Photographing Alopecia: How Many Pixels Are Needed for Clinical Evaluation?

Determining the minimum image resolution needed for clinical assessment is crucial for computational efficiency, image standardization, and storage needs alleviation. In this paper, we explore the image resolution requirements for the assessment of alopecia by analyzing how clinicians detect the presence of characteristics needed to quantify the disorder in the clinic. By setting the image resolution as a function of width of the patient’s head, we mimicked experiments conducted in the computer vision field to understand human perception in the context of scene recognition and object detection and asked 6 clinicians to identify the regions of interest on a set of retrospectively collected de-identified images at different resolutions. The experts were able to detect the presence of alopecia at very low resolutions, while significantly higher resolution was required to identify the presence of vellus-like hair. Furthermore, the accuracy with which alopecia was detected as a function of resolution followed the same trend as the one obtained when we classified normal versus abnormal hair density using a standard neural network architecture, hinting that the resolution needed by an expert human observer may also provide an upper bound for future image processing algorithms.     

Cellular metabolism dictates T cell effector function in health and disease

In a healthy person, metabolically quiescent T lymphocytes (T cells) circulate between lymph nodes and peripheral tissues in search of antigens. Upon infection, some T cells will encounter cognate antigens followed by proliferation and clonal expansion in a context-dependent manner, to become effector T cells. These events are accompanied by changes in cellular metabolism, known as metabolic reprogramming. The magnitude and variation of metabolic reprogramming are, in addition to antigens, dependent on factors such as nutrients and oxygen to ensure host survival during various diseases. Herein, we describe how metabolic programmes define T cell subset identity and effector functions. In addition, we will discuss how metabolic programs can be modulated and affect T cell activity in health and disease using cancer and autoimmunity as examples.     

Phylogenetic Analysis of Spread of Hepatitis C Virus Identified during HIV Outbreak Investigation,Unnao, India

An HIV outbreak investigation during 2017–2018 in Unnao District, Uttar Pradesh, India, unearthed high prevalence of hepatitis C virus (HCV) antibodies among the study participants. We investigated these HCV infections by analyzing NS5B and core regions. We observed no correlation between HIV–HCV viral loads and clustering of HCV sequences, regardless of HIV serostatus. All HCV isolates belonged to genotype 3a. Monophyletic clustering of isolates in NS5B phylogeny indicates emergence of the outbreak from a single isolate or its closely related descendants. The nucleotide substitution rate for NS5B was 6 × 10⁻³ and for core was 2 × 10⁻³ substitutions/site/year. Estimated time to most recent common ancestor of these isolates was 2012, aligning with the timeline of this outbreak, which might be attributable to unsafe injection practices while seeking healthcare. HIV–HCV co-infection underlines the need for integrated testing, surveillance, strengthening of healthcare systems, community empowerment, and molecular analyses as pragmatic public health tools.     

Controlled Active Mobilization After Dorsal Capsulodesis to Correct Capitolunate Dissociation

Study DesignCase Report. Capitolunate instability is a form of midcarpal instability. If conservative management is unsuccessful, surgical reconstruction is often indicated. However, the literature is limited regarding postoperative management after reconstruction. Often patients are immobilized for a 6- to 12-week period, which can produce secondary complications, including wrist stiffness, tendon adherence, and muscle atrophy. The purpose of the case report was to demonstrate that controlled early mobilization may be implemented postoperatively after dorsal capsulodesis procedures to correct capitolunate instability. This early mobilization may prevent secondary complications, which can be associated with lengthy immobilization periods. A 27-year-old female underwent a dorsal capsulodesis procedure to correct capitolunate instability. The intraoperative findings of the reconstruction and tension on the capsulodesis procedure were communicated to the therapist by the surgeon. This close communication allowed the therapist to institute early controlled mobilization immediately postoperatively using a hinged wrist splint. The patient was followed by our unit for 13 years. Early controlled mobilization using a hinged wrist splint may have maximized the subject’s recovery, with no secondary complications. At 13-year follow-up, fluoroscopic and radiographic examination was normal, and no symptoms of pain or instability had reoccurred. In conclusion, early controlled mobilization using a hinged wrist splint may optimize the recovery period while retaining the desired arc of motion that is set intraoperatively.Level of Evidence4.     

A school-based intervention can reduce body fat and blood pressure in young adolescents.

PURPOSE: To determine the effect of increasing the aerobic component of the school's physical activity program and improving the knowledge about weight control and blood pressure on the blood pressure and body fat of early adolescents. METHODS: The subjects were 1140 youth aged 11 to 14 years (630 females, 510 males; 64% white, 24.4% African-American, and 11.6% "other"), who were randomly assigned by school into four treatment groups: exercise only, education only, exercise and education combined, and control group. Heights, weights, and skinfold thicknesses were measured, and body mass index (BMI) was computed kg/m(2). Blood pressure was obtained in duplicate using a random-zero mercury sphygmomanometer. Maximal oxygen uptake was predicted from a submaximal cycle ergometer test. Data were analyzed using analysis of covariance statistics, adjusting for gender, ethnicity, age, socioeconomic status, and initial baseline characteristics. RESULTS: Systolic and diastolic blood pressures increased more in the control group than in the intervention groups (p =.001). The BMI did not change significantly (p =.709), but the sum of skinfolds increased less in subjects in the exercise intervention groups than the education only or control groups (p =.0001). The small increase in (p)VO(2)max of the combined exercise and education group was significantly greater than the education only group (p =.0001). CONCLUSION: An exercise program for youth can have a positive effect on blood pressure independent of body weight loss.     

Longitudinal growth pattern of children during pre-school age and its relationship with different socio-economic classes

Summary This report deals with the study of longitudinal growth of pre-school children from different socio-economic classes in the urban community of Delhi. The role of socio-economic factors which affect the growth standards of weight, height, circumference of head, chest, arm, calf and pelvic width of these children at different ages from birth up to 5 years is discussed. It is observed that in malnutrition resulting from an adverse effect of poor socio-economic status, all measurements of the body are affected, the height and the head being the least and the weight, the circumferences of the chest, arm and calf the most. From the Longitudinal Morbidity and Mortality Survey of Children’s Unit, Indian Council of Medical Research, New Delhi.