Background: Stroke is a devastating complication of tuberculous meningitis and is an important determinant of its outcome. Aim: To prospectively evaluate the predictive factors for stroke in patients ...with tuberculous meningitis and to assess the impact of stroke on the overall prognosis and outcome. Methods: We evaluated and followed 100 patients of tuberculous meningitis for 6 months. Magnetic resonance imaging was performed at inclusion and after 6 months. We evaluated the predictors of stroke and also assessed the effect of stroke on the outcome. Outcome was defined with the help of modified Rankin scale. Results: Of the 100 patients, 6 lost to follow-up. Thirty patients had stroke, 27 of them had stroke at inclusion. Three patients developed stroke during follow-up. In most of the patients, stroke was a manifestation of advanced stages of tuberculous meningitis. Internal capsule/basal ganglia were the most frequently involved sites. Infarcts commonly involved the middle cerebral arterial territory. On univariate analysis, predictors of stroke were aged >25 years (P < 0.001), cranial nerve involvement (P < 0.001), sylvian fissure exudates (P = 0.026), posterior fossa exudates (P = 0.016), optic chiasmal exudates (P = 0.04) and vision impairment (P = 0.004). Stage III tuberculous meningitis (P < 0.001) was also a predictor of stroke. On multivariate analysis aged >25 years was found a significant predictor of stroke. Strokes in patients with tuberculous meningitis were associated with poor prognosis. Conclusions: Stroke occurred in 30% of cases with tuberculous meningitis. Advanced stage of tuberculous meningitis, basal exudates, optochiasmatic arachnoiditis and vision impairment were significant predictors of stroke. Stroke independently predicted the poor outcome of tuberculous meningitis.
Vertigo is an abnormal sensation of motion which arises due to a mismatch between various sensory modalities involved in maintaining balance. Vertigo can be due to central or peripheral causes and ...intensely debilitating for some patients. Acute onset vertigo is defined as the commencement of vertigo within 24 h. This can present with a variety of overlapping symptoms, making it difficult to distinguish central from peripheral causes. In the emergency setting, mis-diagnosing acute onset vertigo as benign may have serious implications.
This prospective study included consecutive patients presenting to our Emergency Department with acute vertigo between March 2019 and March 2020. We aimed to evaluate and validate the utility of magnetic resonance imaging (MRI) of the brain among patients with acute onset vertigo.
A total of 70 patients with acute onset vertigo were recruited. MRI of the brain revealed acute changes in 23 (32.9%) out of the 70 patients included in the study. Even among the 29 (41.4%) patients who presented with isolated vertigo without any other clinical signs, MRI of the brain showed acute changes in 3 (10.3%) of them.
MRI is a useful tool in diagnosing and differentiating peripheral from a central cause of vertigo. It avoids misdiagnosis in the emergency setting and facilitates early administration of appropriate treatment.
•MRI Brain demonstrated Acute CVA in 23 (32.9%) patients, while chronic ischaemic changes noted in 45 (64.3%) patients.•Of the 23 cases with acute changes on MRI, 11 displayed posterior circulation strokes.•Among the 29 cases presenting with isolated acute vertigo with no clinical signs, 3 patients had Acute changes on MRI.•Incidental findings observed in 9 (12.9%) patients, which included chronic ischaemic changes in the peri-ventricular region.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
SETTING: Intracranial tuberculomas are commonly observed neuroimaging abnormalities in tuberculous meningitis (TBM).OBJECTIVE: To evaluate the predictors and prognostic significance of tuberculomas ...in patients with TBM.DESIGN: In a retrospective follow-up study, contrast-enhanced
magnetic resonance imaging was performed at study inclusion and after 9 months of follow-up. Univariate analysis and multivariate analysis were used to identify predictive factors for tuberculoma. Prognosis (death and severe disability) was assessed using the modified Rankin scale.RESULTS:
At inclusion, 43 of 110 patients had cerebral tuberculomas. Seven patients developed paradoxical tuberculomas. Predictors of tuberculomas were raised cerebrospinal fluid (CSF) protein (>3 g/l) and meningeal enhancement. Multivariate analysis did not show any significant predictors. During
follow-up, the only significant predictor of paradoxical development of tuberculomas was raised CSF protein (>3 g/l). After 9 months of follow-up, 32 patients had died or had severe disability. Survival analysis revealed that patients with tuberculomas and those without tuberculomas had
a similar prognosis.CONCLUSION: Tuberculomas occurred in approximately 39% of the patients with TBM. Significant predictors were meningeal enhancement and raised CSF protein. TBM patients with or without tuberculomas had a similar prognosis.
Abstract
Carpal tunnel syndrome is a common peripheral nerve entrapment neuropathy caused due to compression of the median nerve at the level of the wrist joint. Bifid median nerve associated with a ...persistent median artery is a rare entity and in itself asymptomatic anatomical variant. However, distension of the persistent median artery due to a thrombus can be symptomatic due to compression on the median nerve and can compromise the blood flow to the palm. We report a case of persistent median artery thrombosis in a young female patient who presented with symptoms of carpal tunnel syndrome diagnosed on the ultrasonography and confirmed on the MRI with subsequent improvement post anticoagulation therapy.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Abstract Background Vision impairment is a devastating complication of tuberculous meningitis. In the present study we evaluated the predictors and prognostic significance of vision impairment in ...tuberculous meningitis. Methods In this study, 101 adult patients with tuberculous meningitis were evaluated for vision status and physical disability and were followed up for 6 months. Contrast enhanced magnetic resonance imaging (MRI) was performed at baseline and 6 months. Result Out of 101 patients, 74 patients had normal vision and 27 patients had low vision or blindness at enrollment. Thirteen patients died during the study period. Out of 88 patients who survived at 6 months, 68 patients had good vision, 11 patients had low vision and 9 patients had blindness. Predictors of vision deterioration were papilledema, cranial nerve palsies, raised cerebrospinal fluid protein (> 1 g/L), and presence of optochiasmatic arachnoiditis in MRI. Predictors of blindness, at 6 months, were found to be papilledema, vision acuity ≤ 6/18, cranial nerve palsies, tuberculous meningitis stage II or III, raised cerebrospinal fluid protein (> 1 g/L), optochiasmatic arachnoiditis, and optochiasmal tuberculoma. At 6 months, 27 patients had death or severe disability. Predictors of death or severe disability at 6 months were vision acuity ≤ 6/18, cranial nerve deficits, hemiparesis, clinical stage II or III, and presence of infarct in MRI. Conclusion Vision impairment occurred in one-fourth of patients with tuberculous meningitis. Principal causes of vision loss were optochiasmatic arachnoiditis and optochiasmal tuberculoma. Impaired vision predicted death or severe disability.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Summary Background Paradoxical appearance of new or expansion of existing optochiasmatic tuberculoma, leading to severe vision loss, is a devastating complication in patient with tuberculous ...meningitis. Methods We report a series of 8 cases of tuberculous meningitis that developed paradoxical vision loss associated with optochiasmatic tuberculoma. Clinical assessment and magnetic resonance imaging (MRI) done at presentation, at the time of deterioration, and at 9 months were analyzed. Results All patients had good vision acuity and normal visual field at baseline. None of them had optochiasmatic tuberculoma on magnetic resonance imaging at baseline, though 3 patients had optochiasmatic arachnoiditis. The mean interval of onset of paradoxical optochiasmatic tuberculoma was 41 days after starting antituberculosis therapy. Paradoxical optochiasmatic tuberculoma was associated with vision deterioration in all patients, 6 of whom developed severe vision loss (vision acuity ≤6/60). Repeat neuroimaging showed new optochiasmatic tuberculoma in all patients. All patients were treated with extended course of dexamethasone for 6 weeks along with antituberculosis therapy. Two patients died at 62 and 211 days respectively. Repeat neuroimaging in rest of the patients showed resolution of optochiasmatic tuberculoma. At 9 months follow-up, vision improved completely in 3 patients and partially in 3 patients. Conclusion Prompt recognition of paradoxical optochiasmatic tuberculoma with the help of vision assessment and neuroimaging is vital for patient's life and vision. Paradoxical reactions should not be labeled as a new or resistant infection. The prior treatment schedule should continue, and dexamethasone may be added or its dose enhanced.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
7.
Facial detection using deep learning Sharma, Manik; Anuradha, J; Manne, H K ...
IOP conference series. Materials Science and Engineering,
11/2017, Volume:
263, Issue:
4
Journal Article
Peer reviewed
Open access
In the recent past, we have observed that Facebook has developed an uncanny ability to recognize people in photographs. Previously, we had to tag people in photos by clicking on them and typing their ...name. Now as soon as we upload a photo, Facebook tags everyone on its own. Facebook can recognize faces with 98% accuracy which is pretty much as good as humans can do. This technology is called Face Detection. Face detection is a popular topic in biometrics. We have surveillance cameras in public places for video capture as well as security purposes. The main advantages of this algorithm over other are uniqueness and approval. We need speed and accuracy to identify. But face detection is really a series of several related problems: First, look at a picture and find all the faces in it. Second, focus on each face and understand that even if a face is turned in a weird direction or in bad lighting, it is still the same person. Third select features which can be used to identify each face uniquely like size of the eyes, face etc. Finally, compare these features to data we have to find the person name. As a human, your brain is wired to do all of this automatically and instantly. In fact, humans are too good at recognizing faces. Computers are not capable of this kind of high-level generalization, so we must teach them how to do each step in this process separately. The growth of face detection is largely driven by growing applications such as credit card verification, surveillance video images, authentication for banking and security system access.
Background
During the second wave of the COVID-19 pandemic, outbreaks of Zika were reported from Kerala, Uttar Pradesh, and Maharashtra, India in 2021. The Dengue and Chikungunya negative samples ...were retrospectively screened to determine the presence of the Zika virus from different geographical regions of India.
Methods
During May to October 2021, the clinical samples of 1475 patients, across 13 states and a union territory of India were screened and re-tested for Dengue, Chikungunya and Zika by CDC Trioplex Real time RT-PCR. The Zika rRTPCR positive samples were further screened with anti-Zika IgM and Plaque Reduction Neutralization Test. Next generation sequencing was used for further molecular characterization.
Results
The positivity was observed for Zika (67), Dengue (121), and Chikungunya (10) amongst screened cases. The co-infections of Dengue/Chikungunya, Dengue/Zika, and Dengue/Chikungunya/Zika were also observed. All Zika cases were symptomatic with fever (84%) and rash (78%) as major presenting symptoms. Of them, four patients had respiratory distress, one presented with seizures, and one with suspected microcephaly at birth. The Asian Lineage of Zika and all four serotypes of Dengue were found in circulation.
Conclusion
Our study indicates the spread of the Zika virus to several states of India and an urgent need to strengthen its surveillance.
USP22 is a positive regulator in tumor growth, its depletion leads to cell cycle arrest at G1 phase. USP22 over expression was positively correlated with proteins involved in proliferation and ...negatively correlated with tumor suppressor protein tumor supprn. Ki-67 expression is associated with USP22 over expression in oral squamous cell carcinoma (OSCC) and also in cervical and prostate cancers. The aim of this study is to evaluate the expression of USP22 and Ki-67 in OSCC by using an immunohistochemical staining procedure.
Immunohistochemistry was used to determine the expression of USP22 protein in 50 archival tissue blocks of histopathologically diagnosed OSCC and 15 normal oral mucosa tissue blocks. The histopathological correlation of USP22 with Ki-67 was done.
Expression of USP22 and Ki-67 was seen in the nuclei of epithelial cells. Statistical analysis of the mean expression of USP22 in OSCC and normal tissue showed a significant difference (
= 0.000000119). A significant difference was also observed in Ki-67 between OSCC and normal tissue (
= 0.00000086). Correlation test showed a weak correlation (R = 0.19) between USP22 and Ki-67 expression of group 1. Similarly, a weak correlation (R = 0.51) was observed in group 2.
A statistically significant difference in the expression of USP22 and Ki-67 was observed between normal mucosa and OSCC. It can be used in early diagnosis of OSCC but its use as a prognostic indicator is questionable and should be exemplified with a larger study sample.
Background and purpose: New antileishmanials from natural products are urgently needed due to the emergence of drug resistance complicated by severe cytotoxic effects. 16α‐Hydroxycleroda‐3,13 ...(14)Z‐dien‐15,16‐olide (Compound 1) from Polyalthia longifolia was found to be a potential antileishmanial and non‐cytotoxic, as evidenced by long‐term survival (>6 months) of treated animals. This prompted us to determine its target and, using molecular modelling, identify the interactions responsible for its specific antileishmanial activity.
Experimental approach: In vitro activity of compound was assessed using intracellular transgenic green fluorescent protein‐stably expressed Leishmania donovani parasites. In vivo activity and survival of animals post‐treatment were evaluated in L. donovani‐infected hamsters. Known property of clerodane diterpenes as potent human DNA topoisomerase inhibitors led us to evaluate the inhibition of recombinant L. donovani topoisomerase I using relaxation assay. Mode of cell death induced by Compound 1 was assessed by phosphotidylserine exposure post‐treatment. Molecular modelling studies were conducted with DNA topoisomerase I to identify the binding interactions responsible for its activity.
Key results: Bioassay‐guided fractionation led to isolation of Compound 1 as a non‐cytotoxic, orally active antileishmanial. Compound 1 inhibited recombinant DNA topoisomerase I which, ultimately, induced apoptosis. Molecular docking studies indicated that five strong hydrogen‐bonding interactions and hydrophobic interactions of Compound 1 with L. donovani DNA‐topoisomerase are responsible for its antileishmanial activity.
Conclusions and implications: The data reveal Compound 1 is a potent and safe antileishmanial. The study further exploited the structural determinants responsible for its non‐cytotoxic and potent activity, to raise the feasibility of specifically targeting the target enzyme responsible for its activity through rational drug design.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
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