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Introduction: The frequency of invasive mycoses has increased dramatically during the past two decades owing to medical advances such as intensive cancer chemotherapy, broad-spectrum antimicrobial therapy, invasive medical devices, organ transplantation, human immunodeÞ ciency virus (HIV) disease epidemic and an expanding aging population. There were few Indian studies regarding the incidence and risk factors for candidemia. Hence the aim of this work was to evaluate the changes in the prevalence of candidemia and invasive candidiasis in a tertiary care hospital and also to assess the risk factors and predictors of mortality Materials and Methods: Nonsystematic review of patients with candidemia/invasive candidiasis was done during the period 1999 to 2004. All in-patients who had shown signs and symptoms of nosocomial blood stream infection were screened for candidial infection. Among these, 29 patients had candidemia/invasive candidiasis. Demographic and clinical data of these patients were recorded on a standardized form, which included age, sex, site of isolation, infectious diagnosis, underlying conditions, predisposing factors, catheter status and clinical outcome. The data were collected during the years of 1999 to 2004, which is divided into two time periods (1999-2001 and 2002-2004). Data collected during these different time spans are compared with each other. Results: A total of 255 patients were screened during the study period. Among these, 100 patients were screened during the period 1999-2001 and 155 patients were screened during the year 2002-2004. Out of these patients, 29 showed positive cultures in blood or other sterile site (ascitic ß uid, bronchial aspirate and urine from suprapubic puncture). Out of these, 24 were males and Þ ve were females. The most common risk factor was use of intravenous canulae (62.1%), followed by prolonged use of antibiotics (34.5%) and HIV infection (24.1%). There were no statistically signiÞ cant differences in the risk factors during the two different study periods. Candida was mainly isolated from blood (75.9%). Other sources included ascitic ß uid (10.4%), bronchial aspirate (3.4%), sputum (3.4%) and urine (6.9%). Distributions of sources were comparable during the two study periods. Candida albicans, Candida tropicalis and Candida parapsilosis caused 89.7%, 3.4%, 6.9% of the candidemia episodes respectively. The overall mortality was 51.7%. Conclusion: The present study emphasizes the importance of candidemia among hospitalized patients. Continued surveillance of candidemia will be important to track trends of this serious infection and to document changes in its epidemiological features. More active screening in high-risk groups should be done to avoid diagnostic delay. Risk factors like prolonged use of multiple antibiotics, central venous catheters, mechanical ventilation and prolonged hospital stay should be restricted whenever possible. Timely use of antiretroviral drugs and other measures to improve the immunity of HIV patients may help to decrease the in...

Correct evaluation and treatment of Scoliosis require accurate estimation of spinal curvature. Current gold standard is to manually estimate Cobb Angles in spinal X-ray images which is time consuming and has high inter-rater variability. We propose an automatic method with a novel framework that first detects vertebrae as objects followed by a landmark detector that estimates the 4 landmark corners of each vertebra separately. Cobb Angles are calculated using the slope of each vertebra obtained from the predicted landmarks. For inference on test data, we perform pre and post processings that include cropping, outlier rejection and smoothing of the predicted landmarks. The results were assessed in AASCE MICCAI challenge 2019 which showed a promise with a SMAPE score of 25.69 on the challenge test set.

Aims/IntroductionDiaphragmatic breathing is known to have a beneficial effect on the cardiopulmonary system, and enhances parasympathetic activation. We evaluated the influence of diaphragmatic breathing on time domain measures of heart rate variability in diabetics and healthy subjects.Materials and MethodsA total of 122 type 2 diabetics and 94 healthy subjects (controls) were randomly allocated to a deep breathing test and diaphragmatic breathing (61 diabetics and 47 controls in each group). Heart rate variability parameters; namely, expiratory:inspiratory ratio (E:I ratio), root mean square of successive N–N interval difference (r‐MSSD) and standard deviation of all the N–N intervals (SDNN), were quantified from 1‐min supine electrocardiogram obtained while subjects carried out the deep breathing test/diaphragmatic breathing at six respiratory cycles per min. Data analysis was carried out by Student's unpaired t‐test. A P‐value <0.05 was taken as significant.ResultsE:I ratio, SDNN and r‐MSSD of type 2 diabetics was significantly lower compared with controls in the diaphragmatic group (P < 0.001). E:I ratio and SDNN were significantly lower in type 2 diabetics compared with controls in the deep breathing group (P < 0.0001, P < 0.019, respectively). In controls, E:I ratio, r‐MSSD and SDNN of the diaphragmatic breathing group were significantly higher compared with the deep breathing group (P < 0.01). In diabetics, none of the measured heart rate variability parameters varied between diaphragmatic breathing and deep breathing.ConclusionsSubclinical cardiac autonomic neuropathy persists in type 2 diabetics. In type 2 diabetics, diaphragmatic breathing quantifies certain aspects of parasympathetic dysfunction, which is not shown by the deep breathing test. Diaphragmatic breathing induces greater cardiac autonomic modulation in healthy subjects.

Retrospective case series with a historical control group. Purpose: To compare the deep wound infection rates in patients undergoing spinal surgery with the application of topical intrawound vancomycin powder (TIVP) in the surgical site in addition to standard systemic prophylaxis with those in a matched historical cohort of patients for whom TIVP was not used. Overview of Literature: Surgical site infection (SSI) after spine surgery is debilitating and is responsible for a significant increase in the health care costs, hospital stay, and morbidities. Although the application of TIVP before surgical closure is a promising method for reducing the SSI rate after spine surgery, its use is controversial, and currently, research trials are focusing on identifying its safety, efficacy, and the potential patient population. Methods: A group of 88 patients who underwent posterior spinal surgery with TIVP administration (treatment group) was compared to a historical control group of 70 patients who had received only standard systemic intravenous prophylaxis (control group) for the analysis of deep SSI rate and the involved organisms. Results: The overall rate of deep SSIs was 2.5% (4/158). All the SSIs were observed in patients who had posterior instrumentation and fusion for ≥3 levels. In the treatment group, the SSI rate was 3.4% (3/88), and the bacteria isolated were Escherichia coli (n=2) and Pseudomonas aeruginosa (n=1). In the control group, the infection rate was 1.4% (1/70), and the isolated bacteria were Morganella morganii and Staphylococcus epidermidis. No statistically significant association was found between the SSI rates of the treatment and control groups.

Level II.

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ObjectivePostoperative dynamic cryo-compression (DC) therapy has been proposed as a method of reducing pain and the inflammatory response in the early postoperative period after orthopedic joint reconstruction surgery. Our aim was to analyze the analgesic efficacy of DC therapy after adult lumbar spinal surgery.MethodsDC was applied for 30 minutes every 6 hours after surgery. Pain was measured by a visual analogue scale (VAS) in the preoperative period, immediately after surgery, and every 6 hours postoperatively for the first 72 hours of the hospital stay. Patients’ pain medication requirements were monitored using the patient-controlled analgesia system and patient charts. Twenty patients who received DC therapy were compared to 20 historical controls who were matched for demographic and surgical variables. ResultsIn the postanesthesia care unit, the mean VAS back pain score was 5.87 ± 0.9 in the DC group and 6.95±1.0 (p=0.001) in the control group. The corresponding mean VAS scores for the DC vs. control groups were 3.8±1.1 vs. 5.4±0.7 (p < 0.001) at 6 hours postoperatively, and 2.7±0.7 vs. 6.25±0.9 (p<0.001) at discharge, respectively. The cumulative mean analgesic consumption of paracetamol, tenoxicam, and tramadol in the DC group vs. control group was 3,733.3±562.7 mg vs. 4,633.3±693.5 mg (p<0.005), 53.3±19.5 mg vs. 85.3±33.4 mg (p<0.005), and 63.3±83.4 mg vs. 393.3±79.9 mg (p<0.0001), respectively. ConclusionThe results of this study demonstrated a positive association between the use of DC therapy and accelerated improvement in patients during early rehabilitation after adult spine surgery compared to patients who were treated with painkillers only.