Reliability of Sit to Stand Test in Fall Identification in Knee Osteoarthritis- A Literature Review

Osteoarthritis is the second most prevalent degenerative illness as well as the most frequent joint condition in India. It is one of the most common degenerative disorder of the articular cartilage and surface of weightbearing joints causing disability in elderly patients. Gait, stair-climbing, unipedal stance, and the sitting-to-standing (STS) task have all been shown to be altered in research. Most of the research article had proved that sit to stand test, we can use to physiotherapy department to identify the risk of fall in knee OA patients. Most of the patients had severe knee pain and reduced lower limb muscle strength so, during the test patient may take a long time to complete the test and there is a loss of balance. Due to pain and reduced endurance and loss of balance, the patient may not be capable of completing the test. So, the test is reliable to determine the risk of a fall in knee OA patient.

Slow Off-Rate Modified Aptamer (SOMAmer) Proteomic Analysis of Patient-Derived Malignant Glioma Identifies Distinct Cellular Proteomes

Malignant gliomas derive from brain glial cells and represent >75% of primary brain tumors. This includes anaplastic astrocytoma (grade III; AS), the most common and fatal glioblastoma multiforme (grade IV; GBM), and oligodendroglioma (ODG). We have generated patient-derived AS, GBM, and ODG cell models to study disease mechanisms and test patient-centered therapeutic strategies. We have used an aptamer-based high-throughput SOMAscan® 1.3K assay to determine the proteomic profiles of 1307 different analytes. SOMAscan® proteomes of AS and GBM self-organized into closely adjacent proteomes which were clearly distinct from ODG proteomes. GBM self-organized into four proteomic clusters of which SOMAscan® cluster 4 proteome predicted a highly inter-connected proteomic network. Several up- and down-regulated proteins relevant to glioma were successfully validated in GBM cell isolates across different SOMAscan® clusters and in corresponding GBM tissues. Slow off-rate modified aptamer proteomics is an attractive analytical tool for rapid proteomic stratification of different malignant gliomas and identified cluster-specific SOMAscan® signatures and functionalities in patient GBM cells.

Prophylactic anticoagulants to prevent venous thromboembolism in patients with nephrotic syndrome—A retrospective observational study

Background Nephrotic syndrome (NS) is associated with increased risk of venous thromboembolism (VTE). Guidelines suggest prophylactic anticoagulants to patients with high risk of thrombosis and low risk of bleeding, but the evidence behind this is poor. This study aims to investigate the effectiveness and risks of prophylactic anticoagulants (PAC) and investigate risk factors for VTE and bleeding in NS. Methods A retrospective medical records study including adults with NS, biopsy proven glomerular disease in the county of Västernorrland, Sweden. Outcomes were VTE, bleeding and death. Patients divided into PAC- and no PAC group were compared using Fisher’s exact test. Patient time was divided into serum/plasma(S/P)-albumin intervals (<20g/L and ≥20g/L) and VTE- and bleeding rates were calculated. Results In 95 included NS patients (PAC = 40, no PAC = 55), 7 VTE (7.4%) and 17 bleedings (18%) were found. Outcomes didn’t differ significantly between the PAC and no PAC group. Time with S/P-albumin <20g/L conferred higher rates/100 years of VTE (IRR 21.7 (95%CI 4.5–116.5)) and bleeding (IRR 5.0 (1.4–14.7)), compared to time with S/P-albumin>20g/L. Conclusion Duration of severe hypoalbuminemia (S/P-albumin <20g/L) in NS is a risk factor for both VTE and bleeding. There is a need for randomized controlled studies regarding the benefit of PAC in NS as well as risk factors of thrombosis and bleeding in NS.

V-Care Pathologist: A-Z Pathology Services

V-Care Pathologist, a mobile application which will provide a-z pathology services to the patients. Patient will be able to see all the test details according to category. Patient will able to book an appointment, he/she will able to book an appointment for lab visit or home visit. Patient will get their test reports online, only if he/she already paid for the test. Patient will able to see their medical history, for that patients will have to fill the form related to their medical history and their personal details. This application will also provide some test suggestions to the patients according to the patient's symptoms using disease prediction feature. This application will reduce the work load of the pathologist, as this application will automate their work. Admin will able to see the graphical representation of the disease, as different patients has different kind of disease, so this feature will help pathologist to get the accurate information about how many patients has particular kind of disease.

Patient–Ventilator Interaction Testing Using the Electromechanical Lung Simulator xPULM™ during V/A-C and PSV Ventilation Mode

During mechanical ventilation, a disparity between flow, pressure and volume demands of the patient and the assistance delivered by the mechanical ventilator often occurs. This paper introduces an alternative approach of simulating and evaluating patient–ventilator interactions with high fidelity using the electromechanical lung simulator xPULM™. The xPULM™ approximates respiratory activities of a patient during alternating phases of spontaneous breathing and apnea intervals while connected to a mechanical ventilator. Focusing on different triggering events, volume assist-control (V/A-C) and pressure support ventilation (PSV) modes were chosen to test patient–ventilator interactions. In V/A-C mode, a double-triggering was detected every third breathing cycle, leading to an asynchrony index of 16.67%, which is classified as severe. This asynchrony causes a significant increase of peak inspiratory pressure (7.96 ± 6.38 vs. 11.09 ± 0.49 cmH2O, p < 0.01)) and peak expiratory flow (−25.57 ± 8.93 vs. 32.90 ± 0.54 L/min, p < 0.01) when compared to synchronous phases of the breathing simulation. Additionally, events of premature cycling were observed during PSV mode. In this mode, the peak delivered volume during simulated spontaneous breathing phases increased significantly (917.09 ± 45.74 vs. 468.40 ± 31.79 mL, p < 0.01) compared to apnea phases. Various dynamic clinical situations can be approximated using this approach and thereby could help to identify undesired patient–ventilation interactions in the future. Rapidly manufactured ventilator systems could also be tested using this approach.

P37 COVID-19 and non-emergency cancer operating: Implementing a successful testing system

Introduction Early evidence has demonstrated poor peri-operative outcomes for patients undergoing cancer surgery with COVID-19 (C-19) . As a tertiary cancer centre, offering major oesophageal and hepatobiliary surgery we were concerned on how the C-19 pandemic would affect our patients. Elective operating was split between our trust and a local private provider as a “clean” site; and an official trust C-19 screening programme started on 24th April. Methods Retrospectively the electronic theatre record was searched for patients undergoing a non-emergency cancer operation between March & May 2020. The data was cross-referenced with investigations and mortality to ascertain swab results (pre-operatively and 30 days postoperatively) and mortality. Results During the 3 months at the height of the pandemic 596 non-emergency cancer operations took place, (compared with 986 in the same time-frame from 2019). In March 6 of 281, April 98 of 141 and May 166 of 175 patients undergoing an operation had a pre-operative swab, with only 6 screening swabs positive (5 in April, 1 in May). In total 4 patients died, only 1 had a positive C-19 test (patient had not been screened pre-operatively). Conclusion Non-emergency cancer surgery was impacted but Screening was successfully implemented in April and by May 95% of patients underwent testing. Six patients were tested positive post-operatively with only one deceased which appears to show a lower mortality rate than currently quoted within the literature. This adds further evidence that with comprehensive screening, cancer surgery can safely take place during a pandemic.

ERPS AS AN INDEX OF IMPAIRED COGNITIVE CONTROL IN AN ISCHEMIC BRAIN STROKE APHASIC PATIENT

Stroke is a sudden-onset neurological deficit resulting from focal vascular lesions. This is either due to a clot-induced obstruction of a vessel (ischemic stroke) or a rupture of a vessel causing haemorrhage (hemorrhagic stroke). The appropriate diagnosis of brain stroke aphasic patients is a major public health problem one so important for effective rehabilitation. Here an important role is played by the diagnosis of impaired cognitive processes. The aim of the research was to find the index of impaired cognitive control with the use of ERPs in a patient following an ischemic stroke with aphasia. A male patient, aged 69, after an ischemic brain stroke experienced 4 months previously with resulting naming problem, was admitted to the Reintegrative and Teaching Center of the Polish Neuropsychological Society. In the neuropsychological evaluation three neuropsychological tests were employed: (a) the Boston Naming Test-Polish version, to evaluate the naming and word finding problem; (b) the nonverbal Bell test to ascertain a selective, visuospatial and strategic attentional evaluation; (c) the Digit Memory test to evaluate working memory capabilities; (d) ERPs as a neurophys- iological index of impaired cognitive control. Significant changes were observed in testing. All cognitive functions including naming, non- verbal, visuospatial and strategic attention, along with the digit memory deviate substantially from the norm. The patient obtained a lo wer score, compared to the norm (p <0.05). Boston Naming Test (patient = 21< Mean-Norm = 57.29; SD= 0.52). Bell test (patient = 23 < Mean-Norm = 31.29; SD= 2.52). Digit Memory Test scores: Forward digit span (patient = 3 < Mean-Norm = 7.65, SD = 0.49). Backward digit span (patient = 2 <Mean-Norm = 6.51, SD = 0.7). Significant changes were observed also in neurophysiological testing: behavioral parameters (except RT) deviate substantially from the reference. EEG spectra show clear abnormalities on the left side within the left Rolandic fis- sure. The deviations include excessive mu-rhythm and beta activity, which means that this area is inhibited. The ERPs show no difference between GO and NOGO conditions in the patient in comparison to the norm from HBI database indicating poor cognitive control. ERPs could be treated as an index of impaired cognitive control in the ischemic stroke aphasic patient.

Cutaneous Diphtheria by Nontoxigenic Corynebacterium Diphtheriae in Diabetic Patient: A Case Report

Chronic diabetes mellitus is a significant risk factor for skin and soft tissue infections. Corynebacterium diphtheriae is a rare cause of wound infection in chronic diabetic patients. Here, a rare case of wound infection by non-toxigenic Corynebacterium diphtheriaein a chronic diabetic 45-year-old female patient has been reported. She presented with multiple discharging punched out ulcers on lower back. Diagnosis was confirmed by conventional PCR detecting rpoB gene and toxigenicity testing by Elek’s gel precipitation test. Patient was treated with IV benzylpenicillin and regular dressing. Isolation of single opportunistic microorganism creates a characteristic feature in the present case.