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While environmental factors, erratic use of topical and oral antifungal agents, increased prevalence of Trichophyton mentagrophytes infections causing inflammatory lesions and probably a growing resistance to antifungal agents may play an important role, one of the most formidable enemies that we have encountered in the recent times is the irrational fixed drug combination (FDC) creams containing a steroid, antifungal, and antibacterial with three to five molecules in the product. An important article highlighting the conclusions of an expert panel meeting on topical treatment of superficial dermatophytoses written after reviewing numerous meta-analyses arrived at some conclusions supporting these combination creams. The authors of this seminal article concluded that adding topical corticosteroid to a topical antifungal agent in the beginning of the therapy can mitigate bothersome inflammation, reduce secondary colonisation with bacteria and enhance the efficacy of the antifungal drug. All the five authors practice in European countries where laws controlling the production and sales of drugs are stringent and are implemented. [...]this publication though comprehensive and erudite is not entirely relevant in the Indian context. The authors have specifically mentioned that the corticosteroid may be added in the initial part of the treatment and improper use of the combination creams may lead to both failure of treatment and adverse reactions. [1],[11] This speaks volumes about the inadequate understanding of the drug control authorities of India who grant permissions to companies manufacturing them. [...]they are used erratically, often only for symptom control and that too without any instructions or supervision. Pande S...

Coronaviruses, hence named because of the crown-like spikes on the viral envelope, are members of Coronaviridae family and Order Nidovirales. SARS-CoV-2 is the seventh human pathogenic coronavirus identified after HCoV-229E, HCoV-OC43, SARS-CoV (SARS-CoV-1), HCoV-NL63, CoV-HKU1, and MERS-CoV. SARS-Cov-2 is highly similar to SARS-CoV. COVID-19 is the corresponding acute disease caused by SARS-CoV-2 that was initially reported in Wuhan, China towards the end of 2019 and spread to millions of humans globally. Unfortunately, limited studies were available on the efficacy of antiviral drugs to treat COVID-19 at the time of this study. ZingiVir-H is an Ayurvedic formulation for use in early therapy of viral disease. This clinical trial was planned to investigate (1) the efficacy and safety of ZingiVir-H and (2) the efficacy of ZingiVir-H as an add-on therapy to the standard of care in hospitalized adults diagnosed with COVID-19. A total of 123 eligible subjects as per inclusion criteria were randomized within the study. Three subjects later declined to participate in the study and four subjects didn't meet inclusion criteria, which brought the final evaluable subject count to 116 for the efficacy and safety endpoint analysis. Thus, a total of 116 patients were equally randomised into two groups, namely, ZingiVir-H and Placebo for this clinical trial. The study patients were assigned to receive either ZingiVir-H or Placebo along with the standard of care as per the National Indian COVID-19 treatment protocol. The time interval until a negative RT-PCR obtained, was evaluated during treatment with ZingiVir-H or Placebo for ten days. Liver and kidney function tests were regularly assessed to ensure the safety profile of ZingiVir-H. The study found that patients who were administered ZingiVir-H had a median recovery time of 5 days (95% confidence interval (CI) 5-5) when compared to 6 days (95% CI 5-6) in those who received Placebo. Besides, in Ordinal Scale analysis of all the patients treated with ZingiVir-H demonstrated significant redistribution to a better clinical status from ordinal scale 5 to 6 and 7 within five to seven days when compared to that of placebo treatment. The time required for clinical improvement and the number of days needed for hospitalization was significantly less in the ZingiVir-H treated group when compared to placebo. The absence of liver and kidney function changes affirmed the safety profile of ZingiVir-H. No serious adverse events were reported in ZingiVir-H treated patients. We found that ZingiVir-H is effective and safe in managing COVID-19 infections and delaying the disease progression from mild to moderate and moderate to severe. To the best of our knowledge, this is the first clinical trial report on the efficacy/safety of a herbo-mineral Ayurvedic drug against COVID-19 as of yet. Clinical Trial Registry of India CTRI/2020/04/024883. Registered on 28/04/2020.

Objective: Allogeneic blood product transfusions are associated with an increased morbidity and mortality risk in cardiac surgery. At present, a few transfusion risk scores have been proposed for cardiac surgery patients. The present study is aimed to develop a new score and to compare with preexisting scores - Transfusion Risk and Clinical Knowledge (TRACK) and Transfusion Risk Understanding Scoring Tool (TRUST) score. Methodology: A total of 1014 adult patients undergoing cardiac surgery were enrolled in the retrospective study. Independent predictors of allogeneic blood transfusions were selected from TRACK and TRUST scores. A predictive score was developed from six variables using logistic regression analysis, and new score was compared to the other existing scores - TRACK and TRUST. Results: The new score had following predictors: age >58 years, weight <63 kg for males and <49 kg for females, gender (female), complex surgery, hemoglobin <13.5 g/dl, and creatinine >1.36 mg/dl. Validation of new score demonstrated an acceptable predictive power (area under the curve [AUC] 0.749) and a good calibration at the Hosmer-Lemeshow test. New score was comparable with TRACK score with P = 0.578 (AUC of TRACK 0.756 and AUC of new score 0.749). There was a significant difference between new score and TRUST score, P = 0.01 (AUC of TRUST 0.72 and AUC of new score 0.749). Conclusion: New score is a simple risk model based on six predictors having a similar accuracy and calibration in predicting the transfusion rate in cardiac surgery as compared to TRACK score.

The massive multiple-input multiple-output (massive MIMO) system is the major section of the fifth generation (5G) future wireless cellular systems. It consists of hundreds of antennas in the base station that serves more number of users, concurrently. Thus, this system will get optimized energy usage, high data rate, and more precision because of their larger degrees of freedom. The computation power to the total power consumption ratio is considered for rapid increment owing to the more data traffic at the baseband unit that seeks more attention in the exploitation of massive MIMO systems for 5G wireless systems. The main intent of this paper is to develop the multi-user massive MIMO systems by deriving the joint optimization problem of computation and communication power. In the existing energy efficiency analysis, there is a negative effect on energy efficiency when increasing the count of RF chains and antennas by considering only computation power or communication power in massive MIMO. In order to overwhelm this problem, this paper focuses on two optimization problems. The first problem is focusing on the improvement of upper bound on energy efficiency with the optimal baseband and RF precoding matrices based on a new hybrid meta-heuristic algorithm. The combination of two well-performing meta-heuristic algorithms like electric fish optimization and dragonfly algorithm is used as the new algorithm, which is named as hybrid dragonfly with electric fish optimization (HD-EFO) for enhancing the efficiency of massive MIMO system. In the second phase, the joint optimization of both computation and communication power is performed by the same HD-EFO for developing the optimized hybrid precoding matrix. The extensive results have shown that the implemented multi-user massive MIMO systems with partially-connected structures using HD-EFO increase the cost and energy efficiencies, and save the maximum power.

Posterior dislocation of the intraocular lens (IOL) is a rare but potentially dangerous complication encountered by a cataract surgeon. We describe a modified balanced two-string technique of internally fixing a posteriorly dislocated rigid IOL using the pars plana approach in eyes which lack adequate capsular support. Five eyes of five patients underwent the procedure. All eyes had successful IOL refixation. One eye had mild temporal decentration. BCVA improved in all patients. Our technique is an alternate method of scleral fixation of posteriorly dislocated IOL with advantages of minimal postoperative astigmatism, minimal anterior segment manipulation, and good IOL centration.

PurposeThe main aim of this paper is to design a technique for improving the quality of EEG signal by removing artefacts which is obtained during acquisition. Initially, pre-processing is done on EEG signal for quality improvement. Then, by using wavelet transform (WT) feature extraction is done. The artefacts present in the EEG are removed using deep convLSTM. This deep convLSTM is trained by proposed fractional calculus based flower pollination optimisation algorithm.Design/methodology/approachNowadays' EEG signals play vital role in the field of neurophysiologic research. Brain activities of human can be analysed by using EEG signals. These signals are frequently affected by noise during acquisition and other external disturbances, which lead to degrade the signal quality. Denoising of EEG signals is necessary for the effective usage of signals in any application. This paper proposes a new technique named as flower pollination fractional calculus optimisation (FPFCO) algorithm for the removal of artefacts from EEG signal through deep learning scheme. FPFCO algorithm is the integration of flower pollination optimisation and fractional calculus which takes the advantages of both the flower pollination optimisation and fractional calculus which is used to train the deep convLSTM. The existed FPO algorithm is used for solution update through global and local pollinations. In this case, the fractional calculus (FC) method attempts to include the past solution by including the second order derivative. As a result, the suggested FPFCO algorithm approaches the best solution faster than the existing flower pollination optimization (FPO) method. Initially, 5 EEG signals are contaminated by artefacts such as EMG, EOG, EEG and random noise. These contaminated EEG signals are pre-processed to remove baseline and power line noises. Further, feature extraction is done by using WT and extracted features are applied to deep convLSTM, which is trained by proposed fractional calculus based flower pollination optimisation algorithm. FPFCO is used for the effective removal of artefacts from EEG signal. The proposed technique is compared with existing techniques in terms of SNR and MSE.FindingsThe proposed technique is compared with existing techniques in terms of SNR, RMSE and MSE.Originality/value100%.

Further enhancement of 4G (or 4G-LTE advanced) spectral efficiency is possible only by allocating more bandwidth i.e., broadcasting on millimeter wave (mmWave) spectrum, by using the concept of small cells and also by increasing the number of spatial channels which is referred to as MIMO systems. However, recognizing the mmWave in MIMO remains a complex task that faces the issues like increased propagation loss. A new optimization based estimation algorithm is proposed to estimate the mm wave channel and to improve the performance of hybrid precoding. Azimuth angle is considered as objective function and is optimized without deviating from the actual characteristics. In this paper, Dragonfly Evaluated Grey Wolf Optimization (DE-GWO) model is introduced that hybridizes the concepts of DA and GWO respectively. The proposed algorithm is validated by comparing with Deer Hunting Optimization Algorithm (DHOA), Lion Algorithm (LA) and LDHOA (combination of LA and DHOA). Finally, the performance of proposed work is compared and validated over other state-of-the-art models with respect to CSI and error measures.

This article introduces a cylindrical dielectric resonator antenna (CDRA) fed with a rhombic ring-shaped tapered feed for Multiple-Input-Multiple-Output (MIMO) applications. The proposed hybrid MIMO CDRA resonates at four frequency bands 2.5, 5.09, 6.8, and 9.0 GHz with isolation levels of 22, 34.22, 30.55, and 18.55 dB. Isolation enhancements are achieved by introducing “L” shaped slots on the partial ground plane. Parametric analysis is performed to validate the optimized dimensions of the tapered feed without and with DRA and defected ground structure. Diversity performance is examined by using envelope correlation coefficient and diversity gain. The proposed antenna operates in the S, C, and X-bands and is suitable for RF communication mobile broadband services, Wi-Fi, radar, and satellite applications. Good agreement is observed between simulated and measured results.

BackgroundGlucocorticosteroids (GC) are standard-of-care treatment for most boys with duchenne muscular dystrophy (DMD). GC use has changed over time with evolving evidence, and we describe GC patterns, dosing and side-effects in the UK over 11 years.MethodNorthStar data from 2012 to 2022 were analysed to understand GC type, regime and starting age. GC dose with age, patterns of GC switching and side-effect profiles by type and regime were also analysed. Participants attributed to ‘other’ regimes were queried and details were included.ResultsData on GC usage were available for 1117 boys, across 6905 observations, with 74% of boys GC treated. Prednisolone was the most common regime in the period (65% of assessments) but deflazacort prescription has increased (17% in 2012 and 43% in 2022). Daily regimes were more common (66% of assessments), and the incidence of intermittent (10 days on/10 days off) regimes has declined (46% in 2012 and 26% in 2022). Older participants were more commonly on less than recommended doses, and this was more common in those on deflazacort or daily regimes. Gastrointestinal symptoms and cushingoid features were more common in those on deflazacort than prednisolone, while increased appetite, cushingoid features, gastrointestinal symptoms and insomnia were more common in those on daily than intermittent regimes.ConclusionsThe use of deflazacort and daily regimes has steadily increased across the UK North Star Network in the last decade. This study provides one of the largest up-to-date real-world set of data of evolution in prescription patterns and the occurrence of side-effects in different groups of GC-treated DMD.