Grey-box modelling and fuzzy logic control of a Leader-Follower robot manipulator system: A hybrid Grey Wolf-Whale Optimisation approach.

This study presents the development of a grey-box modelling approach and fuzzy logic control for real time trajectory control of an experimental four degree-of-freedom Leader-Follower​ Robot (LFR) manipulator system using a hybrid optimisation algorithm, known as Grey Wolf Optimiser (GWO) - Whale Optimisation Algorithm (WOA). The approach has advantages in achieving an accurate model of the LFR manipulator system, and together with a better trajectory tracking performance. In the first instance, the white box model is formed by modelling the dynamics of the follower manipulator using the Euler-Lagrange formulation. This white-box model is then improved upon by re-tuning the model's parameters using GWO-WOA and experimental data from the real LFR manipulator system, thus forming the grey-box model. A minimum improvement of 73.9% is achieved by the grey-box model in comparison to the white-box model. In the latter part of this investigation, the developed grey-box model is used for the design, tuning and real-time implementation of a fuzzy PD＋I controller on the experimental LFR manipulator system. A 78% improvement in the total mean squared error is realised after tuning the membership functions of the fuzzy logic controller using GWO-WOA. Experimental results show that the approach significantly improves the trajectory tracking performance of the LFR manipulator system in terms of mean squared error, steady state error and time delay.

Evaluation of metformin in combination with rifampicin containing antituberculosis therapy in patients with new, smear-positive pulmonary tuberculosis (METRIF): study protocol for a randomised clinical trial.

INTRODUCTION: Shorter duration of treatment for the management of drug-susceptible pulmonary tuberculosis (TB) would be a significant improvement in the care of patients suffering from the disease. Besides newer drugs and regimens, other modalities like host-directed therapy are also being suggested to reach this goal. This study's objective is to assess the efficacy and safety of metformin-containing anti-TB treatment (ATT) regimen in comparison to the standard 6-month ATT regimen in the treatment of patients with newly diagnosed sputum smear-positive drug-sensitive pulmonary TB. METHODS AND ANALYSIS: We are conducting a multicentric, randomised open-label controlled clinical trial to achieve the study objective. The intervention group will receive isoniazid (H), rifampicin (R), ethambutol (E) and pyrazinamide (Z) along with 1000 mg of daily metformin (Met) for the first 2 months while the control group will receive only HRZE. After 2 months, both the groups will receive HRE daily for 4 months. The primary endpoint is time to sputum culture conversion. Secondary endpoints will include time to detection of Mycobacterium tuberculosis in sputum, pharmacokinetics and pharmacogenomics of study drugs, drug-drug interactions, safety and tolerability of the various combinations and measurement of autophagy and immune responses in the study participants. ETHICS AND DISSEMINATION: The ethics committee of the participating institutes have approved the study. Results from this trial will contribute to evidence towards constructing a shorter, effective and safe regimen for patients with TB. The results will be shared widely with the National Programme managers, policymakers and stakeholders through open access publications, dissemination meetings, conference abstracts and policy briefs. This is expected to provide a new standard of care for drug-sensitive patients with pulmonary TB who will not only reduce the number of clinic visits and lost to follow-up of patients from treatment but also reduce the burden on the healthcare system. TRIAL REGISTRATION NUMBER: CTRI/2018/01/011176; Pre-results.

Development of a two-stage gene selection method that incorporates a novel hybrid approach using the cuckoo optimization algorithm and harmony search for cancer classification.

For each cancer type, only a few genes are informative. Due to the so-called 'curse of dimensionality' problem, the gene selection task remains a challenge. To overcome this problem, we propose a two-stage gene selection method called MRMR-COA-HS. In the first stage, the minimum redundancy and maximum relevance (MRMR) feature selection is used to select a subset of relevant genes. The selected genes are then fed into a wrapper setup that combines a new algorithm, COA-HS, using the support vector machine as a classifier. The method was applied to four microarray datasets, and the performance was assessed by the leave one out cross-validation method. Comparative performance assessment of the proposed method with other evolutionary algorithms suggested that the proposed algorithm significantly outperforms other methods in selecting a fewer number of genes while maintaining the highest classification accuracy. The functions of the selected genes were further investigated, and it was confirmed that the selected genes are biologically relevant to each cancer type.

Total truncation of the molybdopterin/dimerization domains of SUOX protein in an Arab family with isolated sulfite oxidase deficiency.

We ascertained a patient with the full-blown phenotype of isolated sulfite oxidase deficiency in a consanguineous Arab family. The proband's phenotype included the presence of intractable seizures in the neonatal period, some dysmorphic features, neuroradiologic findings reminiscent of hypoxic ischemic encephalopathy and rapidly progressive brain destruction leading to severe neurodevelopmental impairment. Biochemically, the patient excreted a large amount of S-sulfocysteine with normal amounts of xanthene and hypoxanthine and had normal plasma uric acid, which was consistent with isolated sulfite oxidase deficiency. We report the identification of the first Arab mutation in SUOX, the gene for sulfite oxidase enzyme, in the ascertained family. The newly identified Arab mutation in the SUOX gene (a single nucleotide deletion, del G1244) is predicted to cause a frame shift at amino acid 117 of the translated protein with the generation of a stop codon and total truncation of the molybdo-pterin- and the dimerizing-domain(s) of SUOX protein expressed from the mutant allele. The identification of this new Arab SUOX mutation should facilitate pre-implantation genetic diagnosis and selection of unaffected embryos for future pregnancy in the ascertained family with the mutation and related families with the same mutation.

Intravenous immunoglobulin G (IVIG) therapy for significant hyperbilirubinemia in ABO hemolytic disease of the newborn.

BACKGROUND: Although intravenous immunoglobulin G (IVIG) therapy has been reported in hyperbilirubinemia of Rh hemolytic disease, its use in ABO hemolytic disease has been reported in only a few studies. In our institute we have observed that almost 30% of babies with hyperbilirubinemia due to ABO hemolytic disease required exchange transfusion. OBJECTIVE: To determine whether administration of IVIG to newborns with significant hyperbilirubinemia due to ABO hemolytic disease would reduce the need for exchange transfusion as a primary goal in these babies. DESIGN: This was a prospective study involving all newborns with significant hyperbilirubinemia due to direct Coombs-positive ABO hemolytic disease. METHODS: All healthy term babies with ABO hemolytic disease with positive direct Coombs test in the period between 2000 and 2002 were identified. Significant hyperbilirubinemia was defined as hyperbilirubinemia requiring phototherapy and/or rising by 8.5 micromol/l per h (0.5 mg/dl per h) or more to require exchange transfusion. Babies were randomly assigned into two groups: group 1 (study group) received phototherapy plus IVIG (500 mg/kg); and group 2 (control group) received phototherapy alone. Exchange transfusion was carried out in any group if at any time the bilirubin level reached 340 micromol/l (20 mg/dl) or more, or rose by 8.5 micromol/l per h (0.5 mg/dl per h) in group 2. RESULTS: A total of 112 babies were enrolled over 2 years, 56 in each group. Exchange transfusion was carried out in four babies in the study group, while 16 babies in the control group required exchange. Late anemia was not of concern in either group. No adverse effects related to IVIG administration were recorded. CONCLUSION: Administration of IVIG to newborns with significant hyperbilirubinemia due to ABO hemolytic disease with positive direct Coomb's test reduces the need for exchange transfusion without producing immediate adverse effects.

Misdiagnosing esophageal perforation as esophageal atresia.

We report a case of traumatic perforation of esophagus misdiagnosed as esophageal atresia in a 1.7 kg preterm (28 weeks) twin. Initial resistance to the passage of orogastric tube and failure of passage of contrast material down the esophagus prompted the diagnosis of esophageal atresia. Subsequently, the passage of orogastric tube as well as radiological findings at the age of 7 days made us change the diagnosis to traumatic perforation of esophagus. The baby was managed conservatively and discharged in good health at the age of 2 months. Literature is reviewed and the attention of pediatricians is drawn to this problem.

Gastric perforation. An unusual cause of ascites in a newborn baby.

We report a case of a low birth weight asymmetrical small for gestational age baby, who presented at the age of 20 hours with sudden abdominal distension. Since birth he has been breastfed and was kept with his mother. Absence of radiological findings of necrotizing enterocolitis or perforation at the time of presentation delayed the diagnosis for 48 hours. At laparotomy the baby was found to have perforation of the stomach with no evidence of other gastrointestinal disorder.

Case of partial trisomy 2q3 with clinical manifestations of Marshall-Smith syndrome.

We describe a girl with physical anomalies, accelerated skeletal maturation, failure to thrive, and respiratory difficulties consistent with a diagnosis of Marshall-Smith syndrome (MSS). Chromosome analysis showed an inverted duplication of chromosome 2 [46,XX,inv dup(2)(q37q32) de novo] identified by G banding and confirmed by FISH. Several cases of trisomy 2q3 have been reported and established a syndrome, but the present case is the first to be associated with accelerated skeletal maturation and a clinical picture resembling MSS. This raises the possibility that the cause of MSS involves the q3 region of chromosome 2. Few reports of MSS include study of the karyotype, although the chromosomes were apparently normal in those cases where they have been examined. We suggest that karyotyping be undertaken with particular attention to the 2q3 region in patients with suspected MSS. It also would be prudent to assess bone age in all children with trisomy 2q.

Iodine deficiency disorders in the Maldives: A public health problem.

Because the Maldives is a country of islands it has been assumed, until now, that iodine deficiency disorders (IDD) are not a public health problem. However, no systematic scientific survey has been carried out to assess the status of IDD in the Maldives. This study represents the first IDD survey by the Government of the Republic of Maldives in association with UNICEF Maldives. Undertaken during June and July 1995, the survey adopted the EPI 30 Cluster sampling technique, as recommended by the Joint WHO/UNICEF/ICCIDD Consultation. Based on population proportion to size, a total of 30 clusters were chosen from sampling frames of all 200 islands. A total of 30 schools and 2834 children aged 6-12 years were surveyed. The total goitre rate was 23.6%, with grade 1 goitre contributing 22.5% of this figure. The prevalence of goitre was greater in girls (26.6%) than in boys (20.7%). The median urinary iodine level was 6.7 µg/dL and 65.5% of children had urinary iodine levels below 10 µg/dL. It is evident from this survey that IDD is a public health problem in the Maldives. Hence, efforts to control IDD should be instituted. The most common method of iodine supplementation is iodised salt. As tested in a non-representative sample of 39 salt samples, only 8% of salt had adequate iodine levels of approximately 15 p.p.m. Because all the atolls are affected there is a need to introduce universal salt iodization in the country.

Rubinstein Taybi syndrome and lymphoblastic leukemia.

Full text is available as a scanned copy of the original print version.

Necrotizing enterocolitis, surgical experience.

Between January 1988 and December 1994, 29 cases of necrotizing enterocolitis (NEC) required surgical management. There were 15 males and 14 females. The gestational age range was 24-38, average 32.7 weeks and body weight range was 565-4500 grams, average 1,680 grams. Necrotizing enterocolitis developed within two weeks of age in 55% of the cases, between two and four weeks in 34% and beyond four weeks in four cases (14%). Pneumoperitoneum was the commonest indication for surgery (55%) of cases, followed by failure of response to medical treatment. The commonest surgical procedure was resection of the gangrenous bowel with creation of an enterostomy for the segmental disease in 15 cases (50%) and resection with primary anastomosis in six cases (20%). Four cases (14%) had NEC totalis for which drainage alone was done, and two cases had external drainage alone. Survival rate was 72%.

Congenital chloride diarrhoea: case report and review of the literature.

Congenital chloride diarrhoea (CCD) usually presents with abdominal distension, visible peristalsis and watery stools from birth that show chloride loss of more than 90 mmol/l. It may mimic low intestinal obstruction on antenatal ultrasound scanning after 30 weeks' gestation. This condition has been reported mainly from Finland. We report a case of CCD in a Saudi boy which was suspected antenatally, confirmed post-natally and managed successfully.

Half a decade of neonatal sepsis, Riyadh, Saudi Arabia.

In a retrospective study to determine the pattern of neonatal sepsis, all cases admitted to the Neonatal Intensive Care Unit (NICU) between October 1983 and July 1988 at King Khalid University Hospital, in Riyadh were studied. During the review period there were a total of 2117 admissions to the NICU. Of those 1252 (59 per cent) underwent septic screening sometimes during their stay in the NICU. The number of babies with proven bacteremia, i.e.; positive blood and or cerebrospinal fluid culture was 190 (15 per cent). Gram-positive organisms were cultured from 132 (69 per cent) and Gram-negative organisms from 47 (25 per cent) of the babies. The single most frequent organism was Staphylococcus epidermidis accounting for 36 per cent (58/190) of all proven cases. These results differ appreciably from other studies reported previously from Riyadh as well as from some other parts of the world, and stress the need to recognize Staphylococcus epidermidis as an increasingly important pathogen in the newborn nursery.