts, obtained from a market leading OCR engine, are utilized for quantitative comparative analysis on document images before and after the proposed enhancement. Finally, the qualitative analysis visually establishes the system's reliability by demonstrating improved readability even for severely distorted image samples.

Anatomical diversity of inferior belly of the omohyoid muscle - Anatomical, physiological and surgical paradigm.

Omohyoid muscle is one of the infrahyoid muscles of the neck which consists of two bellies combined at an angle by an intermediate tendon. The inferior belly is a flat, narrow band, which inclines forwards and upwards in the lower part of the neck. It generally originates from the upper border of the scapula, medial to scapular notch. The present case showed unilateral anomalous attachment of the inferior belly of the omohyoid on the medial part of clavicle on left side. Inferior belly was 2.2cm lateral to left sternoclavicular joint with 3.2 and 1.5cm in length and breadth, innervated by ansa cervicalis. Only 3% of this type of variation has been observed until now according to previous literature. Anterior and posterior triangles of neck on both sides of the cadaver were dissected during routine dissection for undergraduate teaching. There was no scapular attachment of inferior belly of the omohyoid on the left side. It was directly originating from the upper surface of the medial side of the left clavicle. Variation in the attachment of inferior belly can have a direct impact on the internal jugular vein and brachial plexus during neck surgeries or trauma due to its close relation to the mentioned structures. This variation should also be taken care during infrahyoid myocutaneus flap extraction for reconstruction surgery of tongue in cases of lingual carcinoma.

Thoracoscore: Does it predict mortality in the Indian scenario? - A retrospective study.

Background and Aims: Preoperative risk stratification helps in better prognostication and allocation of resources. However, risk scoring models are less often used in thoracic surgery. Thoracoscore, a risk score model for thoracic surgery was originally developed on a French population and was later validated in many countries. As there is no literature on its ability to predict mortality in the Indian population, we aimed to validate Thoracoscore in Indian thoracic surgical patients. Methods: This retrospective study was carried out in a tertiary care centre after obtaining institutional ethics committee clearance. Patients who were operated for lung pathologies via a posterolateral thoracotomy incision between January 2014 and December 2018 were included in the study. Data on Thoracoscore variables and few additional factors (pulmonary arterial hypertension (PAH), redo surgery, blood loss, blood transfusion, duration of anaesthesia, one lung ventilation and surgery) was collected along with observed mortality statistics. Mortality was predicted using online calculator from the site https://sfar.org/scores2/thoracoscore2.php.Significant continuous and categorical variables in causation of mortality were identified using unpaired t-test and Chi-square tests, respectively. These variables were subjected to multivariate logistic regression to find independent risk factors for mortality. The calibration and discrimination of the Thoracoscore model was analysed by using Hosmer-Lemeshow test and area under the curve of receiver operating characteristic curves. Results: Overall observed mortality in the study was 3.2% while predicted mortality was 0.44%. The Thoracoscore had poor calibration and fair discrimination ability. PAH and re-operative surgery along with Thoracoscore were found to be independent risk factors of mortality in thoracic surgery. Conclusion: Thoracoscore fails to predict mortality in the Indian population.

An Interdisciplinary Ethics Panel Approach to End-of-Life Decision Making for Unbefriended Nursing Home Residents.

For those with advanced life-limiting illness, the optimization of quality of life and avoidance of nonbeneficial treatments at the end of life are key ethical concerns. This article evaluates the efficacy of an Interdisciplinary Ethics Panel (IEP) approach to decision making at the end of life for unbefriended nursing home residents who lack decisional capacity and have advanced life-limiting illness, through the use of a nine-step algorithm developed for this purpose. We reviewed the outcomes of three quality-of-care phased initiatives conducted in our facility, a large public nursing home in New York City, between June 2016 and February 2020, which indicated that this IEP approach promoted advance-care planning, as palliative measures were endorsed to optimize quality of life for this vulnerable population at the end of life. We also examined another quality-of-care initiative when this IEP approach was applied to end-of-life decision making for nursing home residents who had a surrogate during the COVID-19 pandemic. This application appeared to be beneficial in adding more residents to our Palliative Care Program while it improved rates of advance-care planning. When all of the above findings are considered, we believe this novel IEP approach and algorithm have the potential to be applied elsewhere after appropriate assessment.

Role of Lipid Indices in the Assessment of Microvascular Risk in Type 2 Diabetic Retinopathy Patients.

INTRODUCTION: Diabetic retinopathy (DR) remains the leading cause of blindness and visual impairment in diabetic patients worldwide. Lipid indices (LI) such as atherogenic coefficient (AC), atherogenic index of plasma (AIP), non-high-density lipoprotein cholesterol (non-HDL-C), and Castelli risk index (CRI) I and II may be associated with bio-physiological changes of DR even when traditional lipids are within normal limit. Hence, the present study was undertaken to evaluate the LI and examine the LI predictive role in assessing the microvascular risk in diabetes patients with and without retinopathy. METHODOLOGY: This case-control study was conducted for six months at a tertiary care hospital and included 90 subjects divided into three groups. Group I had 30 age and sex-matched healthy controls; group II and group III had 30 type 2 diabetes mellitus (T2DM) cases without DR and with DR, respectively. Plasma glucose and lipid profiles including apolipoprotein A-I (Apo A-I) and apolipoprotein B (Apo B) were measured in all subjects. LI such as AIP, AC, CRI-I, CRI-II, and non-HDL-C were calculated from the lipid profile values. ANOVA test was used to compare the means of three groups. RESULTS: The mean age of the study participants was 51.44 ± 11.72, 53.95 ± 12.43, and 57.16 ± 7.96 years for groups I, II, and III, respectively. Triacylglycerol (TG) showed positive correlation with all LI, AIP (r = 0.768, p < 0.00001), AC (r = 0.363, p = 0.048), non-HDL-C (r = 0.372, p = 0.042), and CRI-I (r = 0.363, p = 0.048), except for CRI-II in group III. Low-density lipoprotein cholesterol (LDL-C) showed a statistically significant positive correlation with non-HDL-C and CRI-II in diabetic subjects with and without retinopathy. CONCLUSION: The study showed that LI were raised in diabetic patients with or without DR, suggesting the significant role of LI in assessing microvascular risk in T2DM, particularly when the lipid profile values seem to be normal or not disturbed markedly.

Newly Developed COVID-19 Bundle Greatly Reduces the Infection Fatality Rate for a Highly Vulnerable Nursing Home Population.

This performance improvement initiative used a bundle designed to reduce the COVID-19 infection fatality rate (IFR) by ≥33% and the new infection rate (IR) to <1% among nursing home (NH) residents over a 3-month period at a large public NH in New York City. Participants were all NH residents, newly testing COVID-19 PCR positive between March 1, 2020 and June 30, 2020. Key bundle components involved close observation of all residents with vital signs taken once/shift, including O2 saturation, frequent clinical team follow-up visits for those symptomatic, and ramped-up COVID-19 PCR testing. From April to June, average IFR was 12.3%, a 49.6% reduction from the March baseline (P < 0.05), and average new IR was 5.4%, a 29.9% reduction from baseline (P < 0.05). In the 2 follow-up months, no deaths occurred with a new IR < 1%, indicating sustained improvement. Because of its simplicity, this bundle or components of it could be readily applied elsewhere after appropriate assessment.