Does lung ultrasound-guided ultrafiltration lead to better outcomes in acute kidney injury requiring intermittent hemodialysis: A randomized control trial.

INTRODUCTION: Optimization of ultrafiltration during hemodialysis is a critical parameter in achieving therapeutic efficacy and ensuring hemodynamic stability. While various modalities such as blood volume monitoring, inferior vena cava diameter assessment, natriuretic peptide levels, bioimpedance assay, and lung ultrasound have been widely explored in the context of maintenance hemodialysis, the concept of volume-guided ultrafiltration in dialysis patients with acute kidney injury remains unexplored. METHODS: Adult patients with acute kidney injury requiring dialysis, who were hemodynamically stable and not on ventilator support, without underlying lung pathology or cardiac failure, were randomized into two groups. All patients underwent 28-zone lung ultrasound before dialysis. The ultrafiltration was decided based on the treating physician's clinical judgment in controls. In the intervention group, the ultrafiltration orders prescribed by the treating physician were modified, based on the Kerley B line scores obtained by lung ultrasound. The rest of the dialysis prescriptions were similar. A postdialysis lung ultrasound was done in both groups to assess the postdialysis volume status 30 min after the dialysis session. RESULTS: A total of 74 patients undergoing hemodialysis for acute kidney injury were randomized. The baseline characteristics were comparable except for higher baseline B line score scores in the intervention arm. All patients received similar dialysis prescriptions. The lung ultrasound-guided ultrafiltration arm had a higher change in B line scores (BLS) from baseline (4 [0-9.5] vs. 0 [0-4]; p value 0.004) during the first dialysis session. The predialysis BLS indexed to ultrafiltration (mL/kbw/h) were significantly lower in controls, reflecting a relatively higher rate of ultrafiltration in controls compared with intervention (p = 0.006). The total number of dialysis sessions done in the control and intervention arm were 61 and 59, respectively. Among controls, 23/61 sessions (37.7%) had intradialytic adverse events, whereas, in the intervention arm, only 4/59 sessions (6.7) had any adverse intradialytic events (p < 0.01). CONCLUSION: Lung ultrasound-guided ultrafiltration was associated with a better safety profile, as demonstrated by reduced intradialytic events.

Assessment of Nutritional Status and Correlation of Factors With Body Mass Index of Cancer Patients: A Cross-Sectional Study.

BACKGROUND: Decreased diet intake and malnourishment have profound implications on cancer patients' quality of life and survival. Malnutrition increases the risk of postoperative complications, increases hospital length stays, reduces patient's tolerance to radiation and chemotherapy treatment, and results in poor response to treatment. In the present study, we intended to assess the nutritional status of cancer patients and find the correlation of body mass index with anthropometric and blood parameters. MATERIAL & METHODS: The study was prospective and cross-sectional, and 104 patients with newly diagnosed solid tumors were included. Patient demographics, symptoms, and anthropometric and blood parameters were collected. The correlation was estimated with Pearson's correlation coefficient. A p-value of less than 0.05 was considered significant. RESULTS: The association between stages of the disease, dental status, type of diet, and BMI was p=0.701, 0.216, and 0.422, respectively, and was not statistically significant. The anthropometric parameters mid upper arm circumference (MUAC cm), mid arm circumference (MAC cm), and triceps skinfold thickness (TSF mm) correlated with body mass index (BMI kg/m2) and had statistically significant p values of 0.0001, 0.0001, and 0.033, respectively. The correlation was assessed between hemoglobin, red cell distribution width, neutrophil-to-lymphocyte ratio, and serum albumin levels with BMI, but except for albumin (p=0.05), no other blood parameter correlated. CONCLUSION: Nutritional assessment is vital in recognizing patients at risk of treatment-associated complications and poor responders to treatment. In this study, BMI correlated with anthropometric parameters MUAC, MAMC, and TSF. Baseline dietary assessments of patients will help focus on the nutritional build-up of patients before starting treatment.

Artificial Intelligence's Impact on Drug Discovery and Development From Bench to Bedside.

Artificial intelligence (AI) techniques have the potential to revolutionize drug release modeling, optimize therapy for personalized medicine, and minimize side effects. By applying AI algorithms, researchers can predict drug release profiles, incorporate patient-specific factors, and optimize dosage regimens to achieve tailored and effective therapies. This AI-based approach has the potential to improve treatment outcomes, enhance patient satisfaction, and advance the field of pharmaceutical sciences. International collaborations and professional organizations play vital roles in establishing guidelines and best practices for data collection and sharing. Open data initiatives can enhance transparency and scientific progress, facilitating algorithm validation.

A Comparative Analysis of Methods of Endmember Selection for Use in Subpixel Classification: A Convex Hull Approach.

Mixed pixels in aerial and satellite images are common, especially near the boundaries of two or more discrete classes; that is, they tend to occur at the transitional region between two classes. Ideally, to decipher the mixed pixel, a soft classification is performed compared to a hard- or a per-pixel classification. Soft or subpixel classification is carried out where the fractional cover of the LULC contained within a pixel is derived. Endmembers are extracted for three VNIR bands of ASTER data for two image datasets using three approaches, namely, principal component analysis (PCA), pixel purity index (PPI), and convex hull-Graham scan (CHGS). On comparing the DN values of the identified endmembers, it is observed that the CHGS method provides the most appropriate end members than the PCA-derived and PPI-derived end members. This is based on deriving the endmembers from two different image conditions. Convex hull implemented using the Graham scan algorithm delineates the pure pixel and pinpoints the exact number of endmembers. These accurate end members would result in accurate proportions of the land cover for better modeling of the terrain.

Maltooligosaccharide forming amylases and their applications in food and pharma industry.

Oligosaccharides are low molecular weight carbohydrates with a wide range of health benefits due to their excellent bio-preservative and prebiotic properties. The popularity of functional oligosaccharides among modern consumers has resulted in impressive market demand. Organoleptic and prebiotic properties of starch-derived oligosaccharides are advantageous to food quality and health. The extensive health benefits of oligosaccharides offered their applications in the food, pharmaceuticals, and cosmetic industry. Maltooligosaccharides and isomaltooligosaccharides comprise 2-10 glucose units linked by α-1-4 and α-1-6 glycoside bonds, respectively. Conventional biocatalyst-based oligosaccharides processes are often multi-steps, consisting of starch gelatinization, hydrolysis and transglycosylation. With higher production costs and processing times, the current demand cannot meet on a large-scale production. As a result, innovative and efficient production technology for oligosaccharides synthesis holds paramount importance. Malto-oligosaccharide forming amylase (EC 3.2.1.133) is one of the key enzymes with a dual catalytic function used to produce oligosaccharides. Interestingly, Malto-oligosaccharide forming amylase catalyzes glycosidic bond for its transglycosylation to its inheritance hydrolysis and alternative biocatalyst to the multistep technology. Genetic engineering and reaction optimization enhances the production of oligosaccharides. The development of innovative and cost-effective technologies at competitive prices becomes a national priority.

Self-aggregation, H-bonding, and photoresponse in film and solution states of azobenzene containing polyurea.

We critically understand the hydrogen bonding interactions and electronic transitions occurring in a thin film as well as in solution of a photo-responsive polymer, azo-polyurea (azo-PU). We synthesize azo-PU by covalent attachment of the azobenzene chromophore to the main chain of polyurea. Azo-PU shows reversible photoisomerization between trans and cis states upon light exposure, the occurrence of which is typically analysed using the π-π* and n-π* electronic transition peaks in the UV-visible absorption spectrum. We find that the π-π* and n-π* bands undergo a redshift and blueshift respectively on dissolving azo-PU in DMF solvent, resulting in a single overlapped peak in the spectrum. However, upon UV irradiation, these bands split into two independent transitions that are characteristic of azo-PU solid films. These observations are explained based on the changes in polymer-polymer and polymer-solvent interactions through hydrogen bonding and self-aggregation tendency. The experimental findings are corroborated using DFT simulations which provide useful insights into electronic orbital transitions, electron distribution, and hydrogen bonding interaction through IR vibrational modes.

Assessment of patient's knowledge, attitude, and beliefs about cancer: An institute-based study.

INTRODUCTION: Knowledge about cancer, treatment, and likely treatment outcomes is critically important for decision-making regarding adherence to the treatment. Hence, it seems imperative to find out the attitude and belief of cancer patients to determine the efficacy of cancer diagnostic and treatment available along with assessing the efficacy of prevention. The purpose of this study was to determine the level of knowledge, belief, and attitude of cancer patients who came to our facility. MATERIALS AND METHODS: The present study was a descriptive cross-sectional study which was conducted at All India Institute of Medical Sciences, Rishikesh, from July 2020 to December 2020. One hundred fifty-six newly diagnosed cancer patients were recruited. The participants were provided with a validated 44 key questionnaire divided into four different categories including the sociodemographic profile, knowledge, belief, and attitude subheading. Mean, frequency, percentage, and Chi-square test were calculated to do data analysis using SPSS version 23.0. RESULTS: Out of the total of 156 newly diagnosed cancer patients, only 130 patients provided responses so the overall response rate was 84.3%. Most of cancer patients had moderately adequate knowledge (79 [60.5%]), poor belief (111 [86%]), and neutral attitude (69 [54%]) regarding cancer. The Chi-square test revealed a link between educational level and cancer knowledge (P = 0.01). Males showed a more positive attitude than females, and this difference was statistically significant (P = 0.02). CONCLUSIONS: Cancer patients need to be made more aware of the red flag signs of cancer and improvise their attitude toward cancer. Cancer care programs should not only involve cancer patients but also involve their caregivers because the understanding of family members is of utmost importance to fight this disease.

Fear, Anxiety, Stress, and Depression of Novel Coronavirus (COVID-19) Pandemic Among Patients and Their Healthcare Workers - A Descriptive Study.

PURPOSE: Disease pandemics are known to cause psychological distress. The ensuing mental health issues are not only restricted to the patients and their relatives/friends but affect the healthcare workers (HCWs) as well. Our study aims to assess these psychological trends during the COVID-19 pandemic between the two most affected population groups, that is, patients and frontline healthcare workers. PATIENTS AND METHODS: A survey questionnaire, including scales to assess fear, anxiety, stress, depression - PSS 10, and DASS 21, was distributed and sent to all COVID-19 suspected/confirmed individuals and healthcare workers at a tertiary care center along with a second visit after 14 days of answering the first questionnaire and this continued as follow-up. Data were analyzed with the SPSS version 23 using various tests of significance. RESULTS: In the community, COVID-19 patients in the age group 41-50 with respiratory tract symptoms and those who were home isolated/quarantined experienced a greater tendency of mental health problems. Healthcare workers posted in COVID-19 designated areas of the hospital displayed higher levels of stress, anxiety, and depression. CONCLUSION: The high degree of uncertainty associated with novel pathogens has a profound effect on the psychological state of suspected/confirmed cases as well as healthcare workers. Within the community, individuals suspected of having COVID-19 display a significant mental health burden, while HCWs also experience an unprecedented amount of stress, anxiety, depression and fear during such enduring situations.

Streptomyces lonarensis sp. nov., isolated from Lonar Lake, a meteorite salt water lake in India.

A novel alkaliphilic actinomycete, strain NCL716(T), was isolated from a soil sample collected from the vicinity of Lonar Lake, an alkaline salt water meteorite lake in Buldhana district of Maharashtra State in India. The strain was characterised using a polyphasic taxonomic approach which confirmed that it belongs to the genus Streptomyces. Growth was observed over a pH range of 7-11 at 28 °C. The cell wall was found to contain LL-diaminopimelic acid and traces of meso-diaminopimelic acid. The major fatty acid components were identified as iso-C16:0 (46.8 %), C17:1 (12.4 %), anteiso-C15:0 (5.1 %) and anteiso-C17:1 (4.8 %). The major polar lipids were identified as diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylglycerol and phosphatidylinositol. The major menaquinones were determined to be MK-9 (H6) (70.3 %), MK-9 (H4) (15.5 %) and MK-9 (H8) (7.2 %). The G+C content of the DNA of the type strain was determined to be 71.4 mol %. The 16S rRNA gene sequence has been deposited in GenBank with accession number FJ919811. Although the 16S rRNA gene sequence analysis revealed that strain NCL716(T) shares >99 % similarity with that of Streptomyces bohaiensis strain 11A07(T), DNA-DNA hybridization revealed only 33.2 ± 3.0 % relatedness between them. Moreover, these two strains can be readily distinguished by some distinct phenotypic characteristics. Hence, on the basis of phenotypic and genetic analyses, it is proposed that strain NCL716(T) represents a novel species of the genus Streptomyces, for which the name Streptomyces lonarensis sp. nov., is proposed. The type strain is NCL 716(T) (=DSM 42084(T) = MTCC 11708(T) = KCTC 39684(T)).

Validated RP-HPLC Method for Simultaneous Quantitation of Losartan Potassium and Metolazone in Bulk Drug and Formulation.

A HPLC method has been described for simultaneous determination of Losartan potassium and Metolazone in formulation. This method is based on a HPLC separation of the two drugs on the Thermo Hypersil BDS-C(18) (250 mm × 4.6 mm, 5.0 µm) with isocratic conditions and a simple mobile phase containing acetonitrile:water (60:40) at a flow rate of 0.8 mL/min using UV detection at 237 nm. This method has been applied to a marketed formulation without interference of excipients. The linear regression analysis data for the calibration plots showed a good linear relationship over the concentration range of 2-12 µg/mL for Losartan potassium and 0.2-1.2 µg/mL for Metolazone, respectively. The method was validated for precision, robustness and recovery. Statistical analysis showed that the method is repeatable and selective for the estimation of Losartan potassium and Metolazone.

Application of a stability-indicating thin-layer chromatographic method to the determination of tenatoprazole in pharmaceutical dosage forms.

A sensitive, selective, precise, and stability-indicating thin-layer chromatographic (TLC) method was developed and validated for the determination of tenatoprazole both as a bulk drug and in formulation. The method uses TLC aluminum plates precoated with Silica Gel 60F-254 as the stationary phase and the solvent system toluene-ethyl acetate-methanol (6 + 4 + 1, v/v/v). This system gave compact spots for tenatoprazole (Rf value of 0.34 +/- 0.02). Tenatoprazole was subjected to acid and alkali hydrolysis, oxidation, and photodegradation. The peaks of the degradation products were well-resolved from that of the pure drug and had significantly different Rf values. Densitometric analysis of tenatoprazole was performed in the absorbance mode at 306 nm. The linear regression analysis data for the calibration plots showed a good linear relationship over the concentration range of 100-1500 ng/spot. The mean values of the correlation coefficient, slope, and intercept were 0.9989 +/- 1.42, 10.27 +/- 0.965, and 4894.2 +/- 1.24, respectively. The method was validated for precision, robustness, and recovery. The limit of detection and limit of quantitation were 50 and 100 ng/spot, respectively. Statistical analysis showed that the method is repeatable and selective for estimation of tenatoprazole. Because the method can separate the drug from its degradation products, it can be used to monitor stability.

Continuous glucose monitoring system--useful but expensive tool in management of diabetes.

Until recently, self monitoring of blood glucose (SMBG) was the only tool used for monitoring blood glucose levels. The limitation of SMBG is that it cannot continuously monitor blood glucose levels. In this paper, we present our initial experience with the continuous glucose monitoring system (CGMS) in three different clinical situations. With reduction in cost and further refinement in technology, CGMS could become a valuable tool for clinical practice and research studies in diabetes.

Prevalence of non-diabetic renal disease in type 2 diabetic patients in a diabetes centre in Southern India.

OBJECTIVE: The Aim of Study is to determine the prevalence of non-diabetic renal disease among South Indian type 2 diabetic subjects based on renal biopsy. METHODS: Three thousand five hundred and ninety subjects with complete records were included for the study. One hundred and forty subjects who had proteinuria but no evidence of retinopathy undertook a 24 hour proteinuric estimation. Of these 140 subjects, 28 subjects had proteinuria > 1,000 mg/day and were subjected to renal imaging. Seven subjects were excluded due to renal calculi, cysts or contracted kidneys. Of the remaining 21 diabetic subjects, one subject was excluded as he had a mild diabetic retinopathy on fundus fluorescein angiography. Of the 20 subjects included 18 participated in the renal biopsy study (response rate--90%). Renal pathology of these subjects were studied. RESULTS: Of the 18 renal biopsies, two were excluded due to different reasons. Out of 16 patients, eight (50%) had pathological changes suggestive of diabetic etiology, five (33.3%) had classical membranous nephropathy, one (6.2%) had tubulo-interstitial disease and two (12.5%) were categorized as others with minimal changes. The subjects with non-diabetic renal disease had significantly higher creatinine clearance (p = 0.024), serum cholesterol (p = 0.036), triglyceride levels (p = 0.045) and LDL cholesterol (p = 0.048) compared to subjects with diabetic nephropathy. CONCLUSION: This study suggests that even in subjects clinically suspected to have non-diabetic renal disease many may turn out to have diabetic nephropathy on renal biopsy.