Laxminarayan

No abstract text is available yet for this article.

Background: Hemorrhage remains the leading cause of death on the battlefield. This study aims to assess the ability of an artificial intelligence triage algorithm to automatically analyze vital-sign data and stratify hemorrhage risk in trauma patients. Methods: Here, we developed the APPRAISE-Hemorrhage Risk Index (HRI) algorithm, which uses three routinely measured vital signs (heart rate and diastolic and systolic blood pressures) to identify trauma patients at greatest risk of hemorrhage. The algorithm preprocesses the vital signs to discard unreliable data, analyzes reliable data using an artificial intelligence-based linear regression model, and stratifies hemorrhage risk into low (HRI:I), average (HRI:II), and high (HRI:III)...

INTRODUCTION: Failure to stay within an ethics committee (EC)-approved protocol limits is termed protocol deviation or violation (PD/PV), depending on the seriousness of the transgression and its attendant risks and/or harms. PD/PVs arise in the post-approval phase of the research and are often missed. Current guidelines expect ECs to detect, report and recommend suitable actions such that research participants' risks and harms are mitigated, to the extent possible. OBJECTIVE: Yenepoya Ethics Committee-1 conducted an internal audit of ongoing postgraduate dissertations involving human participants to assess the occurrence of PD/PVs...

Globally, excess deaths during 2020-21 outnumbered documented COVID-19 deaths by 9.5 million, primarily driven by deaths in low- and middle-income countries (LMICs) with limited vital surveillance. Here we unravel the contributions of probable COVID-19 deaths from other changes in mortality related to pandemic control measures using medically-certified death registrations from Madurai, India-an urban center with well-functioning vital surveillance. Between March, 2020 and July, 2021, all-cause deaths in Madurai exceeded expected levels by 30% (95% confidence interval: 27-33%)...

BACKGROUND: Hospital-associated infections (HAIs) are an important cause of morbidity and mortality around the world. Many HAIs are caused by drug-resistant bacterial pathogens, but there are major gaps in our understanding of the number of hospital-associated drug-resistant infections (HARIs) worldwide. As such, we estimated trends in prevalence of HARIs caused by high priority pathogens (Escherichia coli, Acinetobacter spp., Klebsiella spp., Staphylococcus aureus, Enterobacter spp., and Pseudomonas spp...

BACKGROUND: Despite significant global progress in reducing neonatal mortality, bacterial sepsis remains a major cause of neonatal deaths. Klebsiella pneumoniae (K. pneumoniae) is the leading pathogen globally underlying cases of neonatal sepsis and is frequently resistant to antibiotic treatment regimens recommended by the World Health Organization (WHO), including first-line therapy with ampicillin and gentamicin, second-line therapy with amikacin and ceftazidime, and meropenem. Maternal vaccination to prevent neonatal infection could reduce the burden of K...

BACKGROUND: Antimicrobial resistance (AMR) is a pressing, holistic, and multisectoral challenge facing contemporary global health. In this study we assessed the associations between socioeconomic, anthropogenic, and environmental indicators and country-level rates of AMR in humans and food-producing animals. METHODS: In this modelling study, we obtained data on Carbapenem-resistant Acinetobacter baumanii and Pseudomonas aeruginosa, third generation cephalosporins-resistant Escherichia coli and Klebsiella pneumoniae, oxacillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium AMR in humans and food-producing animals from publicly available sources, including WHO, World Bank, and Center for Disease Dynamics Economics and Policy...

BACKGROUND: Declines in outpatient antibiotic prescribing were reported during the beginning of the coronavirus disease 2019 (COVID-19) pandemic in the United States; however, the overall impact of COVID-19 cases on antibiotic prescribing remains unclear. METHODS: This was an ecological study using random-effects panel regression of monthly reported COVID-19 county case and antibiotic prescription data, controlling for seasonality, urbanicity, health care access, nonpharmaceutical interventions (NPIs), and sociodemographic factors...

No abstract text is available yet for this article.

BACKGROUND: Principles of safe cholecystectomy include dissection of the hepatocystic triangle and identification of the bilio-vascular structures to achieve critical view of safety. The aim of the present study was to document the variations in anatomical landmarks and bilio-vascular structures exposed during laparoscopic cholecystectomy. METHODS: All consecutive patients who underwent laparoscopic cholecystectomy were included in the study. Recommended techniques of safe cholecystectomy were followed...

BACKGROUND: Thalassaemia is a quantitative abnormality of haemoglobin caused by mutations in genes controlling production of alpha or beta globins. Abnormally unpaired globin chains cause membrane damage and cell death within organ systems and destruction of erythroid precursors in the bone marrow, leading to haemolytic anaemia. The life-long management of the general health effects of thalassaemia is highly challenging, and failure to deal with dental and orthodontic complications exacerbates the public health, financial and personal burden of the condition...

INTRODUCTION: An uncontrollably rising core body temperature (TC) is an indicator of an impending exertional heat illness. However, measuring TC invasively in field settings is challenging. In contrast, wearable sensors combined with machine-learning (ML) algorithms can continuously monitor TC non-intrusively. Here, we prospectively validated 2B-Cool, a hardware/software system that automatically learns how individuals respond to heat stress and provides individualized estimates of TC, 20-minute ahead predictions, and early warning of a rising TC...

Introduction Pyogenic flexor tenosynovitis (PFT) is a common hand infection that can cause significant morbidity. Although treatment involves surgical debridement and inpatient intravenous (IV) antibiotics, there is a paucity of literature guiding antibiotic use. This study aims to determine if the use of postoperative outpatient oral antibiotics leads to poor outcomes compared to IV antibiotics given in an institutional setting. Methods A retrospective review of 110 patients treated post-operatively with either outpatient oral or inpatient IV antibiotics at our institution from 2016-2019 was performed...

INTRODUCTION: Personal protective equipment (PPE) inhibits heat dissipation and elevates heat strain. Impaired cooling with PPE warrants investigation into practical strategies to improve work capacity and mitigate exertional heat illness. PURPOSE: Examine physiological and subjective effects of forearm immersion (FC), fan mist (MC), and passive cooling (PC) following three intermittent treadmill bouts while wearing PPE. METHODS: Twelve males (27 ± 6 years; 57...

Antimicrobial resistance (AMR) poses a serious threat to human, animal and environmental health worldwide. Colistin has regained importance as a last-resort treatment against multi-drug-resistant Gram-negative bacteria. However, colistin resistance has been reported in various Enterobacteriaceae species isolated from several sources. The 2015 discovery of the plasmid-mediated mcr-1 (mobile colistin resistance) gene conferring resistance to colistin was a major concern within the scientific community worldwide...

Inhibition of leucine-rich repeat kinase 2 (LRRK2) kinase activity represents a genetically supported, chemically tractable, and potentially disease-modifying mechanism to treat Parkinson's disease. Herein, we describe the optimization of a novel series of potent, selective, central nervous system (CNS)-penetrant 1-heteroaryl-1 H -indazole type I (ATP competitive) LRRK2 inhibitors. Type I ATP-competitive kinase physicochemical properties were integrated with CNS drug-like properties through a combination of structure-based drug design and parallel medicinal chemistry enabled by sp3 -sp2 cross-coupling technologies...

A proposed European Union-directive requests that member states monitor antibiotic resistance at all sewage treatment plants serving >100,000 people. Sewage surveillance could provide information on the resistance situation in the underlying population and on environmental transmission risks. There are opportunities to make such surveillance data more informative and actionable, but there are also challenges.

OBJECTIVE: Several advanced therapies have been licensed across the related conditions of psoriatic arthritis (PsA), Crohn disease (CD), ulcerative colitis (UC), and noninfectious uveitis. We sought to summarize results from randomized controlled trials (RCTs) investigating the efficacy and safety of advanced therapies for these related conditions in patients with PsA. METHODS: We updated the previous systematic search conducted in 2013 with literature reviews of MEDLINE, Embase, and the Cochrane Library (from February 2013 to August 2020) on this subject; only those new studies are presented here...

International medical graduates (IMGs) have made significant contributions in the field of hand surgery in terms of bringing in skill, innovation, research, and leadership and have gone onto mentor the next generations of hand surgeons. In this article, we have highlights some such contributions. We also highlight various pathways that IMGs take to establish their practice in the United States and the various challenges and hurdles they face.

Mathematical models of human cardiovascular and respiratory systems provide a viable alternative to generate synthetic data to train artificial intelligence (AI) clinical decision-support systems and assess closed-loop control technologies, for military medical applications. However, existing models are either complex, standalone systems that lack the interface to other applications or fail to capture the essential features of the physiological responses to the major causes of battlefield trauma (i.e., hemorrhage and airway compromise)...