FIGO 2023 endometrial staging: a leap of faith into the new "prognostic based' rather than "anatomical based" staging-too fast too furious??

BACKGROUND: In 2023 FIGO revised the endometrial cancer staging system after 13 years. There is a lacuna of data regarding the performance and practicality of the revised 2023 FIGO staging schema for endometrial cancer from Low Middle-Income Countries (LMIC). OBJECTIVE: To estimate the shift of stage and adjuvant management of endometrial cancer based on the FIGO 2023 system compared to the FIGO 2009 system and assess the predictive potential of the FIGO 2023 system. MATERIAL AND METHODS: A retrospective study was conducted from 1st January 2017 to 31st December 2022. All patients with endometrial cancer were staged according to the FIGO 2023 and FIGO 2009 staging system. Follow-up of patients was done to determine recurrence. RESULTS: A total of 152 patients were included. Aggressive histology was seen in 66 (45%) patients. Eighteen (11%) had subserosal involvement. Substantial LVSI was noted in 23 (15%) of patients. Twenty-four (47%) patients of FIGO 2009 Stage IA and 26 patients (63%) of FIGO 2009 Stage IB were upstaged. Eleven (50%) patients of FIGO 2009 Stage IIIA were down staged to IA3. Overall 23 patients (15%) had a shift of stage. Fifteen out of 152 patients (15%) would have had a possible risk stratification change which would imply 23 patients (15%) would have needed a more radical treatment. Molecular classification was done in 32 patients; however, only 2 patients could afford POLE testing. Kaplan-Meier curves showed significant PFS differences in FIGO 2009 Stage IB and Stage IIIA when restaged according to the FIGO 2023 system. CONCLUSION: The FIGO 2023 endometrial staging is a more robust prognosticator; however, the practicality of molecular classification in LMICs is still a distant dream.

NCCP-ICS joint consensus-based clinical practice guidelines on medical thoracoscopy.

ABSTRACT: Medical Thoracoscopy (MT) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. The aim of the study was to provide evidence-based information regarding all aspects of MT, both as a diagnostic tool and therapeutic aid for pulmonologists across India. The consensus-based guidelines were formulated based on a multistep process using a set of 31 questions. A systematic search of published randomized controlled clinical trials, open labelled studies, case reports and guidelines from electronic databases, like PubMed, EmBase and Cochrane, was performed. The modified grade system was used (1, 2, 3 or usual practice point) to classify the quality of available evidence. Then, a multitude of factors were taken into account, such as volume of evidence, applicability and practicality for implementation to the target population and then strength of recommendation was finalized. MT helps to improve diagnosis and patient management, with reduced risk of post procedure complications. Trainees should perform at least 20 medical thoracoscopy procedures. The diagnostic yield of both rigid and semirigid techniques is comparable. Sterile-graded talc is the ideal agent for chemical pleurodesis. The consensus statement will help pulmonologists to adopt best evidence-based practices during MT for diagnostic and therapeutic purposes.

To study the survival outcomes of uncommon recurrences among patients with cervical cancer compared with loco-regional and nodal recurrences at a tertiary care center in North East India - Bridging the knowledge gap in the existing literature.

Background: Recurrence rates of FIGO stage IB-IIA and IIB-IVA cervical cancer  28-64  respectively. There is a scarcity of data on the recurrence recurrence pattern for unusual sites and theirrecurrence pattern for unusual sites and its association with survival and prognosis. Objective: To study overall survival in patients with distant metastasis compared to local and regional nodal metastasis. Methods: A retrospective study was done from 1/1/2017 to 30/12/22. Cervical cancer patients post primary treatments were included. Survival was analyzed with respect to 3 groups local, regional nodalconducted from 1/1/2017 to 30/12/22. Cervical cancer patients who had received primary post-primary treatments were included. Survival was analyzed with respect to three groups: local, regional nodal, and distant metastasis. Results: 225 patients had recurrences   post-completion of primary treatment, of which 105 (46.6%)(46.6 %) had local, 46 (20.4%)(20.4 %) had regional nodal, and 74 (33.3 %) had distant recurrences. The median time for recurrence in local, regional nodal, and atypical recurrences were 9, 9, and 13 months (p value - <0.05), respectively. Treatment included systemic chemotherapy 122 (54.2 %), metronomic therapy 19 (8.4 %), palliative radiotherapy 44 (19.5 %), palliative surgery 8 (3.5 %) and best supportive care 30 (13.3 %) patients. Median Time to treatment-death of patients after recurrence in local, nodal and distant recurrences was 17.0 months, 18.0 months and 10.0 months respectively (p value - < 0.05). Overall Survival of patients after primary treatment with local, nodal and distant recurrences was 35.0 months, 47.0 months and 50.0 months respectively (p value <0.05). Conclusion: Local recurrence is most common, followed by regional, nodal, and distant recurrences. Overall survival post recurrence was lowest for distant recurrences and highest for local recurrences however overall survival after primary treatment completion was highest for distant recurrence due to the late presen; however, tation of distant recurrences.

A Case Report of Caudal Migration of a Lumbar Epidural Catheter Confirmed by Doppler Ultrasound: Ultrasound to the Rescue!

Combined spinal-epidural anaesthesia is an excellent technique for providing intraoperative and postoperative analgesia in patients undergoing total knee arthroplasty. Epidural catheters threaded through a Tuohy needle with a cephalad needle bevel orientation follow a winding pattern within the epidural space. Caudal or downward migration of an epidural catheter may lead to unsatisfactory anaesthesia and epidural failure. Colour flow Doppler sonography is emerging as an effective technique to determine the epidural catheter tip position. We report an interesting case of caudal migration of a lumbar epidural catheter confirmed by colour flow Doppler ultrasound.

Cardiovascular risk assessment in inflammatory bowel disease with coronary calcium score.

The interplay between inflammatory bowel disease (IBD) and atherosclerotic cardiovascular disease (ASCVD) underscores the intricate connections between chronic inflammation and cardiovascular health. This review explores the multifaceted relationship between these conditions, highlighting the emerging significance of the coronary calcium score as a pivotal tool in risk assessment and management. Chronic inflammation, a hallmark of IBD, has far-reaching systemic effects that extend to the cardiovascular system. Shared risk factors and mechanisms, such as endothelial dysfunction, lipid dysfunction, and microbiome dysregulation, contribute to the elevated ASCVD risk observed in individuals with IBD. Amidst this landscape, the coronary calcium score emerges as a means to quantify calcified plaque within coronary arteries, offering insights into atherosclerotic burden and potential risk stratification. The integration of the coronary calcium score refines cardiovascular risk assessment, enabling tailored preventive strategies for individuals with IBD. By identifying those at elevated risk, healthcare providers can guide interventions, fostering informed shared decision-making. Research gaps persist, prompting further investigation into mechanisms linking IBD and ASCVD, particularly in the context of intermediate mechanisms and early atherosclerotic changes. The potential of the coronary calcium score extends beyond risk assessment-it holds promise for targeted interventions. Randomized trials exploring the impact of IBD-modifying therapies on ASCVD risk reduction can revolutionize preventive strategies. As precision medicine gains prominence, the coronary calcium score becomes a beacon of insight, illuminating the path toward personalized cardiovascular care for individuals living with IBD. Through interdisciplinary collaboration and rigorous research, we embark on a journey to transform the paradigm of preventive medicine and enhance the well-being of this patient population.

A Remarkable Case of Acute Stroke Unveiling Congenitally Corrected Transposition of Great Arteries.

Acute stroke and the transposition of great arteries are two distinct medical entities that rarely intersect in clinical practice. Acute stroke, a devastating neurological event, occurs due to a sudden interruption of blood flow to the brain, leading to focal neurological deficits. On the other hand, the transposition of great arteries is a congenital heart defect characterized by a complete reversal of the aorta and pulmonary artery, resulting in abnormal blood circulation. Traditionally, transposition of great arteries is diagnosed in infancy and managed with surgical interventions. However, instances of this condition being discovered in adulthood are exceedingly rare. We present the case of a 35-year-old male who presented to the emergency department with acute stroke symptoms such as sudden-onset left-sided weakness and speech difficulties. Upon further investigation, we uncovered an unexpected finding of congenitally corrected transposition of great arteries, a congenital heart defect usually diagnosed in infancy. The patient's medical history was unremarkable for cardiovascular issues, making this association even more intriguing. The clinical course of the patient involved immediate management of the acute stroke, followed by comprehensive cardiac evaluations to assess the implications of the transposition of great arteries. Cardiac imaging revealed anatomical variations and hemodynamic consequences, prompting a multidisciplinary approach to address both conditions.

Impact of Anti-nuclear Antibody Seropositivity on Clinicopathological Parameters, Treatment Response, and Survival in Lymphoma Patients.

PURPOSE: Lymphoproliferative disorders and autoimmune diseases both are interrelated. The high incidence of lymphoma in autoimmune diseases and frequent antinuclear antibody (ANA) positivity in lymphoma patients have been observed. But the impact of ANA positivity on various clinical parameters and responses to therapy has not been elucidated properly. METHODS: In the present study, 73 treatment-naive lymphoma patients were recruited prospectively and samples were collected at baseline and after completion of therapy for evaluation of ANA. Comparative analysis was performed for various parameters between ANA-positive and ANA-negative groups. RESULTS: The prevalence of ANA at baseline was 27% in lymphoma patients which further increased to 35% after chemotherapy. The ANA-positive group had a significantly higher mean age (58±14.7 vs 47±19.9; p=0.01), early stage (77% vs 38%; p=0.02,) and infrequent B-symptoms (25% vs 52%; p=0.03) as compared to ANA-negative group. No significant difference was observed in the response to therapy and survival (both event-free and overall survival). The most frequent ANA pattern was speckled (50%) at baseline, and homogenous (42%) after the therapy. CONCLUSION: ANA is more frequent in lymphoma and increases further after chemotherapy. Higher mean age, early stage, and infrequent B symptoms were found to be significantly more frequent in ANA-positive lymphoma patients; however, only limited evidence supports its role as a prognostic marker or response to therapy. A wider study with appropriate follow-up data and molecular assay could shed light on the immunobiology of ANA production and its more defined clinical utility in lymphoma.

Overlapping Phenotypes of Alcoholic Cardiomyopathy and Left Ventricular Non-compaction: A Case Report and Discussion of Converging Cardiomyopathies.

Left ventricular non-compaction cardiomyopathy, often known as LVNC, is a form of congenital cardiomyopathy that is extremely uncommon. It is a condition that may be identified by an elevated number of endomyocardial trabeculations as well as an increase in their prominence. Alcoholic cardiomyopathy, also known as ACM, is a non-ischemic form of dilated cardiomyopathy that is characterized by contractile failure and an enlargement of the heart ventricles. It is not entirely known whether or not there is a clinically significant overlap in phenotypic characteristics between the two illnesses. We report a patient who had previously been diagnosed with ACM and who had cardiac MRI results that fit the criteria for both LVNC and ACM.

Osteoporosis in Asthma and COPD.

Asthma and Chronic Obstructive Pulmonary Disease (COPD) are principally lifestyle related chronic inflammatory airway disease. They are globally associated with various systemic comorbidities and mortality. Osteoporosis is the common associated metabolic bone disease with respiratory disturbances, which affect the prognosis and increase mortality and morbidity in the patients. Apart from OSTEOPOROSIS, exhaustive attention has been paid towards other associated systemic comorbidities like cardiovascular diseases, cerebrovascular diseases, metabolic syndrome, malnutrition, skeletal muscle dysfunction (sarcopenia), anxiety, depression and so on (Iheanacho et al. in Int J Chronic Obstr Pulm Dis 15:439-460, 2020; Singh et al. in Eur Respir J 53:1900164, 2019). Osteoporosis is a significant extrapulmonary manifestation in asthma and COPD, which are grossly neglected and inadequately treated. The comorbidities have significant impact in terms of morbidity, mortality and economic burden in asthma and COPD patients, hence management of asthma and COPD should comprise thorough management, as this will also have an impact on the outcome of these patients. Various risk factors such as smoking, systemic inflammation, vitamin deficiency, and the use of oral or inhaled corticosteroid are responsible for osteoporosis in patients with asthma and COPD. The presence of osteoporosis in patients with asthma and COPD is invariably asymptomatic unless complicated by fragility fractures, therefore, it is necessary to explore the pathogenesis of osteoporosis in asthma and COPD and special attention is to be paid for early recognition of patients at high risk for osteoporosis in these patients. This chapter is focussed on osteoporosis as an extrapulmonary manifestation of asthma and COPD with an emphasis on the pathogenesis, risk factor, potential mechanism of osteoporosis, diagnosis, and prevention with passing reference to treatment as well in asthma and COPD patients.

Advancements in the Management of Endocrine System Disorders and Arrhythmias: A Comprehensive Narrative Review.

In recent years, notable advancements have been made in managing endocrine system disorders and arrhythmias. These advancements have brought about significant changes in healthcare providers' approach towards these complex medical conditions. Endocrine system disorders encompass a diverse range of conditions, including but not limited to diabetes mellitus, thyroid dysfunction, and adrenal disorders. Significant advancements in comprehending the molecular underpinnings of these disorders have laid the foundation for implementing personalized medicine. Advancements in genomic profiling and biomarker identification have facilitated achieving more accurate diagnoses and developing customized treatment plans. Furthermore, the utilization of cutting-edge pharmaceuticals and advanced delivery systems presents a significant advancement in achieving enhanced glycemic control and minimizing adverse effects for individuals afflicted with endocrine disorders. Arrhythmias, characterized by irregular heart rhythms, present a substantial risk to cardiovascular well-being. Innovative strategies for managing arrhythmia encompass catheter-based ablation techniques, wearable cardiac monitoring devices, and predictive algorithms powered by artificial intelligence. These advancements facilitate the early detection, stratification of risks, and implementation of targeted interventions, ultimately leading to improved patient outcomes. Incorporating technology and telemedicine has been instrumental in enhancing the accessibility and continuity of care for individuals diagnosed with endocrine disorders and arrhythmias. The utilization of remote patient monitoring and telehealth consultations enables prompt modifications to treatment regimens and alleviates the need for frequent visits to the clinic. This is particularly significant in light of the current global health crisis. This review highlights the interdisciplinary nature of managing endocrine disorders and arrhythmias, underscoring the significance of collaboration among endocrinologists, cardiologists, electrophysiologists, and other healthcare professionals. Multidisciplinary care teams have enhanced their capabilities to effectively address the intricate relationship between the endocrine and cardiovascular systems. In summary, endocrine system disorders and arrhythmias management have undergone significant advancements due to groundbreaking research, technological advancements, and collaborative healthcare approaches. This narrative review provides a comprehensive overview of the advancements, showcasing their potential to enhance patient care, improve quality of life, and decrease healthcare expenses. Healthcare providers must comprehend and integrate these advancements into their clinical practice to enhance outcomes for individuals with endocrine system disorders and arrhythmias.

Revolutionizing Cardiac Care: A Comprehensive Narrative Review of Cardiac Rehabilitation and the Evolution of Cardiovascular Medicine.

Cardiovascular disease (CVD) stands as a global health crisis, with its complex web of conditions, including coronary artery disease, heart failure, hypertension, and stroke, continuing to exact a heavy toll on individuals and healthcare systems worldwide. Despite substantial advances in medical technology and pharmaceutical interventions, CVD remains a formidable adversary, necessitating innovative prevention, management, and rehabilitation approaches. In tracing the historical trajectory of CVD, the narrative reveals the antiquated practices of early 20th-century medicine, marked by extended bed rest as the primary modality for heart-related conditions. It underscores the critical juncture when exercise was first recognized as a therapeutic tool for cardiac health, setting the stage for the evolution of cardiac rehabilitation (CR). CR programs have transcended their initial focus on exercise, expanding to encompass dietary guidance, psychosocial support, and comprehensive risk factor modification. These holistic interventions enhance physical recovery and address the psychosocial and lifestyle aspects of CVD management, ultimately improving patients' overall well-being. CR programs increasingly leverage advanced technologies and personalized strategies to tailor interventions to individual patient needs, ultimately enhancing outcomes and reducing the burden of CVD. In conclusion, this narrative review illuminates the transformative journey of cardiac care, with a particular spotlight on the indispensable role of CR in reshaping the landscape of cardiovascular medicine. By evolving from historical practices to comprehensive, patient-centered interventions, CR has made significant strides in improving the prognosis, quality of life, and holistic well-being of individuals grappling with the complexities of CVD. Understanding this historical context and the contemporary advancements is paramount for healthcare professionals and policymakers as they navigate the intricate terrain of cardiovascular medicine and endeavor to mitigate the impact of this pervasive disease.

Heart Failure With Preserved Ejection Fraction: An Evolving Understanding.

Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome in which patients have signs and symptoms of HF due to high left ventricular (LV) filling pressure despite normal or near normal LV ejection fraction. It is more common than HF with reduced ejection fraction (HFrEF), and its diagnosis and treatment are more challenging than HFrEF. Although hypertension is the primary risk factor, coronary artery disease and other comorbidities, such as atrial fibrillation (AF), diabetes, chronic kidney disease (CKD), and obesity, also play an essential role in its formation. This review summarizes current knowledge about HFpEF, its pathophysiology, clinical presentation, diagnostic challenges, current treatments, and promising novel treatments. It is essential to continue to be updated on the latest treatments for HFpEF so that patients always receive the most therapeutic treatments. The use of GnRH agonists in the management of HFpEF, infusion of Apo a-I nanoparticle, low-level transcutaneous vagal stimulation (LLTS), and estrogen only in post-menopausal women are promising strategies to prevent diastolic dysfunction and HFpEF; however, there is still no proven curative treatment for HFpEF yet.

The Bidirectional Link Between Diabetes and Kidney Disease: Mechanisms and Management.

The complex and mutually influential connection between diabetes mellitus and chronic kidney disease (CKD) is a significant focal point in the current healthcare landscape. Diabetes, a medical condition characterized by elevated blood glucose levels resulting from impaired insulin action or secretion, has become a significant global epidemic. It poses considerable challenges to healthcare systems and affects millions of individuals worldwide. Concurrently, CKD, characterized by the gradual decline of kidney function, has become a persistent health challenge. This narrative review explores the complex relationship between these two conditions, shedding light on their significant implications for public health, clinical practice, and biomedical research. The correlation between diabetes and kidney disease is not merely coincidental. Diabetes is recognized as a significant risk factor for CKD, as individuals with diabetes are considerably more vulnerable to developing renal complications. Diabetic nephropathy, a distinct type of kidney disease closely associated with diabetes, is a significant factor in developing end-stage renal disease. It is imperative to implement efficient diabetes management strategies to regulate blood sugar levels and prevent potential kidney damage. On the other hand, kidney disease may contribute to the development of diabetes. The kidneys regulate glucose levels by filtering the blood and selectively reabsorbing glucose as necessary. In compromised kidney function, such as CKD, impaired glucose metabolism can give rise to insulin resistance and diabetes. As a result, the management of kidney disease plays a dual role in both preserving renal function and preventing diabetes in individuals who are at risk. The coexistence of diabetes and kidney disease in a patient presents complex clinical challenges. Achieving effective management requires a meticulous balance between glycemic control and preservation of renal function. Failing to maintain this delicate equilibrium can lead to cardiovascular complications and subsequent hospitalizations. This comprehensive narrative review aims to thoroughly examine the pathophysiological mechanisms that connect diabetes and kidney disease. It will provide insights into the clinical manifestations and diagnostic methods, explore various approaches to managing the condition, discuss the crucial role of nutrition, delve into pharmacological interventions, emphasize the importance of patient education and self-care, and shed light on emerging research areas. In addition to impacting individual health outcomes, this reciprocal relationship has significant implications for healthcare systems, socioeconomic landscapes, and public health policy. Comprehending this complex interaction is crucial for making well-informed clinical judgments, improving patient care, and developing a more efficient public health approach to address the interconnected issues of diabetes and kidney disease.

Sex differences in cognitive function among people with HIV-1 clade C infection in Northern India.

Human immunodeficiency virus-1 (HIV-1) clade C is the most prevalent form of HIV-1 comprising nearly 46% of global infections and is the dominant subtype in India. Despite its predominance, the impact of HIV-1 clade C infection on cognitive function has been understudied in comparison with other subtypes, notably clade B, which is primarily found in Europe and North America. Few studies have assessed cognitive impairment in antiretroviral therapy (ART) naïve men and women with HIV-1 clade C infection. In this study conducted in Northern India, differences in neuropsychological functioning were compared between 109 participants (70 men, 39 women) with untreated HIV-1 clade C infection and 110 demographically matched healthy controls (74 men, 36 women). A comprehensive neuropsychological battery was used to examine depression, self-assessment of functioning, and cognitive performance in six domains of functioning. Group differences were assessed by HIV-1 status and sex, controlling for age and education. Results indicated that cognitive deficits were substantially greater among male participants with HIV-1 clade C compared to male controls in all domains of cognitive functioning; in contrast, women with HIV-1 clade C had only minor deficits compared to healthy female participants. In addition, a larger proportion of men with HIV-1 clade C exhibited high levels of depression than women with HIV-1 clade C. These findings suggest that untreated HIV-1 clade C infection in men can have debilitating effects on neuropsychological function and depression, and stress the importance of facilitating rapid access to treatment to reduce the impact of HIV-1 infection.

Endovascular management of traumatic pseudoaneurysm of left subclavian artery: A case report.

We present a case report of a 20-year-old male who suffered a stab injury to the left supraclavicular region, resulting in the formation of a pseudoaneurysm of the left subclavian artery. Initial endovascular management with a self-expandable covered stent graft showed promising results, but recurrence with proximal and distal end leaks necessitated further intervention. The patient's financial constraints delayed subsequent treatment, leading to worsening symptoms, including left upper limb paraparesis. Facing technical challenges due to the large size of the aneurysm and proximity to the vertebral artery, a vertebral artery confluence was performed, followed by a longer stent-graft placement to address the pseudoaneurysm successfully. This case highlights the potential advantages of endovascular approaches in complex subclavian artery injuries and emphasizes the importance of timely intervention to avoid complications and improve patient outcomes.

A tertiary care study to assess the effectiveness of 'Supplement adherence kit' on intake of nutritional supplements among pregnant women.

Background: An antenatal mother undergoes significant changes throughout pregnancy and most of which occur during the second trimester. Supplements are important for normal growth and development of fetus, Deficiency of supplements during pregnancy leads to anemia and can have a negative impact on perinatal and maternal outcomes. These complications can be prevented by supplementing needed vitamins and minerals. Method: A Quasi-experimental study was conducted on 137 subjects visiting gynecology OPD enrolled by total enumerative sampling technique. Hemoglobin level and the adherence of supplements were assessed during the second trimester of antenatal mothers in both the groups. Results: Adherence of supplements has increased significantly (p value = 0.005, 0.004, and 0.040 for iron, folic acid, and calcium, respectively) among subjects in the experimental group. Results of SMAQ shows that there is increase in adherent mothers from 33.3% to 71.2% experimental group. Conclusion: Supplement adherence kit was effective in increasing supplement adherence level along with an improvement in hemoglobin levels among antenatal mothers in the Experimental group.

Circulating "Neutrophils extra-cellular traps" during the early post-renal transplant period and correlation with graft dysfunction and rejection.

BACKGROUND: Neutrophil extracellular traps (NETs) have a role in infection, autoimmunity, autoinflammation, thrombosis, ischemia-reperfusion injury (IRI), epithelial-mesenchymal transition, vasculitis, and metabolic diseases. However, its role in early graft injury and graft outcome has not been elucidated till now. We evaluated the circulating NETs during early post-transplant periods and their correlation with graft outcome and IRI. METHODS: Prospectively, thirty kidney transplants recipient (KTR) were recruited and grouped into non-dysfunction (Group-A) and dysfunction groups (Group-B). Serum levels of circulating NETs were estimated by measuring myeloperoxidase-DNA complex at three-time points: pre-transplant, 8 h post-transplant, and 18 h post-transplant; and correlated with early graft outcome. Malondialdehyde (MDA), a marker of oxidative stress or IRI, was also measured to assess its relation with NETs and early graft outcome. RESULTS: Circulating NETs were significantly increased in both non-dysfunctional [Median OD: 0.11 (0.01-0.19) to 0.51 (0.22-0.91); p = 0.001] and dysfunctional [Median OD: 0.16 (0.12-0.27) to 0.38 (0.19-0.68); p = 0.047] KTR during first 8 h of transplant followed by fall at 18 h post-transplant [0.25 (0.18-0.72) and 0.35 (0.26-0.36) respectively]; however, no significant difference were observed between two groups at any time points. Isolated biopsy-proven graft rejection KTR also had higher circulating NETs during the early post-transplant period [Median OD: 0.16 (0.13-0.31) to 0.38 (0.28-1.5); p > 0.05] but no significant difference compared to non-dysfunctional KTR. MDA also displayed similar trends with an early significant rise [9.30 (7.74-12.56) µM to 17.37 (9.11-22.25) µM; p = 0.03 in group-A, and 8.7 (6.04-10.30) µM to 14.66 (13.39-21.63) µM; p = 0.01in group-B] followed by fall at 18 h in both groups [10.21 (7.64-13.90) µM and 11.11 (9.15-17.54) µM respectively]. Despite similar trends of both NETs and MDA, there was no significant correlation between these; however, creatinine exhibits a significant inverse correlation with NETs and MDA both. CONCLUSION: Circulating NETs are significantly increased during the early post-transplant period in KTR irrespective of early graft outcome. Similar dynamics of MDA indicate that the early rise of NETs might be a part of IRI. However, molecular studies with large sample sizes and longer follow up are required to reach more defined conclusions.

Risk factors for pulmonary mucormycosis in subjects with diabetes mellitus-A case-control study.

BACKGROUND: Factors associated with pulmonary mucormycosis (PM) among subjects with diabetes mellitus (DM) remain unclear. Following the coronavirus disease (COVID-19)-associated mucormycosis outbreak in India, specific environmental exposures (especially cattle dung exposure) were proposed as possible aetiology. We hypothesized that environmental factors are associated with PM. We compared subjects with DM with (cases) and without PM (controls). METHODS: In this case-control study, for each PM case, we included five unmatched diabetic controls (hospital [n = 2], community [n = 3]) without PM. We collected information on demography, COVID-19 infection, glycated haemoglobin% (HbA1c), the type of house (pucca vs. kutcha) where the participants reside, and other environmental factors. The primary exposure tested was cattle dung exposure (CDE; using cattle dung cakes as fuel or cattle handling). We performed a multivariate logistic regression to explore factors associated with PM and report the association as an adjusted odds ratio (OR) with 95% confidence intervals (CI). RESULTS: We enrolled 39 PM cases and 199 controls (hospital [n = 80], community [n = 119]). CDE (OR 0.68, 95% CI [0.14-3.31]; p = 0.63) was not associated with increased PM in DM. We found male sex (OR 4.07, 95% CI [1.16-14.31]), higher HbA1c (OR 1.51, 95% CI [1.18-16.32]), COVID-19 (OR 28.25, 95% CI [7.02-113.6]) and residence at kutcha house (OR 4.84, 95% CI [1.33-17.52]) associated with PM. CONCLUSION: Cattle dung exposure was not associated with PM in subjects with DM. Instead, male sex, poor glycaemic control, COVID-19 and the type of housing were associated with pulmonary mucormycosis.

Modified Whale Optimization Algorithm based ANN: a novel predictive model for RO desalination plant.

In recent decades, nature-inspired optimization methods have played a critical role in helping industrial plant designers to find superior solutions for process parameters. According to the literature, such methods are simple, quick, and indispensable for saving time, money, and energy. In this regard, the Modified Whale Optimization Algorithm (MWOA) hybridized with Artificial Neural Networks (ANN) has been employed in the Reverse Osmosis (RO) desalination plant performance to estimate the permeate flux (0.118‒2.656 L/h m2). The plant's datasets have been collected from the literature and include four input parameters: feed flow rate (400‒600 L/h), evaporator inlet temperature (60‒80 °C), feed salt concentration (35‒140 g/L) and condenser inlet temperature (20‒30 °C). For this purpose, ten predictive models (MWOA-ANN Model-1 to Model-10) have been proposed, which are capable of predicting more accurate permeate flux (L/h m2) than the existing models (Response Surface Methodology (RSM), ANN and hybrid WOA-ANN models) with minimum errors. Simulation results suggest that the MWOA algorithm demonstrates a stronger optimization capability of finding the correct weights and biases so as to enable superior ANN based modeling without limitation of overfitting. Ten MWOA-ANN models (Model-1 to Model-10) have been proposed to investigate the plant's performance. Model-6 with a single hidden layer (H = 1), eleven hidden layer nodes (n = 11) and the thirteen search agents (SA = 13) produced most outstanding regression results (R2 = 99.1%) with minimal errors (MSE = 0.005). The residual errors for Model-6 are also found to be within limits (span of - 0.1 to 0.2). Finally, the findings show that the screened MWOA-ANN models are promising for identifying the best process parameters in order to assist industrial plant designers.

Novel Flow Cytometry-Based Method for Detection of Anti-HLA Complement Activating Donor-Specific Antibodies in Renal Transplant Recipients and Its Comparison With Other Conventional Detection Methods.

BACKGROUND: Presence of preformed donor specific antibodies (DSAs) detected by complement-dependent cytotoxicity (CDC-XM) is a strong contraindication for transplant. However, it has limitations including its sensitivity and its inability to distinguish between HLA-specific and other non-HLA-specific antibodies. In this study, we standardized CDC-XM by flow cytometry and determined its relevance by comparing its results with other methods of DSA detection, such as routine CDC-XM, antibody binding assay by flow cytometry (FC-XM), and Luminex-based crossmatch assays, such as Luminex crossmatch (LXM) and virtual crossmatch (VXM). MATERIALS AND METHODS: A total of 79 serum samples were tested for DSAs by the flow cytometric complement-dependent cytotoxicity crossmatch assay (FC-CDC-XM) and then the results of FC-CDC-XM were compared with other detection methods such as CDC-XM, FC-XM, LXM, and VXM. RESULTS: We found that the FC-CDC-XM assay is more sensitive than routine CDC-XM. Out of total 79 sera, 24 sera were detected positive (T cells positive: 1 case and B cells positive: 23) by FC-CDC-XM as compared with 3 sera using CDC-XM; these 3 sera also showed positivity by FC-CDC-XM. After FC-XM assay, 23 samples were positive by FC-XM and out of these 23 samples, 13 were also positive by FC-CDC-XM. On comparing the FC-CDC-XM results with VXM and LXM, 10 sera of 24 FC-CDC-XM positive had HLA class II antibodies detected on a Luminex platform. CONCLUSIONS: The FC-CDC-XM is a more sensitive and specific method for detection of HLA-specific complement-fixing antibodies than CDC-XM and FC-XM. FC-CDC-XM should be used in tissue-typing laboratories after intra- and inter- laboratory validation.