Evolving Advances in the Applications of Carbon Nanotubes (CNTs) for Management of Rheumatoid Arthritis (RA).

Rheumatoid arthritis (RA) is a chronic condition causing joint pain and inflammation that has now spurred the interest in nanotechnology-based drug delivery for more effective treatment, and in this regard, carbon nanotubes (CNTs) are being explored for their potential to deliver the drugs steadily to manage the RA. Many investigators have been investigating both single-walled carbon nanotubes (SWCNT) as well as multi-walled carbon nanotubes (MWCNT) for managing arthritis via targeted drug delivery. Moreover, functionalized CNTs show promise in delivering the drugs precisely and in a controlled manner, thereby minimizing toxicity. However, research on applications of CNTs as drug carriers for RA remains limited, thus necessitating further exploration to address the various challenges. In this present piece of writing, challenges in RA treatment and the advances in applications of CNTs for RA management are reported, consequently reflecting the CNTs as advanced drug delivery vehicles for arthritis treatment.

Safety and feasibility of pulmonary rehabilitation in patients hospitalized with post-COVID-19 fibrosis: A feasibility study.

BACKGROUND: Emerging data suggest a spectrum of pulmonary complications from COVID-19, ranging from dyspnea to difficult ventilator weaning and fibrotic lung damage. Prolonged hospitalization is known to significantly affect activity levels, impair muscle strength and reduce cardiopulmonary endurance. OBJECTIVE: To assess the feasibility and safety of inpatient pulmonary rehabilitation (PR) and to explore effects on functional capacity, physical performance, fatigue levels, and functional status. DESIGN: A prospective feasibility study. SETTING: Inpatient unit of a tertiary care hospital. PARTICIPANTS: Twenty-five hospitalized patients diagnosed with post-COVID-19 fibrosis referred for PR. INTERVENTION: Individualized PR intervention including breathing exercises, positioning, strengthening, functional training, and ambulation twice a day for 6 days a week. OUTCOME MEASURES: One-minute sit-to-stand test (STST), Short Physical Performance Battery (SPPB), Fatigue Assessment Scale (FAS), and Post-COVID-19 Functional Status Scale (PCFS). RESULTS: Twenty-five participants (19 males, 6 females) with a mean age of 54.2 ± 13.4 years were enrolled. Sixteen completed the two-point assessment after undergoing in-patient PR of mean duration 14.8 ± 9 days. PR led to a significant improvement in all functional outcomes that is, STST (from 7.1 ± 4.3 repetitions to 14.2 ± 2.1 repetitions, SPPB (from 5 ± 2.8 to 9.4 ± 1.5), FAS (from 33.3 ± 10.8 to 25.8 ± 4.7) at the p ≤ .001, and PCFS (from 3.6 ± 0.9 to 2.9 ± 1.2, p ≤ .05). CONCLUSION: Early initiation of PR for hospitalized patients with COVID-19 fibrosis was safe, well tolerated, and feasible and may improve functional status.

An Epidemiological Study of Addictive Behavior Pattern Among Adolescent Tobacco Users.

Background: The risk of developing tobacco-related cancer and chronic heart and lung disease is greater if addiction starts in adolescence. Even experimental use of tobacco in adolescents significantly increases the risk of addiction in adulthood. This study intends to collect valuable data regarding sociodemographic characteristic of tobacco use, pattern of dependence among adolescent tobacco users, which will be essential for formulating recommendations, and their possible intervention aimed at reducing the problem of tobacco use. Methods: A community-based cross-sectional study was done where 400 subjects were enrolled. Nonprobability Snowball sampling technique was used to locate adolescents aged 12-18 years, who were practicing tobacco use. Face-to-face interviews were taken for data collection. Fragerstorm dependency test for tobacco was used to classify dependency of tobacco product into high and low dependency. Data was analyzed using Chi-square test and proportions using SPSS software version 21. Results: Majority of the subjects were in the age group of 16-18 years; mean age for initiation of tobacco was 15.6 years. Gutkha was the predominant form of tobacco product being used. Peer pressure 192 (48.0%) was the major reason for initiation of tobacco use. A significant association was found between dependency on tobacco and age, literacy, and socioeconomic status. Conclusions: Tobacco use starting from early age has many health implications. There is a need for stringent laws against the selling of tobacco to adolescents and targeted health awareness program against tobacco.

Acute haemorrhagic leukoencephalitis (AHLE) - our experience and a short review.

BACKGROUND: Acute haemorrhagic leukoencephalitis (AHLE), a rare variant of acute disseminated encephalomyelitis (ADEM), often presents differently from classical ADEM, thereby posing a diagnostic challenge to the clinician. AIM: To report AHLE, its clinic-radiological manifestations, process of diagnosis and prognosis. METHOD AND RESULTS: Eight patients presented with altered sensorium, acute focal deficits with or without seizures. Initial workup showed evidence of haemorrhagic lobar or thalamic lesions in seven patients. All patients underwent extensive evaluation for collagen vascular disease and vasculitis profile, autoimmune encephalitis panel and aquaporin-4 antibody, which were found to be normal. Cerebrospinal fluid (CSF) biochemistry and microscopy was non-contributory and CSF viral PCRs, toxoplasma antibodies, cryptococcal antigen were also negative. All patients had progressively worsening sensorium and neurological deficits. Repeat MRIs showed increase in oedema in the lesions and appearance/expansion of haemorrhage in the thalamic/hemispherical lesions. All patients received intravenous methylprednisolone (IVMP) without any benefit. Four patients underwent plasmapheresis (PLEX), one received intravenous immunoglobulin (IVIG) and one received both second line immunotherapies, without significant improvement. Brain biopsy (performed in three patients) showed inflammatory demyelination and areas of haemorrhage, thus confirming the diagnosis. Six patients succumbed in 7-30 days of the illness, despite aggressive treatment and only two survived, albeit with a significant disability. CONCLUSION: AHLE is a rare, yet very severe variant of ADEM. MRI shows lesions with haemorrhages, oedema and mass effect and histology findings reveal inflammatory infiltrates, haemorrhagic foci and fibrinoid necrosis of vessel walls. Prognosis is worse as compared to the classic ADEM, with a high mortality rate. To the best of our knowledge, this is one of the largest series of AHLE to have been reported anywhere in the world. KEYMESSAGE: Acute encephalopathy, multifocal deficits accompanied by haemorrhagic CNS demyelinating lesions with oedema and mass effect are the key features of AHLE. It is a rare, yet very severe form of ADEM with very high morbidity and mortality.

Epidemiological study of adverse events following immunization in under 5 year children.

BACKGROUND: The present study was conducted to study the socioeconomic and the demographic profile of children reporting with adverse events following immunization (AEFI) along with the determinants associated with AEFIs, based on investigation of each case and to assess the proportion of programmatic errors linked with AEFI cases. MATERIALS AND METHODS: Record-based cross-sectional study conducted among sample of 118 cases of AEFI were reported. The case reports of all AEFI cases were procured and analyzed to identify factors associated with reported AEFI. The questionnaires related with preliminary investigation reports (PIRs) including forensic evidence of death cases were analyzed. Percentage analysis of data was done by proportions, measures of central tendencies, and Chi-square test. RESULTS: Most of the cases reported were between 0 and 3 months of age constituting 39%. AEFI was seen more in male child than female. more than half of cases of AEFI were recorded following immunization with OPV/DPT/HBV together (66.94%). Most common AEFI reported were convulsion (68.64 %) and fever (58.47%) followed by local swelling at site of injection (11.86%). More than half of the cases of AEFI occurred within 12 hours of immunization (61.88%). Birth weight of most cases of AEFI were in the range between 2 and 2.4 kg (44.06%), followed by range between 2.5 and 2.9 kg (32.20%), the mean of birth weight was 2.51 kg. CONCLUSION: Convulsion was the most commonly reported AEFI, majority of AEFI occur within 12 h of immunization. Most of the AEFI were recorded following immunization with OPV/DPT/HBV together.

Automatic detection of COVID-19 disease using U-Net architecture based fully convolutional network.

The severe acute respiratory syndrome coronavirus 2, called a SARS-CoV-2 virus, emerged from China at the end of 2019, has caused a disease named COVID-19, which has now evolved as a pandemic. Amongst the detected Covid-19 cases, several cases are also found asymptomatic. The presently available Reverse Transcription - Polymerase Chain Reaction (RT-PCR) system for detecting COVID-19 lacks due to limited availability of test kits and relatively low positive symptoms in the early stages of the disease, urging the need for alternative solutions. The tool based on Artificial Intelligence might help the world to develop an additional COVID-19 disease mitigation policy. In this paper, an automated Covid-19 detection system has been proposed, which uses indications from Computer Tomography (CT) images to train the new powered deep learning model- U-Net architecture. The performance of the proposed system has been evaluated using 1000 Chest CT images. The images were obtained from three different sources - Two different GitHub repository sources and the Italian Society of Medical and Interventional Radiology's excellent collection. Out of 1000 images, 552 images were of normal persons, and 448 images were obtained from COVID-19 affected people. The proposed algorithm has achieved a sensitivity and specificity of 94.86% and 93.47% respectively, with an overall accuracy of 94.10%. The U-Net architecture used for Chest CT image analysis has been found effective. The proposed method can be used for primary screening of COVID-19 affected persons as an additional tool available to clinicians.

Neuropathies of leprosy.

Neuropathies form an integral part of the symptomatology of leprosy. Neuropathies of leprosy take various forms and shapes. At one end is the cutaneous nerve involvement adjacent to the anaesthetic skin patch and the other is of symmetrical pansensory neuropathy and the devastating sensory ataxia of leprous ganglionits. Lepra reactions add to the spectrum. Hosts immunological status largely decides the clinical manifestations seen in nerves and skin. A wide array of diagnostic techniques like ultrasonography, magnetic resonance neurography, serological markers, molecular tests, skin biopsy and in selected cases, the nerve biopsy with special stains and electron microscopy are obtainable to help the clinical diagnosis. The unsuspecting clinician, lack of community awareness and limited availability of diagnostic tests are important adverse factors in the total outcome. Multi drug therapy is efficacious and corticosteroids reduce the impact of nerve damage in leprosy. The efficacy, dose and duration of corticosteroid therapy are presently inexact and other immune suppressants like azathioprine are being evaluated. Chronic disabilities and residual deficits require attention of multiple specialties. In the coming time, focus on prevention could lead to favourable results. This review will discuss the classification systems, common and uncommon clinical features, diagnostic armamentarium and therapeutic and preventive aspects of neuropathies of leprosy.

Preparedness, administrative challenges for establishing obstetric services, and experience of delivering over 400 women at a tertiary care COVID-19 hospital in India.

OBJECTIVE: To provide a descriptive account of the challenges and administrative preparedness for establishing and sustaining safe obstetric services during the COVID-19 pandemic at Topiwala National Medical College & BYL Nair Charitable Hospital (NH), Mumbai, India. METHODS: The management of pregnant women with COVID-19 was implemented as per international (WHO, RCOG, ACOG) and national (Indian Council of Medical Research) recommendations and guidelines at an academic, tertiary care, COVID-19 hospital in India. RESULTS: Using a multidisciplinary approach and active engagement of a multispecialty team, obstetric services were provided to over 400 women with laboratory-confirmed COVID-19. A sustainable model is established for providing services to pregnant women with COVID-19 in Mumbai Metropolitan Region, India. CONCLUSION: With limited resources, it is possible to set up dedicated maternity services, aligned to international guidelines, for safe pregnancy outcomes in COVID-19 settings. This COVID-19 hospital addressed the challenges and implemented several known and novel methods to establish and sustain obstetric services for women with COVID-19. The model established in the present study can be replicated in other low- and middle-income countries.

Optimizing Investigations for Evaluation of Enlargements of the Roots, Plexuses and Nerves: A Study of 133 Patients.

BACKGROUND AND AIMS: A wide variety of neurological diseases result in clinical and/or radiological enlargement of nerves, roots and plexuses. With the advancement in techniques and use of magnetic resonance neurography (MRN), aided by electrophysiology, proximal segments of the lower motor neuron (LMN) can be well studied. The relative merits of investigative modalities have not been well defined and comprehensive information on this subject is sparse. METHODS: This retrospective study included data from January 2010 to June 2018. Patients having clinical and/or radiological enlargements of lower motor neuron were included. Clinical and laboratory work up, electrophysiology, MRN and biopsy studies were documented and analyzed. RESULTS: 133 patients fulfilled the inclusion criteria. The diagnostic categories were of leprosy (32%), immune neuropathies (27.8%), nerve infiltrations (8.2%), inherited neuropathies (9%), diabetic radiculopathies (9%) and others (12.7%). MRN was essential to diagnosis in 24.8% and supportive in 31.5% patients. Electrophysiology was essential in diagnosis in 70.6%, biopsy in 45.8% and genetic studies in 6.4% patients. CONCLUSION: The manuscript presents a large cohort of diseases causing enlargement of LMN with clinical and investigative aspects of 7 patients of the most unusual condition of chronic immune sensorimotor polyradiculopathy (CISMP) and details of 7 other patients with chronic mononeuropathies at non-entrapment sites. A table of comparative utility and an algorithm depicting the optimization of investigations has been presented.

Does the Tempo and Pattern of Neurological Syndrome Help Diagnose Paraneoplastic Etiology?

BACKGROUND: Paraneoplastic neurological syndromes (PNS) are defined as remote effects of cancer that are not caused by the tumor and its metastasis, or by infection, ischemia or metabolic disruptions. In most patients, the neurological disorder is the manifesting condition and cancer is not detectable clinically at that time. Hence, most often it will be upon the neurologist and not the oncologist to detect paraneoplastic syndrome. AIMS AND OBJECTIVES: To identify characteristic features of a neurological syndrome (presentation pattern and tempo of illness- onset, duration, progression and response to treatment) which indicate a paraneoplastic etiology. MATERIALS AND METHODS: This is a retrospective study. Medical records of all patients who were discharged/ died in Neurology unit of a tertiary care center over a study period of two years with a diagnosis of Paraneoplastic neurological syndrome as per the diagnostic criteria given by F Graus et al1 were studied. RESULTS: Seven PNS cases were identified of which, five had peripheral and two had central nervous system syndrome consistent with the anatomical localisation. Painful pure motor quadriparesis was present in three cases. Subacute onset and rapid progression was seen in six out of seven patients. Ill sustained response to corticosteroid treatment was seen in three patients whereas the remaining four showed no response. In five patients, tumour was detected after the diagnosis of neurological syndrome, as against one patient which had an antecedent tumour and the remaining one patient had classical onconeural antibody without evidence of any detectable tumor. Average time to tumor diagnosis from neurological symptom was 3.5 months. CONCLUSION: A subacute onset, rapidly progressive painful, pure motor quadriparesis; Ganglionopathy in elderly and autoimmune encephalitis with ill sustained or no response to corticosteroids merits consideration of paraneoplastic etiology.

Limb-girdle Muscular Dystrophies in India: A Review.

Limb-girdle muscular dystrophies (LGMDs) are common in India. Information on LGMDs has been gradually evolving in the recent years. This information is scattered in case series and case studies. The aim of this study is to collate available Indian information on LGMDs and put it in perspective. PubMed search using keywords such as limb-girdle muscular dystrophies in India, sarcoglycanopathies, dysferlinopathy, calpainopathy, and GNE myopathy was carried out. The published information on LGMDs in Indian context suggests that dysferlinopathy, calpainopathy, sarcoglycanopathies, and other myopathies such as GNE myopathy are frequently seen in India. Besides these, anecdotal reports of many other forms are available, some with genetic support and others showing immunocytochemical defects. The genotypic information on LGMDs is gradually evolving and founder mutations have been detected in selected populations. Further multicenter studies are necessary to document the incidence and prevalence of these common conditions in India.