Factors associated with unexplained sudden deaths among adults aged 18-45 years in India - A multicentric matched case-control study.

BACKGROUND OBJECTIVES: In view of anecdotal reports of sudden unexplained deaths in India's apparently healthy young adults, linking to coronavirus disease 2019 (COVID-19) infection or vaccination, we determined the factors associated with such deaths in individuals aged 18-45 years through a multicentric matched case-control study. METHODS: This study was conducted through participation of 47 tertiary care hospitals across India. Cases were apparently healthy individuals aged 18-45 years without any known co-morbidity, who suddenly (<24 h of hospitalization or seen apparently healthy 24 h before death) died of unexplained causes during 1 st October 2021-31 st March 2023. Four controls were included per case matched for age, gender and neighborhood. We interviewed/perused records to collect data on COVID-19 vaccination/infection and post-COVID-19 conditions, family history of sudden death, smoking, recreational drug use, alcohol frequency and binge drinking and vigorous-intensity physical activity two days before death/interviews. We developed regression models considering COVID-19 vaccination ≤42 days before outcome, any vaccine received anytime and vaccine doses to compute an adjusted matched odds ratio (aOR) with 95 per cent confidence interval (CI). RESULTS: Seven hundred twenty nine cases and 2916 controls were included in the analysis. Receipt of at least one dose of COVID-19 vaccine lowered the odds [aOR (95% CI)] for unexplained sudden death [0.58 (0.37, 0.92)], whereas past COVID-19 hospitalization [3.8 (1.36, 10.61)], family history of sudden death [2.53 (1.52, 4.21)], binge drinking 48 h before death/interview [5.29 (2.57, 10.89)], use of recreational drug/substance [2.92 (1.1, 7.71)] and performing vigorous-intensity physical activity 48 h before death/interview [3.7 (1.36, 10.05)] were positively associated. Two doses lowered the odds of unexplained sudden death [0.51 (0.28, 0.91)], whereas single dose did not. INTERPRETATION CONCLUSIONS: COVID-19 vaccination did not increase the risk of unexplained sudden death among young adults in India. Past COVID-19 hospitalization, family history of sudden death and certain lifestyle behaviors increased the likelihood of unexplained sudden death.

Analysis on diagnosing diabetic retinopathy by segmenting blood vessels, optic disc and retinal abnormalities.

The main intention of mass screening programmes for Diabetic Retinopathy (DR) is to detect and diagnose the disorder earlier than it leads to vision loss. Automated analysis of retinal images has the likelihood to improve the efficacy of screening programmes when compared over the manual image analysis. This article plans to develop a framework for the detection of DR from the retinal fundus images using three evaluations based on optic disc, blood vessels and retinal abnormalities. Initially, the pre-processing steps like green channel conversion and Contrast Limited Adaptive Histogram Equalisation is done. Further, the segmentation procedure starts with optic disc segmentation by open-close watershed transform, blood vessel segmentation by grey level thresholding and abnormality segmentation (hard exudates, haemorrhages, Microaneurysm and soft exudates) by top hat transform and Gabor filtering mechanisms. From the three segmented images, the feature like local binary pattern, texture energy measurement, Shanon's and Kapur's entropy are extracted, which is subjected to optimal feature selection process using the new hybrid optimisation algorithm termed as Trial-based Bypass Improved Dragonfly Algorithm (TB - DA). These features are given to hybrid machine learning algorithm with the combination of NN and DBN. As a modification, the same hybrid TB - DA is used to enhance the training of hybrid classifier, which outputs the categorisation as normal, mild, moderate or severe images based on three components.