Programmatic implications of a sub-national TB prevalence survey in India

BACKGROUND

Subnational TB estimates are crucial for making informed decisions to tailor TB control activities to local TB epidemiology.

METHODS

A cross-sectional survey was conducted among 143,005 individuals in Tamil Nadu, India. Participants were screened for symptoms and underwent chest X-ray (CXR). Participants with symptoms of TB and/or abnormal CXR were tested for TB using Xpert, smear, and liquid culture.

RESULTS

The prevalence of microbiologically confirmed pulmonary TB (MCPTB) was 212 (95% CI 184-239) per 100,000 population. The prevalence-to-notification ratio (P:N) in the state was 2.05 (95% CI 1.8-2.29). Low body mass index and diabetes together had a population attributable fraction of 54.15 (95% CI 45.68-61.97). Approximately 39% of the TB cases were asymptomatic and were identified only by CXR screening. In the general population, only 26.9% sought care at a health facility among those with symptoms suggestive of TB.

CONCLUSION

The programme needs to prioritise screening with CXR to potentially detect cases earlier and curtail the transmission and upscale molecular tests in the selected population to increase the yield of case finding. Innovative health education strategies must be devised to address health-seeking behaviour..

Bailout Options for Intra-operative Implant and Instrumentation Related Incidents and Complications During Arthroscopic Knee Surgery-A Retrospective Study

Background

Arthroscopic knee procedures are one amongst the common surgical interventions for problems in the knee. It is technically more demanding than an open procedure and is associated with several potential complications. During arthroscopy procedures, several technical challenges may arise, and even experienced surgeons may encounter new issues. However, careful attention to the surgical technique can help prevent or resolve them.

Methodology

The study was conducted on all patients who underwent knee arthroscopy procedure during study period. We recorded details of the implants used and any unexpected situations related to them, as well as how they were managed. Instrumentation-related parameters such as screwdriver issues, radiofrequency ablator issues, scope damages, shaver complications, probe complications, and meniscus suture passing devices were also assessed.

Results

In total, there were 12 (3.73%) implant and instrument-related incidents and complications, of which 5 (1.55%) were implant-related and 7 (2.17%) were instrument related. Among the instrumentation-related incidents and complications, two (0.62%) were screwdriver breakage incidents, two (0.62%) were radiofrequency ablator-related incidents, one was arthroscopic probe (0.31%) related incident, one (0.31%) was meniscus suture passing device related complication and one (0.31%) was arthroscope related incident.

Conclusion

Surgeons must be ready to anticipate and effectively manage any technical difficulties that may arise during the procedure, maintaining composure in the face of unexpected challenges and guiding the team. In most cases, incidents can be addressed intra operatively and may not have long-term effects on patient outcomes. It is crucial to have multiple implant and instrument backup options available for successful surgery.

Validation, Deployment, and Real-World Implementation of a Modular Toolbox for Alzheimer's Disease Detection and Dementia Risk Reduction: The AD-RIDDLE Project

The Real-World Implementation, Deployment, and Validation of Early Detection Tools and Lifestyle Enhancement (AD-RIDDLE) project, recently launched with the support of the EU Innovative Health Initiative (IHI) public-private partnership and UK Research and Innovation (UKRI), aims to develop, test, and deploy a modular toolbox platform that can reduce existing barriers to the timely detection, and therapeutic approaches in Alzheimer's disease (AD), thus accelerating AD innovation. By focusing on health system and health worker practices, AD-RIDDLE seeks to improve and smooth AD management at and between each key step of the clinical pathway and across the disease continuum, from at-risk asymptomatic stages to early symptomatic ones. This includes innovation and improvement in AD awareness, risk reduction and prevention, detection, diagnosis, and intervention. The 24 partners in the AD-RIDDLE interdisciplinary consortium will develop and test the AD-RIDDLE toolbox platform and its components individually and in combination in six European countries. Expected results from this cross-sectoral research collaboration include tools for earlier detection and accurate diagnosis; validated, novel digital cognitive and blood-based biomarkers; and improved access to individualized preventative interventions (including multimodal interventions and symptomatic/disease-modifying therapies) across diverse populations, within the framework of precision medicine. Overall, AD-RIDDLE toolbox platform will advance management of AD, improving outcomes for patients and their families, and reducing costs.

A Cellular atlas of the human fallopian tube reveals the metamorphosis of secretory epithelial cells during the menstrual cycle and menopause

The fallopian tube, connecting the uterus with the ovary, is a dynamic organ that undergoes cyclical changes and is the site of several diseases, including serous cancer. Here, we use single-cell technologies to construct a comprehensive cell map of healthy pre-menopausal fallopian tubes, capturing the impact of the menstrual cycle and menopause on different fallopian tube cells at the molecular level. The comparative analysis between pre- and post-menopausal fallopian tubes reveals substantial shifts in cellular abundance and gene expression patterns, highlighting the physiological changes associated with menopause. Further investigations into menstrual cycle phases illuminate distinct molecular states in secretory epithelial cells caused by hormonal fluctuations. The markers we identified characterizing secretory epithelial cells provide a valuable tool for classifying ovarian cancer subtypes.

Graphical summary

Graphical summary of results. During the proliferative phase (estrogen high ) of the menstrual cycle, SE2 cells (OVGP1 + ) dominate the fallopian tube (FT) epithelium, while SE1 cells (OVGP1 - ) dominate the epithelium during the secretory phase. Though estrogen levels decrease during menopause, SE post-cells (OVGP1 + , CXCL2 + ) make up most of the FT epithelium.

Safeguarding against potential injury from an eye drops bottle

We describe a potential cause of eye injury, its concerns and ways to prevent it. The first author underwent a left cataract operation and was prescribed eye drops postoperatively. While applying one of the eye drops, he felt an object hitting the lower eyelid. A serrated plastic piece had fallen off the bottle. Had it fallen on the operated site, it might have caused serious untoward complications. Nurses, carers and patients need to be educated to remove the serrated piece from the bottle before applying eye drops. Manufacturers of eye drops should design safer bottles without such serrated pieces to prevent such eye injuries.

Revision of Failed Medial Meniscus Posterior Root Repair: A Case Report

Introduction

Meniscal root tear decreases the ability of the meniscus to convert the axial load to radially directed hoop stress. This leads to a decreased contact area and increased contact pressures, leading to early osteoarthrosis of the knee and eventually higher chances of undergoing total knee replacement. Meniscal root repair helps to restore normal knee kinematics; however, non-anatomical repair results in increased strain in the repair and causes early failure of the repair, leading to abnormal knee kinematics.

Case Report

A 45-year-old female with a body mass index of 40.6, hypothyroid, and type II diabetes mellitus presented to the outpatient department with the complaints of left knee pain and difficulty in walking. She had undergone an arthroscopic medial meniscus posterior root repair 1 year back. Clinical and radiological examinations helped to diagnose a re-tear of the medial meniscus root with a non-anatomic tibial tunnel. She then underwent arthroscopic revision root repair surgery. Currently, the patient is at a 1-year follow-up and has resumed her activities of daily living.

Conclusion

Anatomical repair of the posterior horn of the medial meniscus is important in restoring normal knee kinematics and for the ability of the meniscus to maintain the hoop stress. Non-anatomic repair leads to early failure and progression to rapid cartilage degeneration, resulting in early osteoarthritis and eventual knee replacement. Any revision surgery presents its own different set of challenges. The basic principles must be adhered to while addressing any failure of the primary surgery.

A Novel Technique of Resecting Localized Pigmented Villonodular Synovitis of the Knee Joint

Introduction

Pigmented villonodular synovitis is an uncommon benign proliferation of the synovium. In the knee joint, it can present as a localized or a diffuse form and can mimic numerous conditions.

Case Report

We present a case report of a 54-year-old male with localized form of this condition. The diagnosis is not often made clinically but usually made with the help of magnetic resonance imaging and histopathology. We used a novel technique for resecting the tumor by arthroscopy.

Conclusion

A high index of suspicion is required for the diagnosis of the condition and arthroscopic excision results in lower morbidity and lesser recurrence rates.

Anatomical Landmark Technique for Femoral Tunnel Placement of Lateral Extra-Articular Tenodesis

The anterolateral ligament is a crucial part of the anterolateral complex of the knee, providing rotator stability to the knee and being a primary restraint to tibial internal rotation. Lateral extra-articular tenodesis added to anterior cruciate ligament reconstruction can reduce pivot shift without sacrificing the range of motion or increasing the risk of osteoarthritis. A 7- to 8-cm longitudinal skin incision is made and a 9.5- to 10-cm × 1- cm wide iliotibial band graft is dissected, leaving the distal attachment intact. The free end is whip stitched. One of the most important steps during the procedure is the identification of the site of attachment of the iliotibial band graft. The leash of vessels, fat pad, lateral supracondylar ridge, and fibular collateral ligament serve as important landmarks. The tunnel is drilled from the lateral femoral cortex with a guide pin and reamer pointing 20 to 30° anteriorly and proximally while the arthroscope visualizes the femoral anterior cruciate ligament tunnel. The graft is routed under the fibular collateral ligament. The graft is fixed with a bioscrew while the knee is kept in 30° flexion and the tibia is kept in neutral rotation. We believe that lateral extra-articular tenodesis gives the anterior cruciate ligament graft a good chance for faster healing along with addressing anterolateral rotatory instability. Choosing a correct fixation point is very important to restore normal knee biomechanics.

Potential of smartphone enabled otoscopy for teleconsultation and teaching

The smartphone enabled otoscope (SEO) provides an opportunity for telemedicine and enhancing teaching of otoscopy. We describe our preliminary experience with the use of one such inexpensive device bought from an online store. It is a simple and feasible procedure which patients can perform on themselves (or guardians on their wards) after minimal training. The resolution of the image is adequate for follow up through teleconsultation. It is also a good teaching tool as it enables the sharing of views.

Iodine(III)-promoted regioselective and efficient synthesis of β-triazolyl BODIPYs for the selective recognition of nickel ion and bovine serum albumin

Various ꞵ-triazolyl tethered BODIPYs were efficiently prepared in a sequential one-pot protocol involving the initial reaction of BODIPY with iodobenzene diacetate (IBD) and sodium azide to in situ generate BODIPY...

Fingerprint of volcanic forcing on the ENSO-Indian monsoon coupling

Coupling of the El Niño-Southern Oscillation (ENSO) and Indian monsoon (IM) is central to seasonal summer monsoon rainfall predictions over the Indian subcontinent, although a nonstationary relationship between the two nonlinear phenomena can limit seasonal predictability. Radiative effects of volcanic aerosols injected into the stratosphere during large volcanic eruptions (LVEs) tend to alter ENSO evolution; however, their impact on ENSO-IM coupling remains unclear. Here, we investigate how LVEs influence the nonlinear behavior of the ENSO and IM dynamical systems using historical data, 25 paleoclimate reconstructions, last-millennium climate simulations, large-ensemble targeted climate sensitivity experiments, and advanced analysis techniques. Our findings show that LVEs promote a significantly enhanced phase-synchronization of the ENSO and IM oscillations, due to an increase in the angular frequency of ENSO. The results also shed innovative insights into the physical mechanism underlying the LVE-induced enhancement of ENSO-IM coupling and strengthen the prospects for improved seasonal monsoon predictions.

The logistical management of tertiary urethral disease in the United Kingdom: Implications from an online audit of male reconstructive urethral surgery

Objective:

To determine those patient groupings, based on volume and risk, whose optimal urethral reconstructive management might be provided by a reorganisation of UK reconstructive surgeons.

Methods:

Between 2010 and 2017, ~689 men/year were enrolled onto an online audit platform collecting data about urethral reconstruction in the UK; this accrual was compared against hospital episode statistics (HES). The available workforce, and where this was based, was collected. Individual and institutional incumbent patient volumes, pathology, surgical complexity and outcomes from treatment were collated to stratify volume/risk groups.

Results:

More than 90% of all HES-recorded data were accrued, being provided by 50 surgeons at 39 operative sites. Most reconstructive surgery was provided at 10 centres performing >20 procedures/year. More than 50% of all interventions were of a high-volume low-risk type. Of activity, 32.3% was intermediate volume or moderate risk, and 12.5% of men presented for lower-volume or higher-risk procedures.

Conclusion:

Correlation of detailed volume/outcome data allows the definition of patient populations presenting for urethral reconstruction. Stratification of each group’s management, to optimise the surgical outcome, may be applied to a hierarchical service delivery model based on the complexity of the patient’s presenting urethral pathology.

Level of evidence:

Level IV

Direct Error-Driven Learning for Deep Neural Networks With Applications to Big Data

In this brief, heterogeneity and noise in big data are shown to increase the generalization error for a traditional learning regime utilized for deep neural networks (deep NNs). To reduce this error, while overcoming the issue of vanishing gradients, a direct error-driven learning (EDL) scheme is proposed. First, to reduce the impact of heterogeneity and data noise, the concept of a neighborhood is introduced. Using this neighborhood, an approximation of generalization error is obtained and an overall error, comprised of learning and the approximate generalization errors, is defined. A novel NN weight-tuning law is obtained through a layer-wise performance measure enabling the direct use of overall error for learning. Additional constraints are introduced into the layer-wise performance measure to guide and improve the learning process in the presence of noisy dimensions. The proposed direct EDL scheme effectively addresses the issue of heterogeneity and noise while mitigating vanishing gradients and noisy dimensions. A comprehensive simulation study is presented where the proposed approach is shown to mitigate the vanishing gradient problem while improving generalization by 6%.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher.

CONCLUSIONS

Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.

An Empirical Study of Service Quality and Customer Satisfaction of Malaysian Air Passenger

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The influence of carbon concentration on the electronic structure and magnetic properties of carbon implanted ZnO thin films

The influence of carbon concentration on the electronic and magnetic properties of C-implanted ZnO thin films has been studied using synchrotron radiation based X-ray absorption spectroscopic techniques and vibrating sample magnetometer measurements. 20 keV carbon ions were implanted in ZnO films with different fluences (2 × 10¹⁶, 4 × 10¹⁶ and 6 × 10¹⁶ ions per cm²). The pristine ZnO film shows diamagnetic behaviour while the C-implanted films exhibit room temperature ferromagnetism. Our first-principles calculations based on density functional theory show an appreciable magnetic moment only when the implanted C atom sits either in the O-site (2 μ_B) or in the interstitial position (1.88 μ_B), whereas the C atom in the Zn substitutional position does not possess any magnetic moment. X-ray absorption near edge structure analysis at the O K-edge reveals that the charge transfer from O-2p to the C-defect site causes the ferromagnetism in the C-implanted ZnO film at low fluence. However at high fluence, the implanted C replaces the lattice and produces more Zn vacancies, as evidenced by extended X-ray absorption fine structure studies at the Zn K-edge, which favors the ferromagnetism. The persistence of the implanted carbon and ferromagnetism of the C-implanted ZnO film has also been studied by isothermal annealing at 500 °C and discussed in detail.