Differential Pharmacokinetic Interplay of Atorvastatin on Lacosamide and Levetiracetam on Experimental Convulsions in Mice

BACKGROUND

The beneficial effects of statins, other than their hypocholesterolemia role, have been well documented, however, their use as an adjuvant drug with other antiseizure drugs, in the treatment of epilepsy is poorly understood.

OBJECTIVE

This study aimed to investigate the symbiotic effect of ATOR along with either lacosamide (LACO) or levetiracetam (LEVE) on experimentally induced epilepsy (Maximal electro-shock-MES or pentylenetetrazol- PTZ) in mice models.

METHODS

Conventional elevated-maze (EPM) and rotarod methods were performed to observe the behavioral effects.

RESULTS

In both the animal models, we found that co-administration of ATOR along with LACO showed a significant reduction in hind-limb extension (HLE) and clonic convulsion (CC) responses, respectively, but not in the ATOR+LEVE treated group. Intriguingly, comparable Straub tail response and myoclonic convulsion as the diazepam (DIA) group were observed only in the ATOR+LACO treated group. Moreover, a significant muscle-grip strength was observed in both groups. Also, pharmacokinetic analysis has indicated that the mean plasma concentration of ATOR peaked at 2nd hr in the presence of LACO but marginally peaked in the presence of LEVE. An Insilico study has revealed that ATOR has a higher binding affinity toward neuronal sodium channels.

CONCLUSION

This study has demonstrated that the plasma concentration of ATOR was potentiated in the presence of LACO, but not in the presence of LEVE and it has provided significant protection against both the electro and chemo-convulsive models in mice. This could be due to the symbiotic pharmacokinetic interplay of ATOR with LACO, and possibly, this interplay may interfere with sodium channel conductance.

A cross sectional observational study on the effect of music on the anxiety state of patients admitted for COVID 19 in a tertiary care hospital in New Delhi

Introduction

COVID 19 has led to dramatic changes in the lives of people leading to an increase in stress and anxiety. Music intervention is a non-medicated method for relieving anxiety. This current study aims to understand whether music can be effectively used to alleviate anxiety in admitted COVID-19 patients.

Objectives

To study the effect of music on anxiety in patients admitted for COVID-19 in a tertiary care hospital in New Delhi

Methods

34 patients (17 females &17 males) were randomly divided into two groups, a control (N=17) and a music group (N=17). Vitals of all the patients were noted. Patients of the music group were asked to listen to relaxing instrumental for 30 minutes, while patients of the control group were asked to relax for 30 minutes. Vitals of all the patients were noted again. Patients were asked to fill State Trait Anxiety Inventory (STAI) before and after intervention.

Results

The post-intervention mean scores of STAI after the music session were lower in the music group than the control group [95.06 (SD 8.5)) versus 102.37 (SD 10.3)]. The differences in mean values of pre- to post-intervention changes between both groups after music session were statistically significant.

Conclusions

Our findings suggest that listening to music lowers anxiety. As music is non- invasive and free of side-effects we recommend that music intervention service should be used to improve health care quality.

Disclosure

No significant relationships.

Hydrogeochemical characteristics and risk evaluation of potential toxic elements in groundwater from Shanmughanadhi, Tamilnadu, India

Hydrogeochemical and Health Risk Assessments of trace elements are integral to groundwater resource assessment, utilization, and human health. Investigation of groundwater chemistry and trace elemental impact on local inhabitants were attempted in Shanmuganadhi basin, Tamilnadu, India. About 60 groundwater samples were collected during the pre-monsoon period and analyzed for hydrochemical composition, including major and trace elements (Fe, Cr, Ni, Cu Pb, Mn, and As) to isolate chemical characteristics and human health risk assessment. Groundwater geochemistry is prejudiced by geochemical reactions uniting cation exchange, dissolution and precipitation, adsorption, and anthropogenic contributions. About thirty-two percent of groundwater samples recorded higher F^-(>1.5 mg/L) than the prescribed limit suggests sources from rock weathering and silicate dissolution. Nitrates (>45.0 mg/L) suggest sources from agricultural influences. Water types indicate alkalis (Na⁺ + K⁺) dominating alkali earth (Ca²⁺ - Mg²⁺) and strong acids (Cl^- and SO₄^2-) looming weak acid (CO₃^2- and HCO₃^-) irrespective of water samples. The geochemical stability diagram suggests precipitation of silica, carbonate, and magnesium and dissolution of sulphate minerals along the groundwater flow path. Significant correlation between major ions and trace elements (Pb, Mn, Ni, and Cu) suggests origin from rock weathering, human impacts, and cultivation practices. Non-carcinogenic human risk for trace elements was higher in children compared with adults via ingestion and dermal exposure. The carcinogenic result suggests that Cr in CHK (7.1 × 10^-2) and HBG (4.3 × 10^-2) have the most excellent chance of cancer risk. The environmental risk category attempted using Comprehensive risk factor (CRI) suggests Pb (3.2-CHK, 2.6-HBG) with potential cancer risk. The comprehensive evaluation index recommends environmental damage between mild to moderate, indicating continuous exposure of traceable elements might result in cancer cause to the inhabitants. The study suggests water quality seems to be prejudiced by various geological and anthropogenic causes and endorses counteractive measures and proper execution of existing laws to protect groundwater resources in the study area.

An enhanced whale optimized fractional order piλ controller based power quality improvement for sensorless brushless dc motor under dynamic operating conditions

This paper presents an Enhanced Whale Optimization Algorithm (EWO) approach for tuning to perfection of Fractional Order Proportional Integral and integral order Controller (FOPI λ) is used to sensorless speed control of permanent magnet Brushless DC (PMBLDC) motor under the operating dynamic condition such as (i) speed change by set speed command signal (ii) varying load conditions, (iii) integrated conditions and (iv) controller parameters uncertainty. On the other hand, it deals with a reduced THD (Total Harmonic Distortion) under dynamic operating conditions to improve the power quality for the above control system. Here present are three optimization techniques, namely (i) Enhanced Whale Optimization (EWO), (ii) Invasive Weed Optimization (IWO), and (iii) Social Spider Optimization (SSO) for fine-tuning of the FOPI λ controller parameters with reduction of THD. The proposed optimization algorithm optimized FOPI λ controller are compared under various BLDC motor operating conditions. Based on the results of MATLAB/Simulink models, the proposed algorithms are evaluated. Here, both the simulation and the results of the experiments are validated for the proposed controller technique. It demonstrates that the effectiveness of the proposed controllers is completely validated by comparing the three intelligent optimization techniques mentioned above. The EWO optimized FOPI λ controller for speed control of sensorless PMBLDC motor clearly outperforms the other two intelligent controllers by minimizing the time domain parameters, THD, performance Indices error, convergence time, control efforts, cost function, mean and standard deviation.

A Cross-Sectional Evaluation of Self-Perceived Orthodontic Treatment Needs Amongst Tribal Adolescent With Remote Access to Orthodontic Treatment Using a Simplified Malocclusion Index

Background:

Self-perceived orthodontic treatment need is strongly influenced by what is perceived to be the esthetic norm amongst a community, and reluctance toward treatment amongst adolescents with clinically ascertained malocclusion may often be due to readily remediable factors. Of particular interest is the prevalence of malocclusion amongst such communities as a probable indicator of the role of diet and genetics in establishing a predominant clinical phenotype that may also play a role in the construct of what is perceived as the esthetic norm amongst the community, thereby influencing the self-perceived need for treatment. Studies aimed at evaluating the association between self-perceived esthetics, and self-perceived treatment need have not been performed amongst a population with no prior exposure to orthodontic treatment

Objectives:

The purpose of this study was to evaluate the self-perceived orthodontic treatment need amongst the tribal adolescents belonging to regions with remote access to orthodontic treatment by way of a verbally assigned index and to also identify the reasons of reluctance toward treatment to better understand how to make orthodontic treatment readily accessible to such populations.

Participants, Materials, and Methods:

The agency areas of Paderu located at 18.0833°N 82.667°E and Parvathipuram located at 18°46'N 83°25'E are 2 revenue districts of Visakhapatnam and Vizianagaram, respectively, in the state of Andhra Pradesh, India, that are home to various tribal populations with remote access to orthodontic treatment. A total of 2,016 school-going tribal adolescents of the Paderu revenue division and 819 tribal adolescents of the Parvathipuram revenue division were examined to ascertain the prevalence of malocclusion. Necessary consent and permissions were obtained from the tribal authorities, the school authorities, parents, and the institutional ethical clearance committee. The screening was done utilizing natural daylight in compliance with infection prevention and control protocol. Clinical examination aimed at categorizing the observed occlusion into either ideal occlusion or one of the three classes of Angle’s class I, II, and III malocclusions. The Simplified Malocclusion Index For Layperson Evaluation (SMILE) was verbally assigned in the vernacular language while interacting with each child and the findings made note of for calculation of relevant scores related to their orthodontic awareness, self-esteem as related to self-perceived esthetics, and their self-perceived need for treatment. Reasons for reluctance to undergo treatment were noted down if expressed. An initial group of 31 adolescents categorized as presenting with clinical malocclusion were randomly picked up and assigned the SMILE index a second time to assess the reliability of the index by way of Cohen’s kappa statistic.

Results:

The initial test group of 31 individuals assigned the SMILE twice showed a Cohen’s kappa of 0.93 validating almost perfect intraoperator agreement. The SMILE index revealed that 80.95% of the adolescents of Paderu revenue division had orthodontic awareness and 79.51% had self-perceived esthetics but only 15.97% felt a need for orthodontic treatment. Pearson’s Chi squared statistical analysis indicated a gender bias related to the self-perceived need for orthodontic treatment ( X 2 [1, N = 1,371] = 19.71, P < .001). The Index assigned to the Parvathipuram division revealed that 77.04% had orthodontic awareness and 78.38 had self-perceived esthetics but only 6.95% felt the need for orthodontic treatment. Pearson’s Chi squared statistical analysis indicated a gender bias related to the self-perceived need for orthodontic treatment ( X 2 [1, N = 764] = 4.95, P = .02).

Conclusion:

The self-perceived need for orthodontic treatment is often based on the self-perceived esthetics of an individual or the self-esteem as influenced by the perceived esthetic norm of the community. Orthodontic treatment of adolescents with borderline malocclusion derangements requires careful ascertaining of the actual perceived need of the patient to enable the rendering of a justifiable orthodontic treatment with the complete trust of the young patient. This helps build community trust in regions where orthodontic treatment has not yet made in roads and may help ensure higher end of treatment satisfaction levels.

Intuitionistic fuzzy stability results of additive functional equation by two different approaches

In this current work, we examine the Hyers-Ulam(H-U) stability results for a finite variable additive functional equation (Ref.[6]) in Intuitionistic Fuzzy Normed space(IFN-space) is discussed by means of direct and fixed point methods.

Pre-hospital heparin use for ST-elevation myocardial infarction is safe and improves angiographic outcomes

AIMS

This study aims to evaluate if pre-hospital heparin administration by paramedics is safe and improves clinical outcomes.

METHODS AND RESULTS

Using the multicentre Victorian Cardiac Outcomes Registry, linked with state-wide ambulance records, we identified consecutive patients undergoing primary percutaneous coronary intervention for STEMI between January 2014 and December 2018. Information on thrombolysis in myocardial infarction (TIMI) flow at angiography was available in a subset of cases. Patients receiving pre-hospital heparin were compared to those who did not receive heparin. Findings at coronary angiography and 30-day clinical outcomes were compared between groups. Propensity-score matching was performed for risk adjustment. We identified a total of 4720 patients. Of these, 1967 patients had TIMI flow data available. Propensity-score matching in the entire cohort yielded 1373 matched pairs. In the matched cohort, there was no observed difference in 30-day mortality (no-heparin 3.5% vs. heparin 3.0%, P = 0.25), MACCE (no-heparin 7% vs. heparin 6.2%, P = 0.44), and major bleeding (no-heparin 1.9% vs. heparin 1.4%, P = 0.64) between groups. Propensity-score analysis amongst those with TIMI data produced 552 matched pairs. The proportion of cases with TIMI 0 or 1 flow in the infarct-related artery (IRA) was lower among those receiving pre-hospital heparin (66% vs. 76%, P < 0.001) compared to those who did not.

CONCLUSION 

In this multicentre, propensity-score matched study, the use of pre-hospital heparin by paramedics was safe and is associated with fewer occluded IRAs in patients presenting with STEMI.

The utility of Problem Areas in Diabetes (PAID) scale amongst patients with Type 2 diabetes (T2DM): An experience from a teaching hospital in Southern India

Objectives:

The purpose of this study was to establish the prevalence of diabetes-specific psychological distress (DSPD) among patients with type 2 diabetes mellitus (T2DM) using the “Problem areas in diabetes” (PAID) scale at a teaching hospital in southern India. Other objectives included observing the relationship between socio-demographic factors and DSPD and, finally exploring the level of acceptance of the PAID scale by Asian–Indian patients.

Methods:

The patients with T2DM aged >18 years attending the diabetes outpatient clinic were recruited. They completed two sets of questionnaires; PAID and a satisfactory questionnaire, which included socio-demographic characteristics and questions relating to the acceptance of PAID. Statistical analysis was performed using Stata 13.1 and Excel.

Results:

A total of 253 questionnaires were completed, including 157 (62.1%) male and 96 (37.9%) female patients. The prevalence of DSPD was 32.8% (83/253). Younger age (OR 3.65, 95% CI 1.36–9.80) and presence of retinopathy (OR 2.60, 95% CI 1.12–6.04) were significantly associated with DSPD. However, it was observed that one-third of the patients had an elevated level of distress regardless of socio-demographic or clinical factors. PAID was well accepted by the participants and 84.6% (214/253) were pleased to complete it again.

Conclusion:

About one-third of the patients with T2DM had DSPD. Psychological distress was higher in the younger age group and those with retinopathy. PAID is an easy, well-accepted questionnaire and would serve as a useful tool to screen for DSPD.

An Emphasis on Engineering Controls and Administrative Controls in the Prevention and Control of COVID-19 in an Orthodontic Setting: Thinking Beyond Tomorrow

Introduction: Most of the initial focus in handling COVID-19 had been based on avoiding exposure by refraining from rendering most treatments other than those considered an emergency or urgent. Post-lockdown, with the resumption of most activities, there has been concern over the possibility of transmission scenarios if sufficient care is not taken. The control and prevention of the spread of infections when elimination of exposure is not possible is chiefly achieved through the judicious use of engineering controls and administrative controls in a clinical setting in addition to the standard protocols and transmission-based protocols. True safety lies in being one step ahead. There have been mentions of the possibility that COVID-19 could be opportunistic airborne in its spread, in addition to being spread via saliva, droplets, and contaminated surfaces or objects.

Method: A literature search of PubMed, Google Scholar, Cochrane Library, and advisories released by such organizations as the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), Ministry of Health and Family Welfare (MOFHW), European Centre for Disease Prevention and Control (ECDC), Chinese Center for Disease Control and Prevention (China CDC), American Dental Association (ADA), Canadian Dental Association (CDA), French National Dentists Association, Dental Council of Belgium, National Health Service, England (NHS UK), National Health Service Scotland (NHS Scotland), and International Society for Infectious Diseases (ISID) was performed, with search parameters aimed at gathering information pertaining to infection control and cross infection control in dental settings as related to orthodontics.

Result: There have been numerous articles and advisories published over the last 20 years, but the main focus has been on safe practices and to an extent on personal protective equipment, with relatively less emphasis on the need for respiratory protection by way of engineering controls and administrative controls. This review highlights the engineering and administrative controls that can be put into effect to make infection control and prevention much more effective.

Conclusion: Any health care facility must be able to prevent, contain, and control infections with no risk of nosocomial infections. For this, an assumption has to be made that every individual in a health care setting is either at risk or a risk, depending on whether the person is infected or not. Meticulous attention to stringent policies of hygiene and infection control and prevention, coupled with suitable supporting engineering and administrative controls, is to be made a standard way of life in such facilities.

Hydrochemical and statistical techniques to decode groundwater geochemical interactions and saline water intrusion along the coastal regions of Tamil Nadu and Puducherry, India

The study attempts to decipher saline water invasion and aided geochemical influences activated along the coastal zones of Tamil Nadu and Puducherry. Total 76 groundwater samples representing pre- and post-monsoon seasons were collected and examined for various parameters like Ca²⁺, K⁺, Na⁺, Mg²⁺, Cl^-, HCO₃^-, NO₃^- and SO₄^2-. Multiple techniques such as hydrochemical ionic changes, hydrochemical facies evolution model and seawater mixing index were incorporated to decipher the salinization process in the study area. Hydrochemical facies suggests 38.00% of groundwater samples representing CaHCO₃ facies indicating fresh groundwater, mixed Ca-Cl groundwater by 26.00% of samples and about 36.00% samples suggest Na-Cl indicating saline water. Hydrochemical facies evolution diagram differentiated groundwater facies into freshening and intrusion phase irrespective of seasons. About 23.60% and 21.00% of samples during pre- and post-monsoon suggest samples influenced by seawater intrusion. Hydrochemical ionic changes of samples signify the positive fraction of seawater in both seasons, which shows the mixing of fresh groundwater with saline water. The seawater mixing index confirms a greater percentage of samples during post-monsoon (42.00%) have been influenced by seawater with values greater than one. Principle component analysis extracted three factors with a total variance of 67.31% and 62.03% during pre- and post-monsoon seasons, respectively. Factor 1 replicates the natural processes such as saline water intrusion and ion exchange, whereas factors 2 and 3 signify anthropogenic actions such as improper sewage disposal, use of fertilizers, domestic and industrial waste discharge influencing groundwater chemistry.

Chemical weathering and atmospheric carbon dioxide (CO2) consumption in Shanmuganadhi, South India: evidences from groundwater geochemistry

Chemical weathering in a groundwater basin is a key to understanding global climate change for a long-term scale due to its association with carbon sequestration. The present study aims to characterize and to quantify silicate weathering rate (SWR), carbon dioxide consumption rate and carbonate weathering rate (CWR) in hard rock terrain aided by major ion chemistry. The proposed study area Shanmuganadhi is marked with superior rainfall, oscillating temperature and runoff with litho-units encompassing charnockite and hornblende-biotite gneiss. Groundwater samples (n = 60) were collected from diverse locations and analysed for major chemical constituents. Groundwater geochemistry seems to be influenced by geochemical reactions combining dissolution and precipitation of solids, cation exchange and adsorption along with minor contribution from anthropogenic activities. The SWR calculated for charnockite and hornblende-biotite gneiss was 3.07 tons km^-2 year^-1 and 5.12 tons km^-2 year^-1, respectively. The calculated CWR of charnockite and hornblende-biotite gneiss was 0.079 tons km^-2 year^-1 and 0.74 tons km^-2 year^-1, respectively. The calculated CO₂ consumption rates via silicate weathering were 1.4 × 10³ mol km^-2 year^-1 for charnockite and 5.8 × 10³ mol km^-2 year^-1 for hornblende-biotite gneiss. Lithology, climate and relief were the key factors isolated to control weathering and CO₂ consumption rates.

Submarine Groundwater Discharge from an Urban Estuary to Southeastern Bay of Bengal, India: Revealed by Trace Element Fluxes

Submarine groundwater discharge and associated trace element fluxes from the Coleroon River estuary to south bay, India, has been attempted, because increasing trace elements could result in harmful algal blooms and eutrophication. Trace elements (Al, Cr, Mn, Fe, Ni, Cu, Zn, Sr, Mo, Ba, Pb, Th, and U) in surface water, pore, and groundwater samples were monitored for 10 days in three locations (A, B, and C) by considering tidal fluctuations. The trace elements Al, Cr, Fe, Ni, Zn, Sr, Mo, Pb, Th, and U were greater and found to be influenced by processes, such as fresh groundwater discharge and seawater intrusion. Lower Mn, Cu, and Ba signifies impact due to sediment adsorption, mixing, and elemental exchange during fresh groundwater and seawater mixing. Salinity versus trace element plot infers greater trace element mobility with cumulative salinity influenced by the conformist behavior of freshwater, seawater, and mixing. The calculated submarine groundwater discharge supported dissolved trace elements fluxes were 107,047.8 n mol d^-1 m^-1 for location A, 183,520.2 n mol d^-1 m^-1 for location B, and 181,474.4 n mol d^-1 m^-1 for location C, respectively. Variations in dissolved trace elements fluxes are attributed to variations in pH, free redox environment in the aquifer, adsorption or desorption by sediments, and the environmental cycle of marine organisms.

Ultrasound Medical Image Denoising Using Threshold Based Wavelet Transformation Method

Ultrasound imaging is most commonly used and secure medical diagnostic approach its low cost, noninvasive nature of real time image construction. However because of signal dependant noise existence, ultrasound imaging gets degraded: A baseline phase in image processing is removing diverse noise types from image. Noise sources of image generally occur during storage, transmission and image acquisition. Image denoising is an issue determined in diverse computer vision and image processing crisis. There are diverse prevailing approaches to denoise image. The significant property of finest denoising of an image model has to remove noise while preserving edges. For wavelet thresholding paradigm, Fisz transformation method is brought-in in the current work. Furthermore, it has problem with poor denoising performance and hence the quality of image is minimized considerably. In this paper, Improved Threshold based Wavelet Transformation Method (ITWTM) is suggested to rectify above mentioned crisis, to enhance the better denoising images, the soft threshold method is introduced. To enhance visual quality of noisy image, it simply changes coefficients with help of softthresholding method. Speckle noise, additive noise, Gaussian noise and multiplicative noise factors affect the ultrasound images, which minimize the image quality and effects the human interpretation. So, ITWTM helps to minimize the noise rate considerably for the provided US image. The experimental result confirms that the proposed ITWTM provides better performance with respect to higher PSNR, SSIM and lower MSE, execution time rather than the previous Fisz transformation and DWT methods.

Submarine groundwater discharge as sources for dissolved nutrient fluxes in Coleroon river estuary, Bay of Bengal, India

Groundwater contributed nutrients aided with increasing population threaten the global coastal ecosystems. In this study, attempt has been made using major ions and nutrients to evaluate the significance of submarine groundwater discharge (SGD) in a semi-arid estuary of south India. Surface, seepage and groundwater chemistry altered from fresh (NaK-CaMg-NO₃Cl) to mixed (NaK-NO₃Cl) to saline water (NaCl) type from upstream to outlet that connects Bay of Bengal. We predicted abundant nitrate (NO₃^-) along upstream and towards the bay due to application of fertilizers and aquaculture activities, respectively. Elevated ammonium (NH₄⁺) observed in the recirculated groundwater/sea water suggests contribution from sea water intrusion and higher phosphate (PO₄^3-) noted at the outer bay suggests sources from phosphatic nodules. Decreasing Redfield ratio towards the bay suggests anoxic aquifer condition due to salinization. The SGD driven nutrient fluxes were 40.0-47.0% for NO₃^-, 43.0-51.0% for NH₄⁺ and 9.0-32.0% for PO₄^3- from the total input fluxes. The estimated nutrient fluxes showed that NO₃^- and PO₄^3- discharges to the sea due to SGD and NH₄⁺ removed from the coast due to consumption by microorganisms that creates toxic algal blooms in the study area.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Tracing groundwater salinization using geochemical and isotopic signature in Southeastern coastal Tamilnadu, India

Attempt has been made to discriminate groundwater salinity causes along the east coast of India. A total of 122 groundwater samples (61/season) were collected for two diverse seasons (Pre Monsoon and Post Monsoon) and analyzed for physical and chemical components along with stable isotopes. The Piper diagram proposes samples along the coast predisposed by saltwater incursion. Ionic ratio plots recommend groundwater discriminatory by changing geochemical signatures. The statistical correlation suggests impact of saltwater incursion, anthropogenic and rock water interaction as sources for dissolved constituents in groundwater. The thermodynamic stability plot suggests higher silicate dissolution, weathering and ion exchange prompting water chemistry nevertheless of seasons. The δ¹⁸O and δ²H increases towards the sea suggesting enrichment attributed to the sea water influence and rainfall influences along the southwestern parts of the study area.

Edge Detection of Images Using Improved Fuzzy C-Means and Artificial Neural Network Technique

Edge detection (ED) is an embryonic development, which is essential for any intricate image processing and recognition undertaking. This paper proposed another system to upgrade the method and Artificial neural network for speaking to vulnerability in the image slopes and collection. The vulnerability in the image inclination distinguishes the genuine edges which might be overlooked by other systems. This e is valuable in the field of restorative imaging applications, for example, MRI division, cerebrum tumor, filtering and so on. Attractive reaction imaging connected in restorative science to analyze tumors in body parts by creating great images of within the human body, by utilizing different edge identifiers. There exist many edge finders yet at the same time, requirement for inquire about is felt improve their execution. And furthermore, this paper distinguishes the edges in the broken bones, edge ID, satellite edge detection ID. An exceptionally basic issue looked by many edge finders is the decision of limit esteems. This paper presents fuzzy and ANN based edge detection utilizing Improved Fuzzy C-means clustering (FCM) strategy. Enhanced FCM approach is utilized in producing different gatherings which are then contribution to the Mamdani fuzzy surmising framework. In this, we are utilizing versatile middle separating for evacuating commotion; this strategy adequately expels the clamor and gives better outcomes. This entire procedure results in the age of the limit parameters which is then encouraged to the established sobel edge locator which helps in improving its edge detection capacity utilizing the fuzzy logic. This entire setup is connected to Images. The recovered outcomes express to that fuzzy and ANN based Improved Fuzzy C-means clustering enhances the introduction of customary sobel edge identifier in associate with retentive information around the tumors of the mind.

Natural History of Spontaneous Coronary Artery Dissection With Spontaneous Angiographic Healing

OBJECTIVES

Given the uncertainty regarding the degree and prevalence of spontaneous healing following spontaneous coronary artery dissection (SCAD), the aim of this study was to assess the angiographic characteristics of the dissected segments in a large cohort of patients with SCAD who underwent subsequent repeat coronary angiography.

BACKGROUND

SCAD is an uncommon yet important cause of myocardial infarction in women. Very little is known about the characteristics of healing of dissected arteries.

METHODS

Patients with nonatherosclerotic SCAD followed prospectively at Vancouver General Hospital who underwent repeat angiography were included in this study. Those who underwent percutaneous coronary intervention for SCAD were excluded. Baseline patient demographics and in-hospital and long-term cardiovascular events were recorded. Angiographic characteristics of the SCAD artery at index and repeat angiography were assessed by 2 experienced angiographers. Criteria for angiographic healing were as follows: 1) improvement of stenosis severity from index event; 2) residual stenosis <50%; and 3) TIMI (Thrombolysis In Myocardial Infarction) flow grade 3.

RESULTS

One hundred fifty-six patients with 182 noncontiguous SCAD lesions were included. The mean age was 51.5 ± 8.7 years, 88.5% were women, 83.3% were Caucasian, and 75.6% had fibromuscular dysplasia. All patients presented with myocardial infarction. At index angiography, type 2 SCAD was most commonly observed, in 126 of 182 lesions (69.2%); TIMI flow grade <3 was present in 85 of 182 (46.7%); and median lesion stenosis was 79.0% (interquartile range: 56.0% to 100%). Median time to repeat angiography was 154 days (interquartile range: 70 to 604 days), with median residual lesion stenosis improving to 25.5% (interquartile range: 12.0 to 38.8 days), and TIMI flow grade <3 observed in 10 of 182 lesions (5.5%). Angiographic healing occurred in 157 of 182 lesions (86.3%). Of repeat angiography performed ≥30 days post-SCAD, 152 of 160 (95%) showed spontaneous angiographic healing.

CONCLUSIONS

The majority of coronary arteries affected by SCAD heal spontaneously on repeat angiography, with apparent time dependency, with the vast majority having complete healing after 30 days from the SCAD event.

Comparative evaluation of angiogenesis using a novel platelet-rich product: An in vitro study

Background:

In vivo angiogenesis is normal and vital process in growth and development, wound healing, and formation of granulation tissue wherein new blood vessels form from preexisting vessels as part of revascularization. Platelet-rich products promote wound healing associated with angiogenesis. Biomaterials such as titanium were found to be angiogenic. Unlike in vivo situations, in vitro angiogenesis, study cells, within a controlled environment.

Aims:

The aim of this study is to evaluate the angiogenic potential of a novel platelet-rich product.

Materials and Methods:

Blood was drawn from volunteers with informed consent. Blood samples were centrifuged to obtain platelet-rich products. Platelet concentrates prepared were platelet-rich plasma (PRP), platelet-rich fibrin, and a novel platelet-rich product which is titanium-prepared PRP (TPRP), obtained using titanium. The study which compared platelet concentrate was divided into four groups subjected to tissue culture. Phase-contrast microscope was used to determine the rate of growth by cell counting.

Statistical Analysis:

ANOVA was used for comparison within groups and post hoc for multiple comparisons.

Results:

TPRP group showed granular ground substance. Group with platelet-rich fibrin (PRF) shows a high rate of growth whereas those with TPRP showed better growth rate when compared to its counterpart, PRP.

Conclusions:

This is the first study which introduces TPRP. Previous studies have proved that titanium-prepared PRF has better structural quality than its counterpart platelet-rich fibrin. This study concludes that TPRP has better angiogenic potential than its counterpart PRP. Further in vivo studies are needed to promote TPRP as a new generation of platelet products.

Assessment of heavy metals in the surface sediments of the Emerald Lake using of spatial distribution and multivariate techniques

The study aims to assess the heavy metals such as cobalt (Co), nickel (Ni), lead (Pb), chromium (Cr), cupper (Cu), zinc (Zn), manganese (Mn), and iron (Fe) from 25 surface sediment samples at different sites of the Emerald Lake, Tamilnadu, India using spatial distribution and multivariate techniques like Pearson correlation matrix and principal component analysis. From the result, the ranges of Fe, Cu, Cr, Mn, Zn, Ni, Co, and Pb are noticed to be 78,128 to 132,876; 314 to 462; 336 to 523; 520 to 701; 20.1 to 53.21; 128 to 215; 91 to 129.9; and 151 to 158 μg g^-1, respectively. The order of the average heavy metals concentration is Fe > Mn > Cr > Cu > Pb > Zn > Co > Ni. From the result, Ni, Cu, Cr, Pb, and Cd are found to be considerably correlated as they are usually related to anthropogenic activities, wastewater, and sewage. From the principal corresponding analysis (PCA) results retrieved from PC3 suggest that Fe, Mn, Cr, Cu, Pb, and Ni have common origin and are mainly due to anthropogenic input, inorganic fertilizers in agriculture, human activities, sewage effluents, traffic, and boat activities. The study relatively provides a significant approach for heavy metal pollution origin in the surface sediment in the Emerald Lake.

Characteristics of extension and de novo recurrent spontaneous coronary artery dissection

AIMS

Spontaneous coronary artery dissection (SCAD) is an under-recognised and important cause of myocardial infarction in young women. Recurrent SCAD is frequent but poorly understood. We aimed to explore the clinical and angiographic characteristics, and outcomes of recurrent SCAD.

METHODS AND RESULTS

Patients with SCAD extension or recurrence prospectively followed at Vancouver General Hospital were included in this retrospective study. SCAD diagnosis was confirmed by two experienced cardiologists. Detailed medical history, baseline demographics, angiographic results, and clinical details of index SCAD and recurrent events were recorded. SCAD extension was defined as angiographic extension of a previously dissected coronary segment, and de novo recurrent SCAD was defined as new spontaneous dissection. We identified 43 patients with SCAD recurrence with mean age 48.9±8.4 years; 38/43 were women, and 32/43 had fibromuscular dysplasia. Nine patients had SCAD extension at median time of five (1-19) days, while 34 patients had de novo recurrent SCAD at median time of 1,487 (107- 6,461) days after the index SCAD event. All SCAD extension patients had worsening of the index dissected segment, with 5/9 involving extension to adjacent segments, while all de novo recurrent SCAD patients had new dissections affecting coronary segments distinct from the index dissection.

CONCLUSIONS

De novo recurrent SCAD invariably affected new segments distinct from previously dissected segments.

Spontaneous Coronary Artery Dissection: Clinical Outcomes and Risk of Recurrence

BACKGROUND

Spontaneous coronary artery dissection (SCAD) is underdiagnosed and an important cause of myocardial infarction (MI), especially in young women. Long-term cardiovascular outcomes, including recurrent SCAD, are inadequately reported.

OBJECTIVES

This study sought to describe the acute and long-term cardiovascular outcomes and assess the predictors of recurrent SCAD.

METHODS

Nonatherosclerotic SCAD patients were prospectively followed at Vancouver General Hospital systematically to ascertain baseline, predisposing and precipitating stressors, angiographic features, revascularization, use of medication, and in-hospital and long-term cardiovascular events. Clinical predictors for recurrent de novo SCAD were tested using univariate and multivariate Cox regression models.

RESULTS

The authors prospectively followed 327 SCAD patients. Average age was 52.5 ± 9.6 years, and 90.5% were women (56.9% postmenopausal). All presented with MI; 25.7% had ST-segment elevation MI, 74.3% had non-ST-segment elevation MI, and 8.9% had ventricular tachycardia/ventricular fibrillation. Precipitating emotional stressors were reported in 48.3% and physical stressors in 28.1%. Fibromuscular dysplasia was present in 62.7%, connective tissue disorder in 4.9%, and systemic inflammatory disease in 11.9%. The majority (83.1%) were initially treated medically, with only 16.5% or 2.2% undergoing in-hospital percutaneous coronary intervention or coronary artery bypass graft surgery, respectively. The majority of SCAD patients were taking aspirin and beta-blocker therapy at discharge and at follow-up. Median hospital stay was 3.0 days, and the overall major adverse event rate was 7.3%. Median long-term follow-up was 3.1 years, and overall major adverse cardiac event rate was 19.9% (death rate: 1.2%; recurrent MI: 16.8%; stroke/transient ischemic attack: 1.2%; revascularization: 5.8%). Recurrent SCAD occurred in 10.4% of patients. In multivariate modeling, only hypertension increased (hazard ratio: 2.46; p = 0.011) and beta-blocker use diminished (hazard ratio: 0.36; p = 0.004) recurrent SCAD.

CONCLUSIONS

In our large prospectively followed SCAD cohort, long-term cardiovascular events were common. Hypertension increased the risk of recurrent SCAD, whereas beta-blocker therapy appeared to be protective.

Functional block of IL-17 cytokine promotes bone healing by augmenting FOXO1 and ATF4 activity in cortical bone defect model

We determine the effect of interleukin (IL)-17 neutralizing antibody on new bone regeneration. Anti-IL-17 antibody promoted new bone regeneration in cortical bone defect model by augmenting FOXO1 and ATF4 activity thereby decreasing oxidative stress. Our study demonstrates the bone healing and regeneration potential of neutralizing IL-17antibody in osteoporotic fractures.

INTRODUCTION

The immune system plays important role in the fracture healing process. However, fracture healing is prolonged in disorders associated with systemic inflammation. Fracture healing is decelerated in osteoporosis, condition linked with systemic inflammation. Bone regeneration therapies like recombinant human BMP2 are associated with serious side effects. Studies have been carried out where agents like denosumab and infliximab enhance bone regeneration in osteoporotic conditions. Our previous studies show the osteoprotective and immunoprotective effects of neutralizing IL-17 antibody. Here, we determine the effect of IL-17 neutralizing antibody on new bone regeneration and compare its efficacy with known osteoporotic therapies.

METHODS

For the study, female BALB/c mice were ovariectomized or sham operated and left for a month followed by a 0.6-mm drill-hole injury in femur mid-diaphysis. The treatment was commenced next day onwards with anti-IL-17, anti-RANKL (Receptor activator of nuclear factor kappa-B ligand), parathyroid hormone (PTH), or alendronate for a period of 3, 10, or 21 days. Animals were then autopsied, and femur bones were dissected out for micro-CT scanning, confocal microscopy, and gene and protein expression studies.

RESULTS

Micro-CT analysis showed that anti-IL-17 antibody promoted bone healing at days 10 and 21, and the healing effect observed was significantly better than Ovx, anti-RANKL antibody, and ALN, and equal to PTH. Anti-IL-17 also enhanced new bone regeneration as assessed by calcein-labeling studies. Additionally, anti-IL-17 therapy enhanced expression of osteogenic markers and decreased oxidative stress at the injury site.

CONCLUSION

Overall, our study demonstrates bone healing and regeneration potential of neutralizing IL-17 antibody in osteoporotic fractures.

The prognostic importance of the diastolic pulmonary gradient, transpulmonary gradient, and pulmonary vascular resistance in patients undergoing transcatheter aortic valve replacement

OBJECTIVES

To evaluate the association between markers of precapillary pulmonary hypertension (PH) and survival in transcatheter aortic valve replacement (TAVR).

BACKGROUND

The importance of precapillary PH has been sparsely investigated in patients undergoing TAVR. It may prove an important risk factor for poor outcomes.

METHODS

We identified patients at our institution undergoing TAVR with a baseline right heart catheterization (RHC) demonstrating PH. We evaluated the association between markers of precapillary PH and survival including the diastolic pulmonary gradient (DPG), transpulmonary gradient (TPG), and pulmonary vascular resistance (PVR). A multivariable analysis was performed using Cox Proportional Hazards Models, adjusting for age, gender, body mass index, and pulmonary artery systolic pressure (PASP) on echocardiography.

RESULTS

We identified 133 patients with PH on RHC. Of these 111 had low DPG and 22 had high DPG. All 3 markers of precapillary PH were associated with worse survival post TAVR, with OR of 2.1 (95% CI 1.1-3.9, P = 0.02), 3.4 (95% CI 1.8-6.4, P < 0.001) and 2.5 (95% CI 1.4-4.5, P = 0.003) for high DPG, TPG, and PVR, respectively. On multivariable analysis, both TPG and PVR remained predictors of worse survival, with OR of 3.4 (95% CI 1.7-6.9, P = 0.001) and 2.5 (95% CI 1.4-4.5, P = 0.003). Echocardiographic PASP and DPG were not predictive of survival.

CONCLUSIONS

In patients undergoing TAVR, parameters of precapillary PH are associated with lower survival, and provide incremental prognostication over echocardiographic PASP. RHC should continue to play an important role in risk stratification prior to TAVR. © 2017 Wiley Periodicals, Inc.

Network Coded Cooperative Communication in a Real-Time Wireless Hospital Sensor Network

The paper presents a network coded cooperative communication (NC-CC) enabled wireless hospital sensor network architecture for monitoring health as well as postural activities of a patient. A wearable device, referred as a smartband is interfaced with pulse rate, body temperature sensors and an accelerometer along with wireless protocol services, such as Bluetooth and Radio-Frequency transceiver and Wi-Fi. The energy efficiency of wearable device is improved by embedding a linear acceleration based transmission duty cycling algorithm (NC-DRDC). The real-time demonstration is carried-out in a hospital environment to evaluate the performance characteristics, such as power spectral density, energy consumption, signal to noise ratio, packet delivery ratio and transmission offset. The resource sharing and energy efficiency features of network coding technique are improved by proposing an algorithm referred as network coding based dynamic retransmit/rebroadcast decision control (LA-TDC). From the experimental results, it is observed that the proposed LA-TDC algorithm reduces network traffic and end-to-end delay by an average of 27.8% and 21.6%, respectively than traditional network coded wireless transmission. The wireless architecture is deployed in a hospital environment and results are then successfully validated.

Massive expanding hematoma of the chin following blunt trauma

Posttraumatic hematoma of the face is common and usually self-limiting in nature. We report an unusual massive expanding hematoma of the chin within 9 h following a blunt trauma with no associated injuries or fracture.