Bangalore Medical Center

Background: Abruptio placentae is the premature separation of a normally situated placenta after 20 weeks of gestation and before delivery of the fetus. It is a major cause of antepartum hemorrhage and is associated with significant maternal and perinatal morbidity and mortality. This study aimed to determine the incidence, risk factors, complications and fetomaternal outcomes of abruptio placentae in a tertiary care center. Methods: This retrospective study was conducted at Bangalore Medical College and Research Institute, Bengaluru, including Vani Vilas Hospital and GOSHA Hospital, from January 2021 to August 2021. Demographic details, obstetric history and maternal risk factors were recorded. Gestational age was determined by last menstrual period and ultrasonography. Diagnosis was based on clinical features and ultrasonographic findings and confirmed by retroplacental clots or hematoma at delivery. Other causes of antepartum hemorrhage were excluded. Results: The incidence of abruptio placentae was 0.95%. The most affected age group was 20–25 years and 52% were multiparous. Hypertensive disorders of pregnancy were present in 38.46% of cases, with severe preeclampsia in 23.07%. Vaginal delivery occurred in 66.35% cases, while 33.65% underwent cesarean section. Anemia was observed in 52.88% cases. Stillbirth occurred in 56.73% cases. Major maternal complications included postpartum hemorrhage (23.07%), disseminated intravascular coagulation (12.5%) and ICU admission (21.15%). Conclusions: Abruptio placentae remains a significant contributor to maternal and perinatal morbidity and mortality. Early identification of high-risk pregnancies, timely referral, availability of blood bank facilities and prompt multidisciplinary management are essential to improve outcomes.

Traffic prediction is a critical component of Intelligent Transportation Systems (ITS), requiring advanced models to capture complex spatio-temporal dependencies across sensor networks while meeting real-time constraints. This paper presents an HPC-optimized implementation of Gated Multi-Scale Spatio-Temporal Graph Transformer (GMSTGT) on the METR-LA dataset, utilizing distributed training across 4 GPUs on Param Utkarsh HPC system for simultaneous multi-horizon prediction. The proposed GMSTGT architecture integrates dynamic graph construction with hierarchical attention mechanisms, reducing memory complexity from $\mathbf{O}\left(\mathbf{N}^{2}\right)$ to $\mathrm{O}(\mathrm{N} \log \mathrm{N})$ for 207 -sensor networks. Experimental validation demonstrates Mean Absolute Error (MAE) of 2.68 (15-min), 3.24 $(30-\mathrm{min})$, $3.89(45-\mathrm{min})$, and $4.45(60-\mathrm{min})$ with 15.8 ms inference latency at batch size 64. The distributed implementation achieves nearly linear scaling ($\approx 4$) speedup over sequential approaches while maintaining prediction accuracy within 0.1% of single-GPU baselines.

Systemic lupus erythematosus (SLE) is an autoimmune disorder with heterogeneous phenotypes. The symptoms range from mild to life-threatening features. Azathioprine (AZA) is a routinely used immunosuppressive agent in mild to moderate SLE. Although bone marrow suppression is reported in AZA usage, severe alopecia is not very common with AZA. We report a 45-year-old female with stable clinical and serological lupus maintained on mycophenolate mofetil 500 mg twice per day and hydroxychloroquine 200 mg once per day. She was lost to follow-up with us for >1 year. Since her disease was stable, we switched to AZA 25 mg twice per day to start with and escalated to 50 mg in the morning and 25 mg at night after 2 weeks, with an advice for 4-week follow-up after starting AZA. Hydroxychloroquine was continued at 200 mg once per day. No corticosteroids were used at this time as it was not deemed necessary. Monitoring blood tests for AZA were planned at 4 weeks. She presented at 6 weeks with severe leukopenia as summarized in the table of investigations below and the graph summarizing the trend in leukocyte counts after AZA usage. She was managed in the hospital with intravenous dexamethasone, antibiotic prophylaxis, and hematology consultation, who opined as AZA-induced severe bone marrow suppression and severe alopecia due to AZA. Bone marrow examination was not deemed necessary by the hematologist. AZA was stopped in the hospital and mycophenolate mofetil was prescribed in the immediate follow-up after discharge, as she had previously responded to this drug. Hydroxychloroquine continued throughout her hospital stay. Although her blood counts responded very well after AZA withdrawal, it took nearly 3 months for her to have her normal scalp hair. One of the major differentials that was considered was SLE flare-up, but her clinical features and serology did not support a lupus flare. Bone marrow suppression is a severe complication of AZA in SLE. Leukopenia and hair loss are the major adverse effects reported during the therapy of AZA. It is sensible to recognize this relationship as prompt diagnosis and treatment is crucial.

Objectives: Continuous connected breathing (CCB) is a high-frequency breathing technique without breath retention. This study examines changes in electroencephalogram (EEG) band power and heart rate variability (HRV) before, during and after breathwork intervention of 3 rounds of 40 CCB versus normal breathing in healthy volunteers. Materials and Methods: Thirty-three healthy volunteers, aged between 19 and 23 years, participated in the study (n = 15; female = 7; mean age = 21.5 years) group, while the control group consisted of 18 individuals (n = 18; male = 11; mean age = 19.6 years). After acquiring baseline measures, the study group engaged in 40 CCB practice online for 10 days, while the control group continued with their usual activities. EEG and HRV signals were recorded for both groups after the 10 days. Post-intervention, the study group practised 40 CCB breathwork, while the control group breathed normally during signal acquisition. EEG was recorded for 1-min durations at five different time events (1st, 4th, 5th, 7th and 10th min) according to the protocol. HRV was continuously recorded for the entire 10 min, and 1-min readings corresponding to the EEG recording time intervals were analysed. EEG signals were acquired using an Enobio-8 cap with dry electrodes in pre-frontal (FP1 and FP2), temporal (T7 and T8), central (C3 and C4) and occipital (O1 and O2) regions. HRV data were acquired from Polar H7/H10 chest strap sensors through Bluetooth using Elite HRV app on android phone and data were later processed with Kubios software. EEG signals were processed using MATLAB software to extract EEG power for delta (0– 3.5Hz), theta (4–7 Hz), alpha (8–13 Hz), beta (14–29 Hz) and gamma frequencies (30–50 Hz). The EEG power and HRV signals were later arranged as before-after and during time events and statistically analysed for within and between-group changes using t-tests for significance of means. Results: There was an overall quantitative change in EEG band power of −2 units within the study group and −0.03 within the control group. A significant decrease was found in overall delta (−2.27), theta (−1.7), alpha (−1.8) and beta (−2.27) brain waves in pre-frontal (FP1, FP8), temporal (T7, T8) and occipital (O1, O2) regions after breathwork compared to before within the study group. A significant increase was found in beta (+2.8) band power in the control group with a higher increase in the left compared to the right hemisphere. Bilateral average change ranged from −1.6 to −2.6 in the study and −0.1 to +4.9 in the control group. HRV parameters were reduced after intervention in both groups but without significance. The parameters improved after the intervention compared to during within the study group, though not significant. Conclusion: 10 days of practice of 40 CCB breathworks (3 rounds) for 5 min/day may reduce EEG power in delta, theta, alpha and beta waves. It may help to maintain autonomic balance with an increase of HRV in the recovery phase after an initial decrease during breathwork. Further studies are recommended to test the consistency of outcomes.

Abstract Disclosure: S. Shankar: None. S.S. Sundar: None. M.S. Vaishnav: None. L. Lekkala: None. K. Thummala: None. S. Srikanta: None. T. Deepak: None. R.B. Vijay: None. K. Muniraj: None. V. Nath: None. C. Siddlingappa: None. P. Ravikumar: None. M.D. Chitra: None. Introduction: Autoimmune hypophysitis caused by immune checkpoint inhibitors [ICIs; anti-CTLA-4 (Ipilimumab alone 7.9%), anti-PD-1 (Pembrolizumab alone 1.7%; nivolumab alone 0%)] are being increasingly documented, with anterior hypopituitarism affecting corticotrophs more commonly than thyrotrophs and gonadotrophs (large time span of onset; different recovery patterns). Clinical Case 2021 Sep Age 65 years (type 2 diabetes, hypertension). Renal Cell Carcinoma S/P radical nephrectomy. 2023 Jul PET-CT= Metastatic pleuropulmonary nodules. Four admissions to Specialist Oncology Hospital [Four 2 weekly cycles of Inj Pembrolizumab 200 mg (with Tab Axitinib 10 mg/day)]. After first cycle: progressive fatigue, body aches, drowsiness. S Sodium= Pre-pembrolizumab= 137 mEq/L (135-145); Post-pembrolizumab= 124, 134, 132, 124; T3= 1.63 to 0.60 to 1.24 to 1.35 ng/mL (0.97-1.69); T4= 6.83 to 4.93 to 10.44 to 11.44 mcg/dL (5.53-11); TSH= 10.46 to 6.28 to 5.39 to 9.48 mIU/mL (0.46-4.68); S Cortisol 8 am= 1.54 mcg/dL (5-25); S Potassium= 4.59 mEq/dL (3.5-5.1)]. One episode of loss of consciousness; EEG= abnormal; MRI Brain= normal. During every hospital admission, oncology, medical, endocrinology and nephrology teams attributed the same to “illness” (no specific diagnosis) and provided symptomatic treatment (IV 3% saline, tolvaptan and sodium bicarbonate tablets).2023 Nov Medicine: Very severe nausea, anorexia, generalised weakness, myalgia, hiccoughs, and inability to walk. Frustrated family members sought admission in “new” General Hospital. S Sodium= 119, 120; S Potassium= 4.8; S Creatinine= 1.67 mg/dL (0.7-1.3); S Uric acid= 4.5 mg/dL (4.40-7.60); Urine spot Sodium= 84 mmol/L; ESR= 144 mm. Endocrinology: S Cortisol 8 am= 0.09 mcg/dL;S Cortisol post 250 mcg Inj Synacthen= 3.76 (>20);Plasma ACTH= 5.4 pg/ml (9-52). S T3= 1.35; S T4= 11.44; S TSH= 9.48; LH= 3.61mIU/mL (1.5-9.3); FSH= 1.4mIU/mL (1.4-18.1); PRL= 30.1 (2.6-13.3); Testosterone total= 314 ng/dL (241-827); TPO antibodies negative. MRI-Pituitary: Partial empty sella; infundibulum neurohypophysis normal; mild asymmetric enhancement (5.5 mm) left cavernous sinus. Treatment: Tab Hydrocortisone 25 mg/day, with complete clinical and biochemical response [Suggestion of gonadotroph dysfunction and partial recovery of thyrotrope dysfunction/ injury. Hence, not on thyroxine replacement]. Clinical Lessons: Mechanisms for differential cellular vulnerability for ICI induced autoimmune pathologies [thyroid (destructive versus stimulatory), islet beta cells, adrenal cortical cells, various anterior pituitary cells (corticotrophs vs thyrotrophs and gonadotrophs] need elucidation. Specific molecular and cellular immunopathogenic pathways in different autoimmune endocrinopathies appear distinct and disparate. Presentation: 6/2/2024

Alzheimer disease (AD) leads to cognitive decline and alters functional connectivity (FC) in key brain regions. Resting-state functional magnetic resonance imaging (rs-fMRI) assesses these changes using static-FC for overall correlation and dynamic-FC for temporal variability. In AD, there is altered FC compared to normal conditions. The present study investigates possible region-specific functional abnormalities occurring longitudinally over 1 year. Our aim is to evaluate the potential usefulness of the static and dynamic approaches in identifying biomarkers of AD progression. The study involved 15 AD and 20 healthy participants from the Alzheimer's Disease Neuroimaging Initiative 2 (ADNI2) database, tracked over 2 visits within 1 year. Using constrained-independent component analysis, we assessed FC changes across 80-regions of interest in AD over the year, examining both static and dynamic conditions. The average regional FC decreased in AD compared to healthy subjects at baseline and after 1 year. The dynamic condition identifies similarities with a few additional changes in the FC compared to the static condition. In both analyses, the baseline assessment revealed reduced connectivity between the following regions: right-middle-occipital and left-superior-occipital, left-hippocampus and right-postcentral, left-lingual and left-fusiform, and precuneus and left-thalamus. Additionally, increased connectivity was found between the left-superior-occipital and precuneus regions. In the 1-year AD assessment, increased connectivity was noted between the right-superior-temporal-pole and right-insular, right-hippocampus and left-caudate, right-middle-occipital and right-superior-temporal-pole, and posterior-cingulate-cortex and middle-temporal-pole regions. Significant changes were observed at baseline in the frontal, occipital, and core basal-ganglia regions, progressing towards the temporal lobe and subcortical regions in the following year. After 1 year, we observed the aforementioned region-specific neurological differences in AD, significantly aiding diagnosis and disease tracking.

Pulmonary tumor embolism (PTE) is a rare phenomenon typically presenting as dyspnea in cancer patients. Primary pathophysiology is similar to the thromboembolic disease of the pulmonary vasculature, which involves large vessels to small arterioles. This phenomenon occurs mostly in lung, stomach, liver, and breast adenocarcinoma. The symptoms of hypoxemia and the signs of hemodynamic instability and high-resolution computed tomography (CT) scans, along with a histopathological examination, are essential to make a confirmatory diagnosis of pulmonary tumor embolism. However, treatment options to effectively treat pulmonary tumor embolus are limited and still under investigation. We present a rare case ofpulmonary tumor embolism in a patient with metastatic liver carcinoma and its management in a female with primary breast carcinoma.

Electrocardiogram(ECG) represents the electrical activity of the heart. Currently approved routine ECGs with a bandwidth of 0.05 - 150Hz have a very low sensitivity (approx 48%) defined by the ST segment criteria for ischaemia. High-Frequency ECG (HF-ECG) Signals have been shown to have increased sensitivity and early timing in diagnosing cardiac ischaemia. Ischaemic changes happen first during contraction of the heart, causes disturbances in the higher frequencies in the QRS segments and are in microvolts in amplitude. Additionally, HF-ECG of Microvolts are buried in the Millivolts of QRS waves and are difficult to extract. Technical difficulties in extraction have made us discard this crucial data till now and instead accept ST segments as the gold standard for ischemia diagnosis. ST segments represent repolarisation in time domain where cardiac muscle is relaxed and may allow adequate perfusion hence has low accuracy. We present case studies here, one each in a normal and an ACS patient respectively with a portable high resolution ECG device called Sydantek from Carditek Medical Devices. The hardware details for data capture, the bandpass filters, extraction methods and display are described in this early case reports. The defining features in HF- ECG extraction are described. Our findings confirm the utility of this portable device for possible use in acute emergencies . This device may be most relevant in emergency room settings for chest pain triages and in post angioplasty evaluations once larger trials confirm these findings.