An efficient and fast multi-band focused bioimpedance solution with EIT-based reconstruction for pulmonary embolism assessment: a simulation study from massive to segmental blockage

Objective: Pulmonary embolism (PE) is an acute condition that blocks the perfusion to the lungs and is a common complication of Covid-19. However, PE is often not diagnosed in time, especially in the pandemic time due to complicated diagnosis protocol. In this study, a non-invasive, fast and efficient bioimpedance method with the EIT-based reconstruction approach is proposed to assess the lung perfusion reliably. Approach: Some proposals are presented to improve the sensitivity and accuracy for the bioimpedance method: (1) a new electrode configuration and focused pattern to help study deep changes caused by PE within each lung field separately, (2) a measurement strategy to compensate the effect of different boundary shapes and varied respiratory conditions on the perfusion signals and (3) an estimator to predict the lung perfusion capacity, from which the severity of PE can be assessed. The proposals were tested on the first-time simulation of PE events at different locations and degrees from segmental blockages to massive blockages. Different object boundary shapes and varied respiratory conditions were included in the simulation to represent for different populations in real measurements. Results: The correlation between the estimator and the perfusion was very promising (R = 0.91, errors < 6%). The measurement strategy with the proposed configuration and pattern has helped stabilize the estimator to non-perfusion factors such as the boundary shapes and varied respiration conditions (3-5% errors). Significance: This promising preliminary result has demonstrated the proposed bioimpedance method’s capability and feasibility, and might start a new direction for this application.

Food allergies and acute allergic reactions: diagnostic options

Introduction. Anaphylaxis is a systemic potentially life-threatening hypersensitivity reaction featuring the rapid onset, manifestations of the respiratory tract and/or hemodynamics and usually, but not always, accompanied by changes in the skin and mucous membranes [1]. The cause of developing an acute generalized reaction in food anaphylaxis may be the minimum culprit product amount that has entered the patient's body through the mouth or through the skin/mucous membranes. Patients like these are, as a rule, first seen by a paediatrician, a related specialist, or a paramedic. Since the doctors often consider the symptoms of foodborne anaphylaxis separately, the latter does not cause proper suspicion: angioedema and/or acute urticaria accompanying rhinorrhea, acute bronchospasm or laryngitis developed extremely quickly or immediately after contact with an allergen.The aim of the work was to acquaint paediatricians and doctors of related specialties with the food anaphylaxis symptoms, to justify the need for an allergologist-immunologist to consult these patients in order to resolve the issue of required component-resolved diagnosis of allergy and development of an individual elimination diet, taking into account the patient's sensitization profile.Materials and methods. Clinical observation of a child (boy, age — 12 months) with symptoms of atopic dermatitis and episodes of food anaphylaxis in the anamnesis; general clinical examination and allergological examination of the patient by component allergodiagnostics were performed.Results. Sensitization to ovalbumin (Gald 2 -16.60 kU/l) and ovomucoid (Gald 1-9.01 kU/l) was established. The detected sensitization is a predictor of severe systemic allergic reactions to eggs.Discussion. Component diagnostics performed as prescribed by an allergologist not only confirms the causative allergen, but also evaluates the risks of developing acute reactions if the allergen is accidentally introduced to the child and the timing of the patient's tolerance formation. This sensitization will cause sudden systemic allergic reactions for years to come.Conclusion. It is important for a specialist to timely suspect food anaphylaxis, differentiate it from other emergency and urgent conditions, and give the patient the correct recommendations on the need for consultation with an allergologist-immunologist. Only a thoughtful, comprehensive medical approach to each acute condition in a child will significantly reduce the risk of repeated episodes of food anaphylaxis.

Detection of toxoplasmosis in pets and stray cats through molecular and serological techniques in Khyber Pakhtunkhwa, Pakistan

Background Toxoplasma gondii is an important parasite that belongs to the phylum Apicomplexa, distributed globally, causing major health issues for a wide range of hosts, including humans, native and wild animals. Methods In the present study, we detected IgG and IgM antibodies through an ELISA kit and DNA of T. gondii through PCR in 197 pets and stray cats in Peshawar, Charsadda, Mardan, and Kohat districts of Khyber Pakhtunkhwa (Pakistan) to estimate the existence of feline toxoplasmosis. Results The current study revealed that stray cats have a significant infection rate of T. gondii (74.6%) as compared to pet cats (25.4%). In all the four districts, the prevalence of T. gondii was pointedly higher in district Kohat (95.5%) in the feline population. In comparison to the female (75.18%) and male (both pets and stray) cats have a maximum infection of (81.66%) non-significantly. The prevalence of T. gondii was observed to be significantly higher (91.66%) in the older and greater than 4 year old population of cats as compared to the younger ones. In poor health condition, the cat populations has a higher risk of infection of 92.3% as compared to healthy and poor body condition (73.91%) and (82.6%) respectively. The chronic and reactivated chronic conditions of toxoplasmosis were higher (58.37%) as compared to the acute condition. Conclusion It has been concluded that toxoplasmosis is widely spread in the studied population.The outcomes of the present study show that T. gondii infection has a significant impact on the type of cat, age, and area, which implies a serious threat to human beings. Therefore, genotyping of T. gondii strains from different hosts is needed to forecast the current approach for prevention and control of this zoonotic parasite.

Ayurvedic Successful Management of Nodular Episcleritis with Prolonged Period Follow Up-A Case Report

Episcleritis, an acute unilateral or bilateral inflammation, usually idiopathic or autoimmune condition with or without underlying systemic condition is a troublesome manifestation of red eye reported. It manifests as red or pinkeye, varied mild pain to foreign body sensation, tender discomfort on touch, commonly recurs. As an acute condition patient seeks medical assistance. Ayurveda recognised this either as Sirajala, Siraharsha, Sirajapidika and a Shuklabhagaroga. Here a young lady with painful repeated manifestation of episcleritis is reported seeking Ayurveda for holistic management of the condition after repeatedly trying other systems in vain. Patient was treated with suitable Shodhana, Kriyakalpa followed by necessary Dinacharya and Rasayana ensuring non recurrence; Deepan pachana, Anulomana, Kriyakalpa, Rasyana chosen were all Chakshushyadravyas. To add up to synchronize the effect of yoga therapies advised, to achieve non recurrence of symptoms. Trikatu, Trivrt, Triphala, Yashtimadhu, Madhu, Ghrta known Chakshushyadravya having vitamins and trace elements known to be highly beneficial to the eye and all sense organs was advocated, Kriyakalpa play a major role in immediate mitigation of symptoms and also prevents recurrence. Seka is most accepted Kriyakapla for enhancing quick relief, non recurrence, cost effective Ayurveda management reported after a prolonged period of follow up for a year. Yoga therapy included Suryanamaskar, Anulomaviloma pranayama and Trataka, Ayurveda and yoga when added to management ensured non recurrence.

DRUG REVIEW OF KUSHAMOOLA CHURNA WITH TANDULODOK IN ASRUGDARA MANAGEMENT

In Ayurveda, menstruation has been described in 3 phases as rajahkala (menstrual period) rutukala (fertile period) and rutuvyatitkal (premenstrual period) & Do’s and Don’ts regarding this has also been explained in detail. Due to so much physical and emotional stress women are suffering from so many menstrual problems, Asrugdara (menorrhagia) is one of them and in Samhitas its causes, Etiopathogenesis, treatment and complications are ex- plained in detail. Menorrhagia is being treated with hormonal combination have so many side effects in acute as well as chronic therapy. Kushamool churna with tandulodak (Rice water) as explained by Bhaishajya Ratnawali treats Asrugdara in 3 days. Due to its pharmacological properties, it breaks down the pathology of Asrugdara in the acute stage. So, we can formulate this combination for the acute condition of menorrhagia. Keywords: Rajahkala, Rutukala, Rutuvyatitkal, Asrugdara, Menorrhagia, Etiopathogenesis.

Prenatal Noninvasive Trio-WES in a Case of Pregnancy-Related Liver Disorder

Liver disease in pregnancy may present as an acute condition related to the gestational period, characterized by pruritus, jaundice, and abnormal liver function. The disease may be misdiagnosed with other liver diseases, some of which may have consequences for fetal health. It is therefore advisable to implement rapid diagnostic strategies to provide information for the management of pregnancy in these conditions. We report the case of a healthy woman with a twin pregnancy from homologous in vitro fertilization (IVF), who in the third trimester presented jaundice and malaise. Biochemical investigations and liver hyperechogenicity raised the suspicion of acute fatty liver disease of pregnancy (AFLP). Non-invasive prenatal whole-exome sequencing (WES) in the trio identified the Phe305Ile heterozygous variant in the ATP8B1 gene. Considering the twin pregnancy, the percentage of the variant versus the wild allele was of 31%, suggesting heterozygosity present in the mother alone. This analysis showed that the mother was affected by benign recurrent intrahepatic cholestasis of pregnancy (ICP1: # 147480) and indicated the opportunity to anticipate childbirth to avoid worsening of the mother’s health. WES after the birth of the twins confirmed the molecular data.

ROLE OF AGNILEPA IN PAKSHAGHATA (ISCHEMIC STROKE): A CASE STUDY

Stroke is defined as the rapid onset of focal neurological deficit resulting from diseases of the cerebral vasculature and its contents. Stroke represents the third most common cause of death in the developed nations. The prevalence of stroke in India is approximately 200 per 100,000 persons and 9.94% of total deaths. The present article deals with a diagnosed case of ischemic stroke presenting with left sided hemiplegia Acute infarct in the right temporo-parieto-frontal lobe and right ganglio-capsular region with haemorrhagic transformation. The Ayurvedic diagnosis of vama Pakshaghata was made and managed with shamana aushadhi and agnilepa (bahirparimarjana chikitsa). Two assessments were made before and after treatment using the National Institute of Health Stroke Scale (NIH-SS) and CT scan. Maximum improvement was noticed in the symptoms of Stambha, Ruja, Supti, Shotha, Sparsha hani. Even there was also improvement in left upper and lower extremity functions. At the end of the treatment the patient could be able to walk without support. After treatment CT scan showed considerable recovery. Agnilepa plays a major role in the management of Margavaranajanya pakshaghata (acute ischemic stroke) if associated with saama condition, in acute condition. The drugs used for Agnilepa are having Katu Rasa Pradhana, ruksha, teekshna, lekhana guna, ushna veerya, katu vipaka and kaphavataghna, vedanasthapaka, Shothahara, Stambhahara, Suptihara and helpful in regaining of Sparshana. Agnilepa can be practiced as bahirparimarjana chikitsa in pakshaghata, as many Salvana upanaha are mentioned in the chikitsa.

The Utility of Biomarkers in Diagnosing and Predicting Outcomes in Acute Mesenteric Ischemia

Background: Acute intestinal ischemia stands as the most lethal acute condition encountered by general surgeons and one of the deadliest pathologies in medicine triggered by thromboembolic events. The patients’ survival decreases dramatically to a lower than 30% rate when diagnosed after 24 hours, thus early diagnosis with proper surgical or vascular intervention is mandatory. This study aims to determine the utility of biomarkers and routine blood tests in assessing the severity and mortality risk for patients with acute mesenteric ischemia. Methods: The study was developed on a prospective cross-sectional design over a period of five years, finding a total of 147 patients who underwent emergency surgery after a high suspicion of acute mesenteric ischemia. The available biomarkers used in our Clinic comprised a complete blood count, total bilirubin, CK, CK-MB, LDH, AST, ALT, amylase, and cholinesterase. Results: The leukocyte count (OR=1.105), hemoglobin (OR=3.912), LDH (OR=1.144), NLR (OR=1.154), and LLR (OR=1.286) were all independent and significant risk factors for AMI diagnosis. These covariates proved a good and reliable tool for diagnosing AMI with a 75.3% predicted probability. Conclusion: The prediction tool proved reliable, although it should only be considered in the clinical context where the surgeon suspects a case of acute mesenteric ischemia. The proposed model should be further investigated and validated in larger studies.

Mitigating the stress response to improve outcomes for older patients undergoing emergency surgery with the addition of beta-adrenergic blockade

As population age, healthcare systems and providers are likely to experience a substantial increase in the proportion of elderly patients requiring emergency surgery. Emergency surgery, compared with planned surgery, is strongly associated with increased risks of adverse postoperative outcomes due to the short time available for diagnosis, optimization, and intervention in patients presenting with physiological derangement. These patient populations, who are often frail and burdened with a variety of co-morbidities, have lower reserves to deal with the stress of the acute condition and the required emergency surgical intervention. In this review article, we discuss topical areas where mitigation of the physiological stress posed by the acute condition and asociated surgical intervention may be feasible. We consider the impact of the adrenergic response and use of beta blockers for these high-risk patients and discuss common risk factors such as frailty and delirium. A proactive multidisciplinary approach to peri-operative care aimed at mitigation of the stress response and proactive management of common conditions in the older emergency surgical patient could yield more favorable outcomes.

Injuries resulting from practicing performance sports in table tennis and tennis

Performance sport as an area of human excellence requires, besides an over-average genetic endowment of motor skills, a huge workload of high intensity, which causes the wear of the body systems of the athletes, especially the osteo-musculo-articular. The high ball movement speed for rocket and paddle sports disciplines such as table tennis and field tennis, intensively demands the performance of the body of practitioners when performing specific technical tactics, especially the technical elements of the attack, such as topspin or smash. Based on the theoretical documentation, I noticed an acute condition in the scapulo-humeral joint 21.05%, at the lumbar level 15.79% and 13.16% in the ankle joint in the table tennis and in the field tennis as percentages at scapulo-humeral joint 13.85%, lumbar 15.38% and 20.00% ankle joint, aspects that validate our desire to improve the quality of life of practicing athletes of the two disciplines through a program of amelioration of compensatory nature.The objective of this theoretical research is to identify the areas subject to mechanical stress with high risk of wearor injury from the two "sister" sports disciplines.Tasks: Critical analysis of a larger volume of studies conducted on the direction of our research interest.Purpose: obtaining the information necessary which would highlight the risks the performance athletes, practitioners of the two disciplines, are subjected to, as well as gaining knowledge on tennis and table tennis.