Image Smart Segmentation Analysis Against Diabetic Foot Ulcer Using Internet of Things with Virtual Sensing.

Diabetic foot ulcer (DFU) is a problem worldwide, and prevention is crucial. The image segmentation analysis of DFU identification plays a significant role. This will produce different segmentation of the same idea, incomplete, imprecise, and other problems. To address these issues, a method of image segmentation analysis of DFU through internet of things with the technique of virtual sensing for semantically similar objects, the analysis of four levels of range segmentation (region-based, edge-based, image-based, and computer-aided design-based range segmentation) for deeper segmentation of images is implemented. In this study, the multimodal is compressed with the object co-segmentation for semantical segmentation. The result is predicting the better validity and reliability assessment. The experimental results demonstrate that the proposed model can efficiently perform segmentation analysis, with a lower error rate, than the existing methodologies. The findings on the multiple-image dataset show that DFU obtains an average segmentation score of 90.85% and 89.03% correspondingly in two types of labeled ratios before DFU with virtual sensing and after DFU without virtual sensing (i.e., 25% and 30%), which is an increase of 10.91% and 12.22% over the previous best results. In live DFU studies, our proposed system improved by 59.1% compared with existing deep segmentation-based techniques and its average image smart segmentation improvements over its contemporaries are 15.06%, 23.94%, and 45.41%, respectively. Proposed range-based segmentation achieves interobserver reliability by 73.9% on the positive test namely likelihood ratio test set with only a 0.25 million parameters at the pace of labeled data.

Enhancement and segmentation of medical images through pythagorean fuzzy sets-An innovative approach.

Image segmentation has attracted a lot of attention due to its potential biomedical applications. Based on these, in the current research, an attempt has been made to explore object enhancement and segmentation for CT images of lungs infected with COVID-19. By implementing Pythagorean fuzzy entropy, the considered images were enhanced. Further, by constructing Pythagorean fuzzy measures and utilizing the thresholding technique, the required values of thresholds for the segmentation of the proposed scheme are assessed. The object extraction ability of the five segmentation algorithms including current sophisticated, and proposed schemes are evaluated by applying the quality measurement factors. Ultimately, the proposed scheme has the best effect on object separation as well as the quality measurement values.

Internet of things-based cloud computing platform for analyzing the physical health condition.

BACKGROUND: Health monitoring is important for early disease diagnosis and will reduce the discomfort and treatment expenses, which is very relevant in terms of prevention. The early diagnosis and treatment of multiple conditions will improve solutions to the patient's healthcare radically. A concept model for the real-time patient tracking system is the primary goal of the method. The Internet of things (IoT) has made health systems accessible for programs based on the value of patient health. OBJECTIVE: In this paper, the IoT-based cloud computing for patient health monitoring framework (IoT-CCPHM), has been proposed for effective monitoring of the patients. METHOD: The emerging connected sensors and IoT devices monitor and test the cardiac speed, oxygen saturation percentage, body temperature, and patient's eye movement. The collected data are used in the cloud database to evaluate the patient's health, and the effects of all measures are stored. The IoT-CCPHM maintains that the medical record is processed in the cloud servers. RESULTS: The experimental results show that patient health monitoring is a reliable way to improve health effectively.

Predictors of frequent relapsing and steroid-dependent nephrotic syndrome in children.

AIM: To determine the predictors of frequent relapses and steroid dependency in children with steroid-sensitive nephrotic syndrome. MATERIAL AND METHODS: All children aged six months to 18 years with steroid-sensitive nephrotic syndrome registered in the nephrology clinic between 2003 and 2015 at a tertiary center who were followed up for at least 1year after onset were included in the study. RESULTS: Two hundred seventy-seven patients with steroid-sensitive nephrotic syndrome who were followed up for at least 1 year from onset of disease were included. There were 157 infrequent relapsers and 120 frequent relapsers (frequent relapses and or steroid-dependent). Compared with infrequent relapsers, frequent relapsers had a significantly lower age at onset (51.53±40.42 vs. 61.97±40.66 months; p=0.035), lesser time for first relapse (time from the start of initial treatment to first relapse (8.65±11.99 vs. 23.46±24.05 months; p<0.001) and a higher number of relapses with infection (8.65±11.99 vs. 1.25±1.85; p<0.001). On multivariate logistic regression analysis, time for first relapse less than six months [OR: 3.93; 95% CI: (1.97-7.82)] and concomitant infection during relapses [OR: 1.82; 95% CI:(1.56-2.14)] were significant predictors of frequent relapses, and males were less likely to become frequent relapsers [OR: 0.48; 95% CI:(0.24-0.93)]. Kaplan-Meier analysis and the log-rank test also showed that a first relapse within six months was associated with frequent relapses. Age at onset and inadequate steroid therapy at onset did not determine frequent relapses. CONCLUSION: Shorter time for first relapse and concomitant infection during relapses can predict future frequent relapses. These predictors may be useful to counsel patients, to follow them up more closely, and to develop better treatment protocols and relapse-specific interventions.

A plant oxysterol, 28-homobrassinolide binds HMGCoA reductase catalytic cleft: stereoselective avidity affects enzyme function.

Understanding the influence of ubiquitously present plant steroids on mammalian cell biology is currently of interest. Feedback inhibition of HMGCoA reductase (HMGCR) catalytic activity in the transformation of HMG-CoA to mevalonate is a significant regulatory step in sterol biosynthetic pathway. To assess the role of dietary steroids in this biochemical transformation, the phytosteroid isoform 28-homobrassinolide (28-HB), 90 % pure, obtained from Godrej Agrovet (India) was used to determine its effect on mammalian HMG-CoA reductase. Photometric assay of pure human and select rat tissue HMGCR post 28-HB oral feed, PCR-HMGCR gene expression, and in silico docking of 28-HB and HMGCoA on HMGCR protein template were carried out. Using an oral feed regimen of pure 28-HB, we noted a decrease of 16 % in liver, 17.1 % in kidney and 9.3 % in testicular HMGCR enzyme activity, 25 % in HMGCR gene expression and 44 % in the activity of pure human HMGCR due to this plant oxysterol. In silico docking studies yielded binding metrics for 28-HB-HMGCR lower than for HMGCoA-HMGCR, indicating stronger binding of HMGCR by this ligand. 28-HB exerts differential effects on rat tissue HMGCR, down regulates liver HMGCR gene expression and significantly inhibits HMGCR activity.

Warburg micro syndrome in siblings from India.

Warburg syndrome is a rare disorder characterized by microcephaly, microcornea, congenital cataract, developmental delay, and hypogonadism. Here, we report two siblings from India who presented with developmental delay, microcornea, microphthalmia, and bilateral congenital cataracts, born to the third-degree consanguineously married couple. Both children had hypoplasia of corpus callosum. In this report, we aim to highlight and compare clinical features of these two cases with previously reported cases.

Blue Rubber Bleb Nevus Syndrome in a Child.

Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder with multiple haemangiomas in the skin, gastrointestinal tract and other visceral organs often associated with fatal bleeding and anaemia. We report a 13-year-old female child with multiple haemangiomas on skin and gastrointestinal tract with refractory anaemia. Awareness of this entity is necessary to prevent complications.

Hospital-based surveillance of invasive pneumococcal disease and pneumonia in South Bangalore, India.

OBJECTIVE: To estimate the incidence of invasive pneumococcal disease and pneumonia, distribution of pneumococcal serotypes, and antibiotic susceptibility in children aged 28 days to <60 months. DESIGN: Hospital-based surveillance. SETTING: South Bangalore, India. PARTICIPANTS: 9950 children aged 28 days to <60 months with clinical suspicion of invasive pneumococcal disease or pneumonia. RESULTS: The estimated at-risk population included 224,966 children <5 years of age. Forty cases of invasive pneumococcal disease were identified. Estimated invasive pneumococcal disease incidence was 17.8/100,000 with incidence being highest among children aged 6 months to <12 months (49.9/100,000). Clinical pneumonia syndrome was the most frequent diagnosis (12.5/100,000). Pneumococcal serotypes included: 6A (n=6, 16.7%); 14 (n=5, 13.9%); 5 (n=4, 11.1%); 6B (n=4, 11.1%); 1, 18C, and 19A (n=3 each, 8.3%); 9V (n=2, 5.6%); and 3, 4, 10C, 18A, 18F, and 19F (n=1 each, 2.8%). Serotypes 6A, 14, 6B, 1, 18C, 19A, 9V, 4, 10C, and 18A showed antibiotic resistance. Clinical pneumonia incidence was 2109/100,000, with incidence being highest among children aged 28 days to <6 months (5033/100,000). Chest radiograph-confirmed pneumonia incidence was 1114/100,000, with incidence being highest among children aged 28 days to <6 months (2413/100,000). CONCLUSIONS: Invasive pneumococcal disease and pneumonia were found to be common causes of morbidity in young children living in South Bangalore, India.

Pediatric dermatology inpatient consultations: a retrospective study.

OBJECTIVE: To describe the profile of inpatient consultations seen in department of pediatric dermatology at a tertiary care children's hospital. METHODS: The authors performed a retrospective review of all pediatric dermatology inpatient consultation data from medical record section over a period of 42 mo from January 2010 through June 2013. All children 18 y and below were included in the study. RESULTS: A total of 486 inpatient consultation services were given by pediatric dermatology department. About 124 (25.5 %) of consultations were in the age group of infancy followed by 103 (21.1 %) consultations in the school going age children. Most frequent consultation request was from general pediatrics (49.4 %) followed by pediatric intensive care (37.9 %). The most common diagnostic categories included cutaneous infection (115, 23.7 %), emergency skin conditions (62, 12.8 %), genodermatosis (58, 11.9 %) and skin disorders secondary to systemic illness (55, 11.3 %). CONCLUSIONS: This study highlights the spectrum of conditions that clinicians must be aware that can be seen in general pediatric wards and intensive care unit. This study also highlights the role of pediatric dermatologist in giving care to hospitalized children.

Nevirapine-related adverse events among children switched from efavirenz to nevirapine as compared to children who were started on nevirapine-based antiretroviral therapy directly.

In this retrospective study, incidence of nevirapine (NVP) toxicity in children who were switched from efavirenz (EFV) to NVP (treatment experienced [TE] group) was compared with that of children who had started NVP-based antiretroviral therapy directly (treatment naïve [TN] group). This study also identified risk factors associated with development of NVP toxicity in children. The incidence and risk of developing NVP toxicities were significantly higher in TE when compared to TN group. Median duration of onset of NVP toxicity from the initiation was 2.14 and 3.84 weeks in TE and TN children, respectively. Mean CD4 count was found to be significantly higher in children who developed toxicity (577 ± 81 cells/µL) as compared to the children who did not develop toxicity (403 ± 29 cells/µL). Similarly, children in TE group who developed NVP toxicity had higher mean CD4 cell count than children in TN with NVP toxicity. The risk factors for the development of NVP toxicity include female gender with CD4 count >250 cells/µL and TE children especially girls with CD4% >15% and boys with CD4 count >400 cells/µL. To conclude, the higher incidence of NVP toxicity among TE group warrants a cautious approach while switching the NVP- from EFV-based therapy.

28-Homobrassinolide: a novel oxysterol transactivating LXR gene expression.

Cholesterol is the template for steroid hormone biosynthesis. Cholesterol homeostasis is regulated by Cyt-P450 oxygenated cholesterols acting as ligands on LXR-α and LXR-ß transcription factors that are now emerging as drug targets. Heterodimerization of LXRs with retinoic acid receptor is considered a prerequisite for target gene activation. Dietary plant oxysterol 28-homobrassinolide (28-HB) is a proven antihyperglycemic and a pro-steroidogenic agent in the rat. Whether 28-HB has a role in LXR gene expression was therefore investigated using oral gavage (15 days) of 28-HB (333 µg/kg b w) to normal and diabetic rat. PCR amplified LXR-α and ß mRNA transcripts from treated rat liver and testis exhibited quantitative differences in their expression. Conformational differences in 28-HB docking to LXR-α and ß binding domains were also noted through in silico studies, LXR-ß adopting lesser specificity. We report that 28-HB transactivates LXR genes in the rat tissues.

Gibberellic acid acts as an agonist of steroidogenesis in male rats.

Testicular steroidogenesis has significant implication in male reproductive function. Although the effects of various signalling molecules on testicular functions have been studied earlier, the influence of the plant hormone gibberellic acid (GA3 ) on steroidogenesis has not been investigated. Acute (4 h) and subacute (15 days) studies using this compound through oral administration (150 µg day(-1) ) to groups of normal and diabetic Wistar male rats were therefore carried out. Results indicate that (i) enhanced activity of steroidogenic markers 3ß-hydroxysteroid dehydrogenase (3ß-HSD), 17ß-hydroxysteroid dehydrogenase (17ß-HSD), elevated tissue testosterone (T) content, increased steroidogenic acute regulatory protein (StAR) and androgen binding protein (ABP) levels with reduced lipid peroxidation and improved antioxidant defence in this treatment group of normal and diabetic rat testis, and (ii) elevated lipid peroxidation and diminished antioxidant defence, with insignificant change in 3ß-HSD and 17ß-HSD activity and testosterone level in acute treatment group of normal and diabetic rats testis, were noted. The observed increase in the activity of testicular 3ß-HSD and 17ß-HSD along with elevated testosterone content established GA3 as an inducer of steroidogenesis in rat.

A phytooxysterol, 28-homobrassinolide modulates rat testicular steroidogenesis in normal and diabetic rats.

Steroidogenesis in testicular cells depends upon the availability of cholesterol within testicular mitochondria besides the activities of 3ß-hydroxysteroid dehydrogenase (3ß-HSD, 17ß-hydroxysteroid dehydrogenase [17b-HSD]), and the tissue levels of steroidogenic acute regulatory protein (StAR), androgen-binding protein (ABP), and testosterone (T). Cellular cholesterol biosynthesis is regulated by endogenous oxycholesterols acting through nuclear hormone receptors. Plant oxysterols, such as 28-homobrassinolide (28-HB), available to human through diet, was shown to exhibit antihyperglycemic effect in diabetic male rat. Its role in rat testicular steroidogenesis and lipid peroxidation (LPO) was therefore assessed using normal and streptozotocin-induced diabetic male rats. Administration of 28-HB (333 µg/kg body weight) by oral gavage for 15 consecutive days to experimental rats diminished LPO, increased antioxidant enzyme, 3ß-HSD and 17ß-HSD activities, and elevated StAR and ABP expression and T level in rat testis. We report that 28-HB induced steroidogenesis in normal and diabetic rat testis.

A study on the reversal of sterilisation in women over two decades.

OBJECTIVES: The present study was undertaken to check the relevance of reversal of sterilization in women in the present era of test tube babies, to evaluate the Standard guidelines for sterilization, (The site of the occlusion of the fallopian tube must be always be within 2-3 cm from the uterine cornu in the isthmal portion, excision of 1 cm of the tube should be done. Use of cautery and crushing of the tube should be avoided.) are being followed universally in the institution and outside, to study the demographic patterns of women coming for reversal of sterilization and to evaluate the causes for either the inability to perform reversal of sterilization or the adversaries like ectopic pregnancy that occur after the procedure. METHODS: The present study is a retrospective study carried out in the Department of Microsurgery, Obstetrics and Gynecology, Government Kilpauk Medical College and Hospital Chennai based on the case records maintained in the institution. Three groups of women have been chosen at various periods and the various factors related have been compared. This includes the women who have come to the institution for reversal of sterilization during the years 1991-1995, 2000-2004 and 2006-2008 respectively. RESULT: The demand for reversal has increased almost 81 % after 2005 whereas the standards of sterilization are actually being followed in <17 % of women. The incidence of Ectopic pregnancies has increased and the incidence of take home pregnancies has come down. CONCLUSION: There is a need to stick to the standards of sterilization. Proper selection of candidates for sterilization and reversal of sterilization is important.

Acute renal failure due to acute tubulointerstitial nephritis.

Acute interstitial nephritis (AIN) should be ruled out in children with unexplained acute renal failure. We present a 4 1/2 year old girl who presented with oliguric acute renal failure preceded by a febrile illness. Renal histopathology revealed features of drug induced AIN. She recovered with dialysis, other supportive treatment and a course of steroids.

Effect of gastrointestinal proteases on purified human intrinsic factor-vitamin B12 (IF-B12) complex.

Intrinsic factor (IF) from human gastric juice was purified and complexed with vitamin B12 (IF-B12 complex) on Sepharose-vitamin B12 affinity matrix. By labeling studies, using [(57)Co] vitamin B12 and (125)I, the specific B12 binding activity of IF was found to be 23 microg B12/mg protein, and the molecular size by gel filtration 60 kDa. Proteolysis of the IF-B12 complex by sequential treatment with pepsin, trypsin, alpha-chymotrypsin and carboxypeptidase A, followed by chromatography of proteolysed complex and IF-B12 showed higher mobility of proteolysed fraction. Gel filtration, however, showed same molecular size for both proteolysed and the IF-B12 complex. On SDS-PAGE, purified IF-B12 appeared as a single band of 60 kDa. The proteolysed complex had higher mobility on SDS-PAGE and did not bind to zirconium phosphate gel. Immunodiffusion with rabbit antisera had positive reaction with IF-B12, but there was no reaction with the proteolysed sample.