Consensus Statement from India on the Renal Benefits of ARNi, SGLT-2i, and Bisoprolol in Chronic Kidney Disease.

Chronic kidney disease (CKD) is a major contributor to morbidity and mortality in India. CKD often coexists with heart failure (HF), diabetes, and hypertension. All these comorbidities are risk factors for renal impairment. HF and CKD are pathophysiologically intertwined, and the deterioration of one can worsen the prognosis of the other. There is a need for safe renal pharmacological therapies that target both CKD and HF and are also useful in hypertension and diabetes. Neurohormonal activation achieved through the activation of the sympathetic nervous system (SNS), the renin-angiotensin-aldosterone system (RAAS), and the natriuretic peptide system (NPS) is fundamental in the pathogenesis and progression of CKD and HF. Angiotensin receptor neprilysin inhibitor (ARNi), sodium-glucose cotransporter 2 inhibitors (SGLT-2i), and selective ß1-blocker (B1B) bisoprolol suppress this neurohormonal activation. They also have many other cardiorenal benefits across a wide range of CKD patients with or without concomitant HF, diabetes, or hypertension. This consensus statement from India explores the place of ARNi, SGLT-2i, and bisoprolol in the management of CKD patients with or without HF and other comorbidities.

Current Place of SGLT2i in the Management of Heart Failure: An Expert Opinion from India.

Heart failure (HF) is a global health concern that is prevalent in India as well. HF is reported at a younger age in Indian patients with comorbidity of type 2 diabetes (T2DM) in approximately 50% of patients. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), originally approved for T2DM, are new guideline-recommended and approved treatment strategies for HF. Extensive evidence highlights that SGLT2i exhibits profound cardiovascular (CV) benefits beyond glycemic control. SGLT2i, in conjunction with other guideline-directed medical therapies (GMDT), has additive effects in improving heart function and reducing adverse HF outcomes. The benefits of SGLT2i are across a spectrum of patients, with and without diabetes, suggesting their potential place in broader HF populations irrespective of ejection fraction (EF). This consensus builds on the updated evidence of the efficacy and safety of SGLT2i in HF and recommends its place in therapy with a focus on Indian patients with HF.

Role of Bisoprolol in Heart Failure Management: A Consensus Statement from India.

In India, heart failure (HF) is an important health concern affecting younger age groups than the western population. A limited number of Indian patients receive guideline-directed medical therapy (GDMT). Selective ß-1 blockers (BB) are one of the GDMTs in HF and play an important role by decreasing the sympathetic overdrive. The BB reduces heart rate (HR) reverse the adverse cardiac (both ventricular and atrial), vascular, and renovascular remodeling seen in HF. Bisoprolol, a ß-1 blocker, has several advantages and can be used across a wide spectrum of HF presentations and in patients with HF and comorbid conditions such as coronary artery disease (CAD), atrial fibrillation (AF), post-myocardial infarction (MI), uncontrolled diabetes, uncontrolled hypertension, and renal impairment. Despite its advantages, bisoprolol is not optimally utilized for managing HF in India. This consensus builds on updated evidence on the efficacy and safety of bisoprolol in HF and recommends its place in therapy with a focus on Indian patients with HF.

Can machine learning predict the accuracy of preoperative planning for total hip arthroplasty, basing on patient-related factors? An explorative investigation on Supervised machine learning classification models.

Background: The success of Total Hip Arthroplasty (THA) is influenced by preoperative planning, with traditional 2D approaches displaying varied reliability as well. The present study investigates the use of Supervised Machine Learning (SML) models with patient-related features to improve accuracy. Methods: Preoperative and perioperative data, as well as planning and final implant information, were obtained from 800 consecutive cementless primary THA, which was performed uniformly by a specialized surgical team. Six Supervised Machine Learning models were trained and validated using patient characteristics and implant data: Logistic Regression (LR), Linear Discriminant Analysis (LDA), K-Nearest Neighbors (KNN), Decision Tree (CART), Gaussian Naive Bayes (GN), and Support Vector Classifier (SVC). The models' ability to predict planning reliability and leg length disparity was evaluated. Results: KNN performed better on the cup model (97.9 %), femur model (96.7 %), and femur size (99.2 %). SVM emerged as the model with the highest accuracy for cup size (60.4 %) and head size (62.1 %). CART had the best accuracy (99 %) when determining leg length discrepancy. Conclusion: The study demonstrates the utility of Supervised Machine Learning models, specifically KNN, in predicting the accuracy of preoperative planning in THA. The accuracy of these models, which are driven by patient-related characteristics, provides useful information for optimizing patients' selection and improving surgical outcome.

Saturated and asymmetric saturated control for projective synchronization of inertial neural networks with delays and discontinuous activations through matrix measure method.

The projective synchronization work presented in this article is focused on a class of nonlinear discontinuous coupled inertial neural networks with mixed time-varying delays and a cluster topological structure. The synchronization problem for discontinuous coupled inertial neural networks with clustering topology is examined in consideration with the mismatched parameters and the mutual influence among various clusters. To determine the required conditions for network convergence under the influence of an extensive range of impulses, the matrix measure technique and the average impulsive intervals are employed. To illustrate the effectiveness of the theoretical findings, graphical representation of varied impulsive ranges for multiple cases are provided using numerical simulations.

Efficacy of Sagittal Split Fix Plates with Adjustable Slider for Intra-operative Identification and Correction of Condylar Sag in Sagittal Split Osteotomy-a Pilot Study.

Aim: To assess the efficacy of sagittal split plate with adjustable slider for intra-operative correction of condylar sag after bilateral sagittal split osteotomy. Subjects and Methods: Patients reporting for correction of mandibular skeletal deformities for correction with sagittal split osteotomy (SSRO) were enrolled in the study. Simple randomization method was followed for patient allocation. Patients in group A had undergone fixation sagittal split fix plates; in group B, miniplate fixation with monocortical screws was used. Occlusion was the key indicator of condylar sage that was checked at different time frames (intra-operatively T0, immediate T1, 6 months postoperatively T2). Preoperative, immediate and late postoperative (at 6 months and 1-year interval) and lateral cephalometric assessment was used to assess their stability. Results: Thirty-three patients were enrolled and 20 patients were included in the study. One patient of group A presented with central condylar sag that was identified intra-operatively and addressed immediately. All the patients in group B presented with type 2 peripheral condylar sag that was addressed by inter-maxillary elastics and orthodontics. Two patients in group A presented with mild degree of relapse at 6 months, which was comparable to the control group indicating good stability. Conclusion: Sagittal split plates appear to be efficacious for intra-operative identification and correction of condylar sag is associated with SSRO. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-022-01782-7.

Evaluation of Serum Metal Ion Levels in Dental Implant Patients: A Prospective Study.

Introduction: Titanium is the most commonly used bio-inert implant material. Nevertheless, there is a possibility of systemic release of metal ions, which could have clinical implications like implant failure and toxicity. This prospective study focuses on the evaluation of serum metal ion levels in patients receiving dental implants. The aim of the study is to evaluate the release of titanium, aluminium, and vanadium from dental implants by comparing the preoperative and postoperative serum levels of these ions. Methodology: Serum samples were collected from 30 patients undergoing dental implant placement preoperatively and postoperatively at intervals of 6 weeks, 3, 6, and 12 months. These samples were analyzed for titanium, aluminium, and vanadium levels using Inductively Coupled Plasma Optical Emission Spectrometry. The difference in preoperative and postoperative serum levels was measured and statistically analyzed using the paired t-test. Results: There was a slight difference in the postoperative levels of titanium and aluminium (2.30 and 4.07 mg/dl) as compared to the preoperative levels (2.28 and 2.30 mg/dl), which was statistically insignificant (P > 0.5). The serum levels of vanadium were too insignificant to be detected by the instrument (<0.0088 mg/dl). Discussion: Mild increase in the titanium and aluminium levels in blood serum was noted. These metallic ion levels might increase significantly due to which further clinical research with larger sample sizes and a long-term follow-up period is required to evaluate the clinical effects of metallic ion release from dental implants. There is no significant difference in the serum metal ion levels before and after the implant placement, although a little increase is observed in the aluminium ion levels after the implant placement.

Development of Screen-Printed Electrode Biosensor for Rapid Determination of Triglyceride Content in Coconut Milk.

The screen-printed electrode biosensor was developed for triglyceride determination in coconut milk. The biosensor was developed by adding lipase, glycerol-3-phosphate (GPO), and glycerol kinase (GK), which is immobilized to a gelatin solution. The concentration of triglyceride is found to be linear to the current produced. The developed screen-printed electrode biosensor showed the optimum response for pH 7.0, 45 mg amount of gelatin, 2.5% glutaraldehyde concentration solution. The developed biosensor was able to find triolein concentrations 0.1 to 1.5 mM. The correlation obtained between these two methods was 93% which was found to be good.

Malignant peripheral nerve sheath tumor of the thorax: Unusual location of a rare tumor.

Malignant peripheral nerve sheath tumor (MPNST) is a rare variety as sporadic tumor but more common when associated with neurofibromatosis, and its usual site of origin lies in the extremities. MPNST of thoracic cavity is a rare site of origin with only anecdotal reports in literature. Progression to a large size without distant metastases is even rarer owing to its high metastatic potential. We present a case of thoracic MPNST highlighting its rarity and the treatment options available to provide a best possible outcome.

Ultrasound as an Assessment Method in Predicting Difficult Intubation: A Prospective Clinical Study.

OBJECTIVE: Aim of the study is to predict the difficulty in intubation preoperatively using ultrasonography. METHODS: One hundred and thirty-seven patients underwent ultrasound followed by surgery under general anesthesia. A experienced radiologist examined the airway and performed measurements of specific airway parameters: visualization of hyoid bone, visualization of vocal cords through thyroid cartilage, visualization of epiglottis, distance from base of tongue to hyoid bone, distance of hyomental region distance of thyrohyoid region, distance between skin and fat pad thickness to thyroid cartilage, thickness of submental region, distance from epiglottis to skin (above hyoid), and visualization of cricothyroid membrane. After performing ultrasound, patient was presented for surgery. An experienced anesthesiologist who is associated with this study did all the laryngoscopy and intubation. RESULTS: We were able to visualize all relevant anatomical structures in all the participants using ultrasound. The receiver operating characteristic curve analysis results showed that hyomental is ≤ 1.09 (P value < 0.01) to classify difficult in intubation. CONCLUSION: The study shows that ultrasound can reliably image all the airway structures. This study suggests that hyomental distance is a more valid criterion in predicting difficult intubation. Further, case control study is needed for assessing the ease of intubation.

Electroporation as a tool to transfer the plasmid pRL489 in Oscillatoria MKU 277.

To establish the gene transfer system in the cyanobacteria, we successfully introduced the shuttle plasmid pRL489 into Oscillatoria MKU 277 by electroporation with transformation frequencies of up to 102 cfu/mug of plasmid DNA. These findings suggest that Oscillatoria MKU 277 can be used as an experimental tool for genetic maneuvering.

Infective endocarditis due to Acinetobacter baumannii complex--a case report.

We report a case of infective endocarditis caused by Acinetobacter baumannii complex in a 27-year-old male patient. The patient presented with fever of five days duration, palpitation, dyspnea, cough and chest pain. He had undergone a surgical repair of ruptured aneurysm of sinus of valsalva a month before. The transthoracic echocardiogram revealed a large vegetation on the aortic valve. Three samples of blood for culture grew gram-negative pleomorphic coccobacilli within 24 hours which were identified by cultural and biochemical characteristics to be Acinetobacter baumannii complex. Antimicrobial susceptibility was performed by Kirby-Bauer method and the isolate were found to be resistant to ampicillin, Ciprofloxacin, Ceftriaxone, Gentamicin, Amikacin, Augmentin, Levofloxacin, Piperacillin-Tazobactam, Netilimicin and sensitive to Imipenem. Patient was initially treated with Ceftraixone and Gentamicin and subsequently with Ampicillin and Amikacin but did not respond to treatment and died of sepsis before therapy with Imipenem could be started.

Preoperative and Postoperative CT Scan Assessment of Pterygomaxillary Junction in Patients Undergoing Le Fort I Osteotomy: Comparison of Pterygomaxillary Dysjunction Technique and Trimble Technique-A Pilot Study.

PURPOSE: To determine the rate of complications and occurrence of pterygoid plate fractures comparing two techniques of Le Fort I osteotomy i.e., Classic Pterygomaxillary Dysjunction technique and Trimble technique and to know whether the dimensions of pterygomaxillary junction [determined preoperatively by computed tomography (CT) scan] have any influence on pterygomaxillary separation achieved during surgery. MATERIALS AND METHODS: The study group consisted of eight South Indian patients with maxillary excess. A total of 16 sides were examined by CT. Preoperative CT was analyzed for all the patients. The thickness and width of the pterygomaxillary junction and the distance of the greater palatine canal from the pterygomaxillary junction was noted. Pterygomaxillary dysjunction was achieved by two techniques, the classic pterygomaxillary dysjunction technique (Group I) and Trimble technique (Group II). Patients were selected randomly and equally for both the techniques. Dysjunction was analyzed by postoperative CT. RESULTS: The average thickness of the pterygomaxillary junction on 16 sides was 4.5 ± 1.2 mm. Untoward pterygoid plate fractures occurred in Group I in 3 sides out of 8. In Trimble technique (Group II), no pterygoid plate fractures were noted. The average width of the pterygomaxillary junction was 7.8 ± 1.5 mm, distance of the greater palatine canal from pterygomaxillary junction was 7.4 ± 1.6 mm and the length of fusion of pterygomaxillary junction was 8.0 ± 1.9 mm. DISCUSSION: The Le Fort I osteotomy has become a standard procedure for correcting various dentofacial deformities. In an attempt to make Le Fort I osteotomy safer and avoid the problems associated with sectioning with an osteotome between the maxillary tuberosity and the pterygoid plates, Trimble suggested sectioning across the posterior aspect of the maxillary tuberosity itself. In our study, comparison between the classic pterygomaxillary dysjunction technique and the Trimble technique was made by using postoperative CT scan. It was found that unfavorable pterygoid plate fractures occurred only in dysjunction group and not in Trimble technique group. Preoperative CT scan assessment was done for all the patients to determine the dimension of the pterygomaxillary region. Preoperative CT scan proved to be helpful in not only determining the dimensions of the pterygomaxillary region but we also found out that thickness of the pterygomaxillary junction was an important parameter which may influence the separation at the pterygomaxillary region. CONCLUSION: No untoward fractures of the pterygoid plates were seen in Trimble technique (Group II) which makes it a safer technique than classic dysjunction technique. It was noted that pterygoid plate fractures occurred in patients in whom the thickness of the pterygomaxillary junction was <3.6 mm (preoperatively). Therefore, preoperative evaluation is important, on the basis of which we can decide upon the technique to be selected for safer and acceptable separation of pterygomaxillary region.

Biotypes of group A streptococci isolated from children.

Thirty-eight isolates of group A streptococci from patients with pharyngitis, 13 isolates from patients with pyoderma and 28 carrier strains were subjected to biotyping by carbohydrate fermentation tests and production of beta-glucuronidase. Biotype 10 was observed most frequently among clinical isolates and biotypes 3 and 4 were most common among carrier isolates.

Group A streptococcal infections of the pharynx in a rural population in south India.

BACKGROUND & OBJECTIVES: There has been a resurgence in the incidence of rheumatic heart disease all over the world and hence surveillance and strain characterization are important. The aim of this study was to screen children in a rural community in south India for throat carriage of group A streptococci and to clinically assess them for signs of rheumatic heart disease. METHODS: Throat swabs were collected from children (5-14 yr) in the village of Orathur, Tamil Nadu and cultured on tryptose blood agar plates. Beta haemolytic streptococci were serogrouped using Streptex kit and biotyped based on their ability to ferment carbohydrates and production of beta-glucuronidase enzyme. Blood samples were also collected and antibodies to streptolysin O demonstrated by latex agglutination tests. All the children were examined by a paediatrician; ECG and echocardiography were performed to assess cardiac function. RESULTS: Eighty of the 310 children included in the study had symptoms of acute respiratory infections; 16 of them grew beta haemolytic streptococci of which 8 belonged to group A (10%). Biotype 4 was most common. Antistreptolysin O (ASO) test did not correlate with culture results. Two of 310 children had rheumatic heart disease but both were culture negative. INTERPRETATION & CONCLUSION: Pharyngeal carriage of group A streptococci was common in this population. The prevalence of rheumatic heart disease was 0.6 per cent. The study emphasizes the need for active surveillance and characterization of GAS isolates.

Rapid discrimination between strains of beta haemolytic streptococci by intact cell mass spectrometry.

BACKGROUND & OBJECTIVES: Beta haemolytic streptococci belonging to Lancefield group A, B, C and G cause a wide spectrum of clinical diseases. Hence there is a need for rapid and accurate typing of these strains. The present study was undertaken to evaluate the use of intact cell matrix assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) for rapid discrimination between strains of beta haemolytic streptococci. METHODS: Colonies of beta haemolytic streptococci were emulsified with chemical matrix on the sample slide, dried and analyzed by MALDI-TOF-MS. RESULTS: The reproducibility of results for all groups of beta haemolytic streptococci was good and spectra obtained for Lancefield group A, C and G streptococci showed discrimination between the groups on visual comparison. A finer difference in spectrum was observed among group A streptococci isolated from different locations at different periods of time. INTERPRETATION & CONCLUSION: MALDI-TOF-MS may be a potential tool in discriminating between strains of beta haemolytic streptococci, and also in the characterisation of untypable strains of group A streptococci.

Familial primary pulmonary hypertension.

Primary pulmonary hypertension is a rare disease affecting mostly females. We report a family where 2 of the 3 male children born to consanguineous parents had severe pulmonary hypertension of unexplained cause. The occurrence of overtly manifest primary pulmonary hypertension is rare in males, especially at an early age.

5-fluorouracil-Induced cardiotoxicity.

Cardiotoxicity due to antineoplastic agents such as doxorubicin, daunorubicin, cyclophosphamide, vincristin, vinblastin, cisplatin and busulfan is well known. However, 5-fluorouracil-induced cardiotoxicity is yet to be widely recognized by cardiologists. We report a patient who developed 5-fluorouracil-induced cardiotoxicity syndrome.

Tolerance of Oscillatoria isolates to agrochemicals and pyrethroid components.

Four isolates of Oscillatoria sp from an Indian paddy field have been tested for their tolerance to agrochemicals and pyrethroid components. The isolates possessed considerable tolerance to agrochemicals and reduced toxicity of pyrethroid components towards fish.