A quality-by-design evaluated liquid chromatography method development and validation for the separation and quantification of nitroxoline and its impurities.

A novel, isocratic, sensitive, stability-indicating high-performance liquid chromatography method was developed for the separation and quantification of related substances in nitroxoline (NTL). The chromatographic separation has been achieved on Inertsil ODS-3 V, (250 × 4.6 mm, 5 µm) at 240 nm using ethylenediamine tetraacetic acid buffer and methanol in the ratio of 60:40 v/v as mobile phase. The performance of the method has been checked as per the International Conference on Harmonization guidelines for specificity, linearity, accuracy, precision, and robustness. Regression analysis showed a correlation coefficient value greater than 0.99 for NTL and its three impurities. The detection limit of impurities was in the range of 0.01% (0.05 µg/mL)-0.22% (1.1 µg/mL) indicating the sensitivity of the newly developed method. The accuracy of the method was established based on the recovery obtained between 94.7% and 104.1% for all the impurities. The percentage relative standard deviation obtained for the repeatability was less than 4.0% at the specification level for all impurities. Forced degradation was performed to establish the stability-indicating nature of the method and to know about the degradation products, the quality of a drug substance changes with time under the influence of stress conditions. Thus, the proposed method was validated and found to be specific, sensitive, linear, accurate, precise, reproducible, and beneficial for routine usage.

Knowledge, Attitude, and Practice of Physiotherapists about Cardiac Rehabilitation Program Adherence among Patients Discharged from the Hospital after Cardiac Surgery in India.

Background: In most settings, patients receive phase 1 cardiac rehabilitation in CTVS ICU at the hospital, but there are several barriers to follow-up after patients are discharged from the hospital. Physiotherapists play an important role in the enrolment and continuation of cardiac rehabilitation. Thus, we aim to study the knowledge, attitude, and practice of physiotherapists about CR program adherence among patients discharged from the hospital after cardiac surgery. Objectives: (i) To study the knowledge of physiotherapists about the importance of cardiac rehabilitation after discharge; (ii) to know the attitude of physiotherapists towards cardiac surgery patients after discharge; and (iii) to know what approach various centres are applying for patients after discharge to ensure adherence to cardiac rehabilitation. Methods: A questionnaire was developed with reference to the objectives of the study, which was answered by a total of 127 physiotherapists. Results: The overall response rate was 42.3%; nearly 35.4% of the participants indicated that they knew a lot about CR, while 5.5% said they knew very little. Regarding the program's content, 36.2% of participants reported having a medium degree of awareness of the diverse CR components, while 8.6% reported having very little knowledge of them. Only about one-third, 35.7% stated that CR in India is effective and 95% believed that CR will have an added value for the country. Approximately 80% of respondents thought that it would be challenging for a physiotherapist to recommend patients to a CR in the nation. Nearly 35% of respondents believed that they, "themselves as physios," needed to commence CR, and slightly less than 70% thought that doctors were required to choose and refer the patients when asked who should take the initiative to start this kind of programme in the country. A little over 40% of respondents said that insurance firms are also involved in starting a CR programme. Conclusion: Physiotherapists have good knowledge of cardiac rehabilitation. However, their attitude and practice towards adherence to exercise protocols are confounded by various clinician- and patient-level factors.

Drug-Carrier Miscibility in Solid Dispersions of Glibenclamide and a Novel Approach to Enhance Its Solubility Using an Effervescent Agent.

The present research aims to investigate the miscibility, physical stability, solubility, and dissolution rate of a poorly water-soluble glibenclamide (GLB) in solid dispersions (SDs) with hydrophilic carriers like PEG-1500 and PEG-50 hydrogenated palm glycerides (Acconon). Mathematical theories such as Hansen solubility parameters, Flory Huggins theory, Gibbs free energy, and the in silico molecular dynamics simulation study approaches were used to predict the drug-carrier miscibility. To increase the solubility further, the effervescence technique was introduced to the conventional solid dispersions to prepare effervescent solid dispersions (ESD). Solid dispersions (SDs) were prepared by microwave, solvent evaporation, lyophilization, and hot melt extrusion (HME) techniques and tested for different characterization parameters. The theoretical and in silico parameters suggested that GLB would show good miscibility with the selected carriers under certain conditions. Intermolecular hydrogen bonding between the drug and carrier(s) was confirmed by Fourier transform infrared spectroscopy and proton nuclear magnetic resonance spectroscopy. Solid-state characterizations like powder X-ray diffraction, differential scanning calorimetry, and microscopy confirm the amorphous nature of SDs. The addition of the effervescent agent improved the amorphous nature, due to which the solubility and drug release rate was increased. In vitro and ex vivo intestinal absorption studies showed improved flux and permeability than the pure drug, suggesting an enhanced drug delivery. The GLB solubility, dissolution, and stability were greatly enhanced by the SD and ESD technology.

Additive-free Aqueous Dispersions of Two-Dimensional Materials with Glial Cell Compatibility and Enzymatic Degradability.

Water-dispersible two-dimensional (2D) materials are desirable for diverse applications. Aqueous dispersions make processing safer and greener and enable evaluation of these materials on biological and environmental fronts. To evaluate the effects of 2D materials with biological systems, obtaining dispersions without additives is critical and has been a challenge. Herein, a method was developed for obtaining additive-free aqueous dispersions of 2D materials like transition metal dichalcogenides and hexagonal boron nitride (h-BN). The nanosheet dispersions were investigated through spectroscopic and microscopic methods, along with the role of size on stability. The aqueous media enabled investigations on cytocompatibility and enzymatic degradation of molybdenum disulphide (MoS2 ) and h-BN. Cytocompatibility with mixed glial cells was observed up to concentrations of 100 µg mL-1 , suggesting their plausible usage in bioelectronics. Besides, biodegradation using human myeloperoxidase (hMPO) mediated catalysis was investigated through Raman spectroscopy and electron microscopy. The findings suggested that additive-free 2H-MoS2 and h-BN were degradable by hMPO, with 2H-phase exhibiting better resistance to degradation than the 1T-phase, while h-BN exhibited slower degradation. The findings pave a path for incorporating 2D materials in the burgeoning field of transient bioelectronics.

Pedometer-based Exercise Interventions for Patients with Breast Cancer Receiving Chemotherapy - A Systematic Review.

BACKGROUND: Exercises such as walking are prescribed for the patients with breast cancer receiving chemotherapy, but only a few studies include pedometers in conjunction with the routine exercises prescribed. Thus, the aim was to find if the adherence and performance of exercise is improved or has no impact if coupled with the physical activity monitors. METHODS: A systematic search using the keywords was conducted in PubMed Central, CINAHL, Embase, Cochrane Library, and Scopus. The search revealed 275 articles, of which 3 randomized controlled trials were selected for qualitative analysis based on the inclusion and exclusion criteria for the review. RESULTS: The three studies retrieved by the systematic review have used different protocols of pedometer-based walking on patients with breast cancer undergoing chemotherapy and studied the following outcome measures: fatigue, body composition, quality of life, and psychological factors. CONCLUSION: The evidence obtained from the review suggests that pedometer-based walking programs have a positive impact on cancer-related fatigue and overall quality of life of patients with breast cancer receiving chemotherapy.

Self-Assembly of Tyrosine into Controlled Supramolecular Nanostructures.

In the context of designing novel amino acid nanostructures, the capacity of tyrosine alone to form well-ordered structures under different conditions was explored. It was observed that Tyr can self-assemble into well-defined morphologies when deposited onto surfaces for transmission electron microscopy, atomic force microscopy, and scanning electron microscopy. The influence of various parameters that can modulate the self-assembly process, including concentration of the amino acid, aging time, and solvent, was studied. Different supramolecular architectures, including nanoribbons, branched structures, and fern-like arrangements were also observed.

Fluorescent Biotin Analogues for Microstructure Patterning and Selective Protein Immobilization.

Benzyl substitution on ureido nitrogens of biotin led to manifestation of aggregation-induced emission, which was studied by steady-state fluorescence, microscopy, and TD-DFT, providing a rationale into the observed photophysical behavior. Besides exhibiting solvatochromism, the biotin derivatives revealed emission peaks centered at ∼430 and 545 nm, which has been attributed to the π-π stacking interactions. Our TD-DFT results also correlate the spectroscopic data and quantify the nature of transitions involved. The isothermal titration calorimetry data substantiates that the binding of the biotin derivatives with avidin are pretty strong. These derivatives on lithographic patterning present a platform for site specific strept(avidin) immobilization, thus opening avenues for potential applications exploiting these interactions. The fluorescent biotin derivatives can thus find applications in cellular biology and imaging.

Comparing distributed versus massed practice on functional recovery and Brain-Derived Neurotrophic Factor (BDNF) in acute stroke subjects.

Objectives: Globally, stroke is known to be one of the major health problems, resulting in disability among an aging population. Rehabilitation is a process of re-learning of skills, lost due to brain injury. Many factors influence motor learning post neurological insult and practice is one of the key factors which influence relearning or reacquisition of lost motor skills. Practice can be varied concerning order (blocked or random), scheduling (massed or distributed), or whole and part practice. The study observed the effect of variations in practice schedules on motor and functional recovery. Materials and Methods: Thirty-two acute stroke subjects were recruited and equally divided into two groups (16 in massed and 16 in distributed). Both groups received an accelerated skill acquisition program (ASAP) for six sessions a week for 2 weeks. Pre- and post-outcome measures included stroke rehabilitation assessment of movement (STREAM) for motor recovery, modified Barthel index (MBI) for functional recovery, and brain-derived neurotrophic factor (BDNF) for neuroplasticity. Results: The median scores of participants in the massed practice group before the intervention, of STREAM total, MBI, and BDNF were 23.5, 19, and 0.65, respectively, whereas post values of STREAM total, MBI, and BDNF were 40.5, 60.5, and 0.75, respectively. The median scores of the distributed practice group of the pre-STREAM total, MBI, and BDNF were 23.5, 6.5, and 0.70, respectively, whereas the post-STREAM total, MBI, and BDNF were 41, 45.5, and 0.80, respectively. P-value was reported to be <0.05 while comparing pre- and post-values of STREAM, MBI, and BDNF within both intervention groups. The median change scores of STREAM, MBI, and BDNF reported P ≥ 0.05 when compared between the groups. Conclusion: Both the groups had significant recovery post-intervention designed based on ASAP, about impairment mitigation, pursuing skilled movement leading to significant functional gains. Appropriate timing along with optimal dosage became an active ingredient in functional recovery in acute stroke subjects. The distributed practice might have added effect of spacing, resulting in easier learning and accuracy of skills. The study reveals that distributed practice can be part of regular clinical practice to enhance functional recovery in acute stroke rehabilitation.

Association of Tumor Necrosis Factor-Alpha (TNF-α) rs1800629 Polymorphism in Chronic Kidney Disease.

Background Chronic kidney disease (CKD) is characterized by progressive loss of kidney function. Tumor necrosis factor-alpha (TNF-α) is a cytokine implicated in inflammatory processes, including those affecting the kidneys. Although this association is not yet comprehensible, a tie-up between renal disease and markers of inflammation - interleukin-6 (IL-6), preceded by TNF-α - is eminent. However, a pause in research is evident concerning the TNF-α gene with kidney disease in the inhabitants of India. So, this study investigates the association between TNF-α rs1800629 polymorphism and CKD. Methodology A prospective case-control study was conducted in Andhra Pradesh for over three years. A total of 579 patients participated in the study. These were divided into premature, late-stage CKD, and control groups. The amplification refractory mutation system (ARMS)-polymerase chain reaction (PCR) was used, and biochemical investigations and genotyping were carried out for the study participants. Hardy-Weinberg expected frequencies (HWE) with chi-square test was used for detecting allele and genotype frequencies. The association between TNF-α (-308 G/A, rs1800629) and CKD was assessed using odds ratios (ORs) with 95% confidence intervals (CIs). Results We found a higher prevalence of CKD among males (n = 301, 52%) compared to females (n = 278, 48%). Both male and female participants diagnosed with CKD exhibited significantly elevated blood urea and serum creatinine levels compared to the control group, indicating impaired kidney function. Furthermore, these markers were generally higher in the late-stage CKD group compared to the early-stage group, suggesting a progressive decline in kidney function as the disease worsens. The homozygous genotype GG was more prevalent in late-stage CKD patients compared to both early-stage CKD patients and controls. Further, the heterozygous genotype GA was more frequent in the early-stage CKD group compared to the late-stage group. The homozygous genotype AA also showed a higher prevalence in the early-stage CKD group compared to the late-stage group. The G/G genotype and the G allele (rs1800629) were significantly associated with susceptibility to CKD (P<0.005). Conclusions Our study reported the TNF-α rs1800629 polymorphism and CKD risk in a South Indian population. G/G genotype and the G allele (rs1800629) were significantly associated with the risk of CKD. However, further research with larger sample sizes is warranted to confirm these observations and elucidate the underlying mechanisms by which TNF-α might influence CKD risk.

Beliefs, barriers, and promotion practices of Indian nurses' regarding healthy eating for cancer survivors in a tertiary care hospital-A cross sectional survey.

Purpose: To describe the beliefs, barriers and promotion practices of Indian nurses' regarding healthy eating (HE) behaviours amongst cancer survivors, and to gain insights into whether their educational qualifications might affect the promotion of HE. Methods: Data was gathered using a validated questionnaire, 388 of the approached 400 nurses who worked at a tertiary care hospital in India gave informed consent to participate in the study. The Mann-Whitney U test and the Chi square analysis (for continuous and categorical variables respectively) were performed to carry out sub-group comparisons based on the qualification of the nurses i.e., Bachelor of Science in Nursing (BSc) and General Nursing and Midwifery (GNM). Results: The nurses believed that dieticians/nutritionists were primarily responsible for educating the cancer survivors regarding HE. HE was promoted by nurses' relatively equally across multiple treatment stages ("during" treatment 24.4%, "post" treatment 23.1%; and "pre" treatment 22.3%). Nurses' believed HE practices had numerous benefits, with improved health-related quality of life (HRQoL) (75.7%), and mental health (73.9%) being the most frequent responses. The most frequently cited barriers by the nurses in promoting HE were lack of time (22.2%), and lack of adequate support structure (19.9%). Sub-group comparisons generally revealed no significant difference between the BSc and GNM nurses in their perceptions regarding HE promotion to cancer survivors. Exceptions were how the GNM group had significantly greater beliefs regarding whether HE can "reduce risk of cancer occurrence" (p = 0.004) and "whether or not I promote HE is entirely up to me" (p = 0.002). Conclusion: The nurses in India believe in the promotion of HE practices among cancer survivors across various stages of cancer treatments. However, they do face a range of barriers in their attempt to promote HE. Overcoming these barriers might facilitate effective promotion of HE among cancer survivors and help improve survivorship outcomes. Implications for cancer survivors: Indian nurses employed in the two tertiary care hospitals wish to promote HE among cancer survivors, but require further knowledge and support services for more effective promotion of HE.

Effect of Home-Based Pulmonary Rehabilitation on Pulmonary Fibrosis.

BACKGROUND: Pulmonary fibrosis is a chronic, progressive lung condition that involves lung tissue scarring and thickening. The effects of home-based pulmonary rehabilitation (PR) in post-covid pulmonary fibrosis (PCPF) and other forms of fibrosis together have not been evaluated. This study aims to evaluate the effectiveness of home-based pulmonary rehabilitation on pulmonary function, functional capacity, and health-related quality of life in people with pulmonary fibrosis (post-COVID pulmonary fibrosis, pulmonary fibrosis secondary to pulmonary tuberculosis (TB), pulmonary fibrosis secondary to interstitial lung disease (ILD), pulmonary fibrosis secondary to bronchiectasis). METHODS: A single-group pretest-posttest experimental study was performed after recruiting 98 pulmonary fibrosis subjects from K.M.C hospitals. After being screened for the inclusion and exclusion criteria, 45 subjects were analyzed, and 6 subjects were lost to follow-up.  A home-based pulmonary rehabilitation program was carried out for 8 weeks (warm-up, stretching exercises, aerobic exercise, strength training for upper limb and lower limb, breathing exercises mainly involved; others: energy saving techniques, controlled coughing techniques, dyspnea relieving positions). The program was supervised via weekly phone calls. Pulmonary function (Pulmonary function test), exercise capacity (6-minute walk test), dyspnea (modified Borg scale), and health-related quality of life (SF-36) were evaluated before and after the intervention. During the enrollment and after the 6-minute walk test, saturation of peripheral oxygen (SPO2) level was also evaluated pre-intervention and after the 8-weeks program. RESULTS: Pulmonary function [FVC(L) t = -12.52, p<0.05; FEV1(L) t = -2.56, p<0.05; FEV1/FVC t = 7.98, p<0.05 and DLCO (ml/min/mmHg) t = -5.13, p<0.05], 6MWD [MD 88.66; p<0.05] and HRQOL measured by SF-36 scores (p<0.05) were improved significantly. Both the baseline SPO2 level before the 6MWT [MD 1.07, p<0.05] and the SPO2 level after the 6MWT [MD 1.16, p<0.05] showed a significant improvement. The rating of perceived exertion(dyspnea) [MD 1.30, p<0.05] was reduced significantly after the 8-week program. CONCLUSION: Our study shows that home-based pulmonary rehabilitation is an effective option for improving lung function and physical functional capacity by reducing dyspnea perception and improving the saturation of peripheral oxygen (SPO2) level, and enhancing the quality of life in people with pulmonary fibrosis.

Effect of exercise based interventions on sleep and circadian rhythm in cancer survivors-a systematic review and meta-analysis.

Background: Disrupted circadian rhythm commonly reported in cancer survivors is closely associated with cancer related fatigue, sleep disturbances and compromised quality of life. As more cancer survivors request non-pharmacological treatment strategies for the management of their chronic sleep-related symptoms, there is a need for meta-analyses of various interventions such as exercise on sleep and circadian rhythm disturbances. Methods: A search for RCT's was conducted in April 2020 and updated in July 2023 using relevant keywords for cancer, sleep, circadian rhythm and exercise interventions on PubMed, Scopus, Web of Science, PEDro and CINAHL. Results: Thirty-six studies were included for qualitative analysis and 26, for meta-analysis. Thirty-five studies analyzed sleep outcomes, while five analyzed circadian rhythm. RCT's studying the effect of aerobic exercise, resistance exercise, combined aerobic and resistance exercise, physical activity, yoga, or tai chi were included. Meta-analysis results showed significant exercise-related improvements on sleep quality assessed by Pittsburgh Sleep Quality index (PSQI) (SMD = -0.50 [-0.87, -0.13], p = 0.008), wake after sleep onset (WASO) (SMD = -0.29 [-0.53, -0.05], p = 0.02) and circadian rhythm, assessed by salivary cortisol levels (MD = -0.09 (95% CI [-0.13 to -0.06]) mg/dL, p < 0.001). Results of the meta-analysis indicated that exercise had no significant effect on sleep efficiency, sleep onset latency, total sleep time and circadian rhythm assessed by accelerometry values. Conclusion: While some sleep and circadian rhythm outcomes (PSQI, WASO and salivary cortisol) exhibited significant improvements, it is still somewhat unclear what exercise prescriptions would optimize different sleep and circadian rhythm outcomes across a variety of groups of cancer survivors. Implication: As exercise does not exacerbate cancer-related circadian rhythm and sleep disturbances, and may actually produce some significant benefits, this meta-analysis provides further evidence for cancer survivors to perform regular exercise.

A stability indicating method development and validation of a rapid and sensitive RP-HPLC method for Nintedanib and its application in quantification of nanostructured lipid carriers.

Background: Nintedanib (NTB) is a multiple tyrosine kinase inhibitor, been investigated for many disease conditions like idiopathic pulmonary fibrosis (IPF), systemic sclerosis interstitial lung disease (SSc-ILD) and non-small cell lung cancer (NSCLC). NTB is available as oral capsule formulation, but its ability to detect degradants formed through oxidative, photolytic and hydrolytic processes makes it difficult to quantify. In the current work, a novel reversed-phase high-performance liquid chromatography (RP-HPLC) method was developed and validated. Methods: The developed method is simple, precise, reproducible, stable and accurate. The inherent stability of NTB was evaluated using the proposed analytical method approach and force degradation studies were carried out. NTB was separated chromatographically on the Shimadzu C 18 column as stationary phase (250 ×4.6 mm, 5 µm) using an isocratic elution method with 0.1% v/v triethyl amine (TEA) in HPLC grade water and acetonitrile (ACN) in the ratio 35:65% v/v. The mobile phase was pumped at a constant flow rate of 1.0 ml/min, and the eluent was detected at 390 nm wavelength. Results: NTB was eluted at 6.77±0.00 min of retention time (t R) with a correlation coefficient of 0.999, the developed method was linear in the concentration range of 0.5 µg/ml to 4.5 µg/ml. The recovery rate was found to be in the range of 99.391±0.468% for 1.5 µg/ml concentration. Six replicate standards were determined to have an % RSD of 0.04. Conclusion: The formulation excipients didn't interfere with the determination of NTB, demonstrating the specificity of the developed method. The proposed approach of the analytical method developed can be used to quantify the amount of NTB present in bulk drugs and pharmaceutical formulations.

Folic acid-chitosan functionalized polymeric nanocarriers to treat colon cancer.

In the present study, polymeric nanoparticles loaded with IRI and quercetin, a p-gp inhibitor, were developed to target folate receptors expressed by colon cancer cells for oral targeted delivery. This work reports the development of PNPs with an entrapment efficiency of 41.26 ± 0.56 % for IRI and 55.83 ± 4.51 for QT. PNPs were further surface modified using chitosan-folic acid conjugates for better targetability to obtain folic acid-chitosan coated nanoparticles. DLS and FeSEM revealed particles in the nanometric size range with spherical morphology, while FTIR and DSC provided details on their structure and encapsulation. In vitro drug release studies confirmed a sustained release pattern of IRI and QT, while cell line studies confirmed the superiority of C-FA-PNPs when tested on Caco2 cells. Pharmacodynamic studies in colon cancer induced rats showed similar efficacy for PNPs and C-FA-PNPs. Further examination from a bio-distribution study in healthy rats, revealed the failure of C-FA-PNPs to deliver the drugs to the colon adequately, while the PNPs improved the available concentration of IRI at the colon by almost 1.8 folds when compared to the available marketed product. Hence, the developed PNP formulation sticks out as a plausible substitute for the intravenous dosage forms of IRI which have been conventionally prevailing.

Cytogenetic investigation of patients with primary amenorrhea.

Primary amenorrhea refers to absence of spontaneous menarche even after the age of 16. Cytogenetic analysis in two cases with primary amenorrhea, short stature, poorly developed secondary sexual characteristics, and growth retardation were studied. Routine GTG-band analysis of metaphases from peripheral blood leucocytes revealed female karyotype with a 15(ps+) and an isochromosome of X, i(Xq), in one patient and 46,X, i(Xq), in another patient. Ascertainment of the karyotype aided in confirmation of the provisional diagnosis, a better phenotype-genotype correlation to understand clinical heterogeneity in genetic counseling.

Evaluation of the Association of Single Nucleotide Polymorphism rs2229238 in Interleukin 6 Receptor Alpha (IL6RA) Gene With the Risk of Preeclampsia.

Introduction Many studies have gone into single nucleotide polymorphisms (SNPs) in inflammatory-associated genes and preeclampsia risk; still, the findings are inconclusive. The current study aims to evaluate the association of SNP rs2229238 in the interleukin 6 receptor alpha (IL6RA) gene with the risk of preeclampsia. Methodology An observational case-control study was conducted and 216 patients were included in this study. Of the patients, 104 were normotensive subjects and 112 were subjects with preeclampsia. Genotyping for SNP rs2229238 was performed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results The genotype allocation of the SNP 2229238 C/A polymorphism was not different in preeclampsia subjects (CC: 42%; CA: 42%; AA: 16%) and normotensive pregnant women (CC: 37%; CA: 48%; AA: 15%) (p-value = 0.73). The frequency of the A allele was 34% in preeclampsia subjects and 31% in normotensive pregnancies. There was no significant variation seen in the allele frequencies among cases and the control population. Conclusion Our study reported that there is no significant relation between preeclampsia and IL6RA SNP rs2229238. Also, there is no significance in the allele frequencies among both cases and control groups.

The Predictive Score for Patients Hospitalized With COVID-19 in Resource-Limited Settings.

Background and aims The second wave of coronavirus disease 2019 (COVID-19) has been devastating in India and many developing countries. The mortality reported has been 40% higher than in the first wave, overwhelming the nation's health infrastructure. Despite a better understanding of the disease and established treatment protocols including steroids and heparin, the second wave was disastrous. Subsequent waves have the potential to further cripple healthcare deliveries, also affecting non-COVID-19 care across many developing economies. It is then important to identify and triage high-risk patients to best use the limited resources. Routine tests such as neutrophil and monocyte counts have been identified but have not been successfully validated uniformly, and their utility is still being understood in COVID-19. Various predictive models that are available require online resources and calculators and additionally await validation across all populations. These, although useful, might not be available or accessible across all institutions. It is then important to identify easy-to-use scores that utilize tests done routinely. In identifying with this goal, we did a retrospective review of the institutional database to identify potential predictors of intensive care unit (ICU) admission and mortality in patients hospitalized during the second wave who accessed healthcare at our academic setup. Results Three predictors of mortality and four predictors of ICU admission were identified. Absolute neutrophil count was a common predictor of both ICU admission and mortality but with two separate cut points. An absolute neutrophil count of >4,200 predicted need for ICU admission (odds ratio (OR): 3.1 (95% confidence interval (CI): 2.0, 4.8)), and >7,200 predicted mortality (adjusted OR: 4.2 (95% CI: 1.9, 9.4)). We observed that a blood urea level greater than 45 was predictive of needing ICU care (adjusted OR: 8.0 (95% CI: 3.7, 17.6)). In our dataset, serum ferritin of >500 was predictive of ICU admission (adjusted OR: 2.7 (95% CI: 1.2, 5.9)). We noted a right shift of partial pressure (p50 is the oxygen tension at which hemoglobin is 50% saturated) (p50c) in SARS-CoV-2 as a predictor of ICU care (OR: 2.6 (95% CI: 1.7, 3.9)) when partial pressure is >26.5. In our analysis, a serum protein of less than 7 g/dL (OR: 2.8 (95% CI: 1.7, 4.4)) was a predictive variable for ICU admission. An LDH value of >675 was predictive of severity with a need for ICU admission (OR: 9.2 (95% CI: 5.4, 15.5)) in our series. We then assigned a score to each of the predictive variables based on the adjusted odds ratio. Conclusion We identified a set of easy-to-use predictive variables and scores to recognize the subset of patients hospitalized with COVID-19 with the highest risk of death or clinical worsening requiring ICU care.

Mutual Information Regularized Feature-Level Frankenstein for Discriminative Recognition.

Deep learning recognition approaches can potentially perform better if we can extract a discriminative representation that controllably separates nuisance factors. In this paper, we propose a novel approach to explicitly enforce the extracted discriminative representation d, extracted latent variation l (e,g., background, unlabeled nuisance attributes), and semantic variation label vector s (e.g., labeled expressions/pose) to be independent and complementary to each other. We can cast this problem as an adversarial game in the latent space of an auto-encoder. Specifically, with the to-be-disentangled s, we propose to equip an end-to-end conditional adversarial network with the ability to decompose an input sample into d and l. However, we argue that maximizing the cross-entropy loss of semantic variation prediction from d is not sufficient to remove the impact of s from d, and that the uniform-target and entropy regularization are necessary. A collaborative mutual information regularization framework is further proposed to avoid unstable adversarial training. It is able to minimize the differentiable mutual information between the variables to enforce independence. The proposed discriminative representation inherits the desired tolerance property guided by prior knowledge of the task. Our proposed framework achieves top performance on diverse recognition tasks, including digits classification, large-scale face recognition on LFW and IJB-A datasets, and face recognition tolerant to changes in lighting, makeup, disguise, etc.

Indian nurses' beliefs on physical activity promotion practices for cancer survivors in a tertiary care hospital-a cross-sectional survey.

Purpose: To describe the physical activity (PA) promotion practices, beliefs, and barriers of Indian nurses working with cancer survivors, and to gain preliminary insights into how their educational qualification might affect PA promotion practices. Methods: A validated questionnaire was used to obtain the data (N = 388). Sub-group comparisons were performed based on nursing qualification i.e., Bachelor of Science in Nursing (BSc) and General Nursing and Midwifery (GNM) using Mann-Whitney U test and chi square analysis for continuous and categorical variables, respectively. Results: The nurses believed that oncologists (47%) followed by physiotherapists (28.9%) were primarily responsible for providing information regarding PA to cancer survivors. The most common period in which the nurses' promoted PA was post treatment (31.7%), although very few nurses (13.3%) promoted PA across more than one of the three treatment periods. Nurses felt that PA had many benefits for cancer survivors; improved mental health (87.7%) and HRQoL (81.1%). Lack of knowledge (42.2%) and lack of time (41.6%) were the most frequently cited barriers. The comparisons based on educational qualification did not typically reveal many significant differences. Conclusion: Indian nurses both BSc and GNM qualified, wish to promote PA to cancer survivors despite numerous barriers, across various stages of treatment and believe PA is beneficial to the survivors in the process of recovery. Overcoming these barriers might aid in better promotion of PA to cancer survivors. Implication for cancer survivors: Nurses working in a tertiary care hospital in India are willing to promote PA amongst cancer survivors but require more training and support in this area of practice.

Association of TNFSF11 rs2200287 and TNFSF11 rs2148072 gene polymorphisms in preeclampsia.

BACKGROUND: Various cytokines released by white blood cells like lymphocytes are linked to the immune system during pregnancy. The polymorphism of the TNFSF11 (rs2200287 and rs2148072) gene is related to the preeclampsia of pregnancy. MATERIALS AND METHODS: This study was a prospective study involving 304 pregnant women with preeclampsia (n = 152) and controls (non-preeclamptic pregnant women) (n = 152). To investigate the rs2200287 and rs2148072 SNP's of TNFSF11 gene polymorphism by using the PCR-RFLP techniques. RESULTS: A significantly different genotype distribution of TNFSF11 (rs2200287 and rs2148072) polymorphisms were observed between the two groups, with the G allele of variant rs2200287 was highly significant in the preeclamptic group (P = 0.000; .5814; OR = .5814; 95% CI = .4211-.8012). And the C allele of variant rs2148072 was also highly significant in the preeclamptic group (P = 0.000; OR = .5076; 95% CI, .362-.71) in this study. CONCLUSION: The outcomes of the present study indicate that there was an association in TNFSF 11 (rs2200287 and rs2148072) gene polymorphism with preeclampsia compared to non-preeclampsia women.