Legal and Ethical Issues Associated With Challenges in the Implementation of the Electronic Medical Record System and Its Current Laws in India.

Electronic health records (EHR) have revolutionized healthcare by providing efficient access to patient information, but their implementation poses various challenges. This paper examines the ethical and legal issues surrounding EHR adoption, particularly focusing on the healthcare landscape in India. Ethical considerations, including patient autonomy, confidentiality, beneficence, and justice, must guide EHR implementation to protect patient rights and privacy. Legal issues such as medical errors, malpractice, data breaches, and billing inaccuracies underscore the importance of robust policies and security measures. Threats to EHRs, such as phishing attacks, malware, encryption vulnerabilities, and insider threats, emphasize the need for comprehensive cybersecurity strategies. Overcoming challenges in EHR implementation requires meticulous planning, financial investment, staff training, and stakeholder support. Despite the complexities involved, the benefits of EHR adoption in improving patient care and operational efficiency justify the efforts required to address legal, ethical, and technical concerns. Embracing EHRs while mitigating associated risks is essential for delivering high-quality healthcare in the digital age.

Clinical profile of infants with late onset sepsis admitted in a North East Indian tertiary care center: insights into the uncharted.

OBJECTIVES: To assess the clinical profile of infants with late onset sepsis admitted in a tertiary care hospital in North-East India. METHODS: Prospective observational study was carried out in Department of Paediatrics, Regional Institute of Medical Sciences hospital during a period of 2 years (September 2019-August 2021). RESULTS: A total of 109 patients were included in the study, of which 80 were community-acquired and 29 infants were hospital-acquired cases of late onset sepsis (LOS). The major risk factors were low socioeconomic status, prematurity, low birth weight, a history of intervention (mechanical ventilation, umbilical venous catheter, total parenteral nutrition, resuscitation) and lack of exclusive breastfeeding. The most common presenting features were decreased feeding, lethargy and respiratory distress. Blood cultures were positive in 33% of patients. Klebsiella was the most common hospital-acquired pathogen while Escherichia coli was the most common isolate in community-acquired cases. Thrombocytopenia was the most common complication. The in-hospital mortality rate was 13.7%. CONCLUSION: Low socioeconomic status, low birth weight, prematurity, invasive interventions and lack of exclusive breastfeeding are the major risk factors of LOS. The clinical signs and symptoms are varied and subtle. The mean C-reactive protein in the hospital-acquired group was significantly higher as compared to the community-acquired group. There is substantial morbidity and mortality, resulting in an increased toll on resources, therefore, an aggressive preventive and treatment approach is recommended for late onset sepsis.

An efficient multi-level pre-processing algorithm for the enhancement of dermoscopy images in melanoma detection.

In this paper, a multi-level algorithm for pre-processing of dermoscopy images is proposed, which helps in improving the quality of the raw images, making it suitable for skin lesion detection. This multi-level pre-processing method has a positive impact on automated skin lesion segmentation using Regularized Extreme Learning Machine. Raw images are subjected to de-noising, illumination correction, contrast enhancement, sharpening, reflection removal, and virtual shaving before the skin lesion segmentation. The Non-Local Means (NLM) filter with lowest Blind Reference less Image Spatial Quality Evaluator (BRISQUE) score exhibits better de-noising of dermoscopy images. To suppress uneven illumination, gamma correction is subjected to the denoised image. The Robust Image Contrast Enhancement (RICE) algorithm is used for contrast enhancement, and produces enhanced images with better structural preservation and negligible loss of information. Unsharp masking for sharpening exhibits low BRISQUE scores for better sharpening of fine details in an image. Output images produced by the phase congruency-based method in virtual shaving show high similarity with ground truth images as the hair is removed completely from the input images. Obtained scores at each stage of pre-processing framework show that the performance is superior compared to all the existing methods, both qualitatively and quantitatively, in terms of uniform contrast, preservation of information content, removal of undesired information, and elimination of artifacts in melanoma images. The output of the proposed system is assessed qualitatively and quantitatively with and without pre-processing of dermoscopy images. From the overall evaluation results, it is found that the segmentation of skin lesion is more efficient using Regularized Extreme Learning Machine if the multi-level pre-processing steps are used in proper sequence.

Hydrothermal Synthesis of Rod Shaped Red Emitting Gd2O3:Eu3+ Phosphor.

Simple hydrothermal method can be applied for synthesizing rod shape Gd2O3:Eu3+ phosphors. X-ray diffraction, Fourier transform infrared spectroscopy and transmission electron microscopy are used for the characterizations of samples. Increase of Eu3+ concentration in Gd2O3:Eu3+ can cause red shift in the charge transfer band (CTB) of Eu - O. The nature of Eu3+ surroundings is asymmetric. It is ascertained from PL emission studies. The calculation of second order crystal field parameter from PL spectra corroborates the asymmetric environment of Eu3+. PL emission and decay lifetime studies confirm the existence of quenching due cross-relaxation. The quantum yield for Y2O3:Eu3+ (19 at.%) under 265 nm excitation is found to be 7%.

Seismic evidence of pop-up tectonics beneath the Shillong Plateau area of Northeast India.

Our detailed 3-D seismic tomographic assimilation using high-quality phase arrival time data recorded by the local seismographic network demonstrated that heterogeneities in the crustal faults have contributed significantly to the pop-up tectonics beneath the Shillong Plateau, characterized by high-V and low-σ. The major seismogenic faults, namely, the north-dipping Dapsi thrust in association with Dauki fault in the south and south dipping Brahmaputra fault in the north, located either side of the Shillong Plateau that acted as the causative factors for the pop-up, which attributed to the lithostatic (high-V, low-σ) and sedimentary (low-V, high-σ) load, respectively. Seismicity is found confined to a depth ≤ 60 km. Uneven distribution of structural heterogeneities in the upper crust is responsible for earthquake genesis of varying strengths. It is intriguing to note that high-velocity anomalies and low-Ï­ in the uppermost crust, interpreted as the Shillong Plateau that acted as a geometric asperity and the juxtaposition of high-V and low-V became the source zone of the 1897 Shillong earthquake (Ms 8.7) as a novel observation for the region. Structural heterogeneities are distinctly distributed between low-V, high-σ and high-V, low-σ in the lower crust plays a major role for future intense seismogenesis due to differential strain accumulation.

Seven day continuous ambulatory electrocardiographic telemetric study with pocket electrocardiographic recording device for detecting hydroxychloroquine induced arrhythmias.

Objective: The use of hydroxychloroquine (HCQ) for COVID-19 treatment and prophylaxis raised issues concerning its cardiac safety owing to the possibility of QT prolongation and arrhythmias. There was no study on long-term electrocardiographic telemetry monitoring of patients taking HCQ. We planned a continuous electrocardiographic Holter telemetry of these patients for 7 days. Material and Methods: Health care workers taking HCQ as pre exposure prophylaxis and patients on HCQ were monitored using seven day Holter electrocardiographic telemetry with continuous beat to beat analysis. Telemetry can instantly convey any arrhythmic event or significant QT prolongation to the medical faculty. Results: Twenty-five participants with a mean age of 42.4 ± 14.1 years were included in the study; 40% were females. Twenty percent of participants needed to stop HCQ. Four patients developed QT prolongation >500 ms and needed to stop HCQ, one patient had accelerated idioventricular rhythm and stopped treatment, and one had short episodes of atrial fibrillation. No malignant arrhythmia or ventricular arrhythmia, or torsade de pointis were noted. No episode of significant conduction disturbance and arrhythmic death was noted. Baseline mean QTc was 423.96 ± 32.18 ms, mean QTc corrected at 24 h was 438.93 ± 37.95, mean QTc was 451.879 ± 37.99 at 48 h, and change in baseline mean QTc to max QTc was 30.74 ± 21.75 ms at 48 h. All those who developed QTc prolongation >500 ms were greater than 50 years of age. Conclusion: Ambulatory telemetry ECG monitoring detects early QT prolongation, and stopping drugs prevents malignant arrhythmias. HCQ seems to have less risk of QT prolongation in young, healthy individuals.

Hybrid multi-kernel SVM algorithm for detection of microaneurysm in color fundus images.

Diabetic retinopathy (DR) is a chronic disease that may cause vision loss in diabetic patients. Microaneurysms which are characterized by small red spots on the retina due to fluid or blood leakage from the weak capillary wall often occur during the early stage of DR, making screening at this stage is essential. In this paper, an automatic screening system for early detection of DR in retinal images is developed using a combined shape and texture features. Due to minimum number of hand-crafted features, the computational burden is much reduced. The proposed hybrid multi-kernel support vector machine classifier is constructed by learning a kernel model formed as a combination of the base kernels. This approach outperforms the recent deep learning techniques in terms of the evaluation metrics. The efficiency of the proposed scheme is experimentally validated on three public datasets - Retinopathy Online Challenge, DIARETdB1, MESSIDOR, and AGAR300 (developed for this study). Studies reveal that the proposed model produced the best results of 0.503 in ROC dataset, 0.481 in DIARETdB1, and 0.464 in the MESSIDOR dataset in terms of FROC score. The AGAR300 database outperforms the existing MA detection algorithm in terms of FROC, AUC, F1 score, precision, sensitivity, and specificity which guarantees the robustness of this system.

Dissecting The role of Plasmodium metacaspase-2 in malaria gametogenesis and sporogony.

The family of apicomplexan specific proteins contains caspases-like proteins called "metacaspases". These enzymes are present in the malaria parasite but absent in human; therefore, these can be explored as potential drug targets. We deleted the MCA-2 gene from Plasmodium berghei genome using a gene knockout strategy to decipher its precise function. This study has identified that MCA-2 plays an important role in parasite transmission since it is critical for the formation of gametocytes and for maintaining an appropriate number of infectious sporozoites required for sporogony. It is noticeable that a significant reduction in gametocyte, oocysts, ookinete and sporozoites load along with a delay in hepatocytes invasion were observed in the MCA-2 knockout parasite. Furthermore, a study found the two MCA-2 inhibitory molecules known as C-532 and C-533, which remarkably inhibited the MCA-2 activity, abolished the in vitro parasite growth, and also impaired the transmission cycle of P. falciparum and P. berghei in An. stephensi. Our findings indicate that the deletion of MCA-2 hampers the Plasmodium development during erythrocytic and exo-erythrocytic stages, and its inhibition by C-532 and C-533 critically affects the malaria transmission biology.

Management of Psoriatic Erythroderma with Ayurvedic herbomineral preparations: A case report.

Psoriatic Erythroderma (PsE) is a presentation of Erythroderma due to a history of psoriasis showing inflammation and exfoliation of epidermal skin characterized by erythema and scaling. There is no definite treatment in contemporary medical science but the principle-based Ayurvedic approach has been proved to be effective. We present a case of PsE treated for 3 months with Ayurvedic herbomineral preparations and dietary restrictions for non-vegetarian and dairy items. As per the Ayurvedic diagnostic view, the presented case is correlated with Audumbara Kushtha and Ekakushtha due to their intricate features. Thus, Ayurvedic approaches were directed to eliminate vitiated doshas responsible for acute exacerbation of Kushtha (∼dermatitis) and to maintain equilibrium among them. The patient was initially considered as a case of Saam stage of Kushtha with Pitta-Rakta-Vata predominance. Thus, management was planned into different domains-treatment of Saam stage of Kushtha, Vyadhipratyanika chikitsa (∼disease antagonistic treatment), Rasayana intervention (∼Immunomodulation therapy) and Ayurvedic drugs were given accordingly. The assessment was done based on subjective parameters and PASI score. The patient was followed for about one and half year without any complication and relapse. This case study shows PsE can be managed with an Ayurvedic approach and proper diet planning.

SecDH: Security of COVID-19 images based on data hiding with PCA.

Nowadays, image security and copyright protection become challenging, especially after the COVID-19 pandemic. In the paper, we develop SecDH as a medical data hiding scheme, which can guarantee the security and copyright protection of the COVID-19 images. Firstly, the cover image is normalized, which offers high resistance against the geometric attacks. Secondly, the normalized principal component as embedding factor is computed, which are calculated based on principal component analysis (PCA) between cover and mark image. Thirdly, the medical image is invisibly marked with secret mark based on normalized component, redundant discrete wavelet transform (RDWT) and randomized singular value decomposition (RSVD) is introduced. Finally, Arnold cat map scheme employed to ensure the security of the watermarking system. Under the experimental evaluation, our SecDH tool is not only imperceptible, but also has a satisfactory advantage in robustness and security compared with the traditional watermarking schemes.

Myofascial release versus other soft tissue release techniques along superficial back line structures for improving flexibility in asymptomatic adults: A systematic review with meta-analysis.

OBJECTIVE: Our review is aimed to find out the efficacy of Myofascial Release Technique (MFRT) based on the Randomised Controlled Trials, on flexibility when given along superficial back line (SBL) structures and to compare it with other soft tissue release techniques. DATA SOURCES: A systematic literature search on MEDLINE (Pubmed), Google Scholar, Science direct, Cochrane Library, Physiotherapy Evidence Database (PEDro) and Clinical Trial Database in English; up to April 2020 was undertaken. STUDY SELECTION: PRISMA (The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) was used for screening the relevant citations and reviewing the relevant studies. The literature searched total of 6,938 articles, however, only 68 were screened for eligibility. In the further screening, 16 studies fulfilled the inclusion criteria for our systematic review. DATA EXTRACTION: Data were extracted into a table containing sample size, mean age of subjects, types of intervention, area to be treated, outcome measures used, and results of the accepted studies. DATA SYNTHESIS: 16 randomized controlled trials and cross-over trials were found to be eligible for our review. Quality assessment of the RCTs was done with the PEDro scoring method. Randomised clinical trials that studied the comparative effect of Myofascial Release (MFRT) technique with different MFRT techniques, control/sham, and other soft tissue release techniques like stretching, were included. Results of this analysis showed little evidence proving the additional effectiveness of MFRT treatment compared to other soft tissue release techniques for improving flexibility so as to consider it as the preferred treatment. Methodological aspects of selected studies for further research are suggested. Study was registered in the PROSPERO database (CRD42020179118). CONCLUSION: MFRT appears to be a good technique for improving flexibility. However, in comparison with other soft tissue release techniques, this therapy becomes less successful. More research is needed regarding its effectiveness.

Estimation and comparison of integral dose to target and organs at risk in three-dimensional computed tomography image-based treatment planning of carcinoma uterine cervix with two high-dose-rate brachytherapy sources: 60Co and 192Ir.

BACKGROUND: Iridium-192 (192Ir) has been a widely accepted radioisotope for high-dose-rate (HDR) brachytherapy. Recently, Cobalt-60 (60Co) radioisotope with a longer half-life (5.26 years) has been gaining popularity due to economic and logistical reasons as compared with the traditional 192Ir. AIM: This study aimed to evaluate and compare the integral dose (ID) to the target and organs at risk (OARs) with two HDR brachytherapy sources in brachytherapy treatment of carcinoma uterine cervix to find appropriate HDR radioisotopes for clinical benefit. MATERIALS AND METHODS: This is a retrospective analysis of 52 computed tomography image-based brachytherapy plans of 52 patients who have received intracavitary treatment with 192Ir HDR source. For each patient plan, one additional set of plan was created using 60Co source in place of 192Ir source keeping the same dwell position, and again dose was optimized. The volume and mean dose for target, OARs, and volume structures of 400%, 200%, 150%, 100%, and 50% were recorded for the estimation and comparison of ID. RESULTS: The mean ID to high-risk clinical target volume was significantly higher by 5.84% in 60Co plan than that in 192Ir plan. For OARs, the mean ID to the rectum was significantly higher by 2.60% in 60Co plan as compared to 192Ir plan, whereas for bladder and sigmoid colon, it was lower in 60Co plan than that in 192Ir plan. The mean ID of central dose volume structures of 400%, 200%, 150%, 100%, and 50% was higher by 12.97%, 9.77%, 8.16%, 6.10%, and 3.22%, respectively, in 60Co plan than that of 192Ir plan. CONCLUSION: The results of our study concluded that 192Ir HDR radioisotope should be preferred for intracavitary brachytherapy due to its ideal physical characteristics for better clinical outcomes.

Genetic gain for rice yield in rainfed environments in India.

The complexity of genotype × environment interactions under drought reduces heritability, which determines the effectiveness of selection for drought tolerance and development of drought tolerant varieties. Genetic progress measured through changes in yield performance over time is important in determining the efficiency of breeding programmes in which test cultivars are replaced each year on the assumption that the new cultivars will surpass the older cultivars. The goal of our study was to determine the annual rate of genetic gain for rice grain yield in a drought-prone rainfed system in a series of multi-environment trials conducted from 2005 to 2014 under the Drought Breeding Network of Indian sites in collaboration with the International Rice Research Institute (IRRI). Our results show a positive trend in grain yield with an annual genetic yield increase of about 0.68 % under irrigated control, 0.87 % under moderate reproductive stage drought stress and 1.9 % under severe reproductive stage drought stress due to breeding efforts. The study also demonstrates the effectiveness of direct selection for grain yield under both irrigated control as well as managed drought stress screening to improve yield in typical rainfed systems. IRRI's drought breeding programme has exhibited a significant positive trend in genetic gain for grain yield over the years under both drought stress as well as favorable irrigated control conditions. Several drought tolerant varieties released from the programme have outperformed the currently grown varieties under varied conditions in the rainfed environments on farmers' fields.