Background: Pineapple vinegar that is often prepared from the by-products of fruit processing, shows promising health and preservative benefits in many areas. Objectives: This review focuses on compiling and analyzing the production and standardization methods of pineapple vinegar. It seeks to assess its therapeutic value including, induction of apoptosis in cancer cell lines, inhibiting metastasis, restoring liver antioxidants, and modifying the gut microbiome. Methods: This study covers a literature review across scientific databases for in-vitro and in-vivo studies that were conducted on Pineapple vinegar’s beneficial properties using PRISMA guidelines. Findings: Fermentation time, differences in the microorganisms used for fermentation, combination of ingredients used as a substrate, variability in bioactive compounds and volatile profiles affect the final vinegar. The most common starter used was Acetobacter sp. Nutrient analysis showed the presence of essential amino acids, B vitamins, Vitamin C, and antioxidants. DPPH, FRAP, SOD, TEAC and NO assays showed increased percentage of antioxidant activity. Pineapple vinegar reduced liver injury and lipid peroxidation while restoring antioxidant defenses (glutathione and superoxide dismutase). It suppressed inflammatory mediators (iNOS, NF‑κB) and brought down cytochrome P450 2E1 protein expression. Reduction in blood glucose and improvement in gonadosomatic index was found. Antimicrobial activity was observed against Escherichia coli, Staphylococcus aureus, Bacillus sp, Candida sp, Salmonella typhi, and Klebsiella sp. Usage of pineapple vinegar in food kept vegetable pickles fresh, prevented spoilage in fish, and improved the tenderness of meat. Novelty: This review comprehensively extracts evidence on the therapeutic properties of pineapple vinegar from recent peer-reviewed studies, addressing a gap in the literature. Its novelty is in the rigorous critical appraisal of the study quality along with a comparative analysis of various fermentation methods. By focusing on these gaps, this work provides a clearer direction for further research to unlock the therapeutic potential of pineapple vinegar. Keywords: Pineapple vinegar, fermentation, bioactive compounds, therapeutic benefits, functional food

INTRODUCTION:Precision prevention has shown an upsurge in popularity among epidemiologists in both developed and developing countries in the past decade. OBJECTIVES:Initially practiced in oncology, this approach is increasingly adopted in public health to guard against other common non-communicable diseases (NCDs), such as diabetes and cardiovascular diseases. It aims to tailor preventive measures according to each individual's unique characteristics, such as genomic data, socio-demographic features, environmental factors, and cultural background. METHODS:Healthcare information technologies, including telehealth and artificial intelligence (AI), have served as a vital catalyst in the expansion of this field in the past decade. Under this framework, real-time contemporaneous clinical data is collected via a wide range of digital health devices, such as telehealth monitors, wearables, etc., and then analyzed by AI or non-AI prediction models, which then generate preventive recommendations. RESULTS:The utilization of telehealth technologies in the precision prevention of cardiovascular diseases (CVDs) is a very illustrative application. This paper explores these topics as well as certain limitations and unintended consequences (UICs) and outlines telehealth as a core enabler of precision prevention as well as public health.

PURPOSE:The study explores the evolving landscape of cataract diagnosis, focusing on both traditional methods and innovative technological integrations. It aims to address challenges with subjectivity in traditional cataract grading and to evaluate how new technologies can enhance diagnostic accuracy and accessibility. METHODS:The research introduces and examines the use of Artificial Intelligence (AI), Machine Learning (ML), and Deep Learning (DL) in automating and improving cataract screening processes. It also explores the role of the Metaverse, Digital Twins, and Teleophthalmology for immersive patient education, real-time virtual replicas of eyes, and remote access to specialized care. RESULTS:Various ML and DL techniques demonstrated significant accuracy in cataract detection. The integration of these technologies, along with the Metaverse, Digital Twins, and Teleophthalmology, provides a comprehensive framework for accurate and accessible cataract diagnosis. CONCLUSION:There is a notable paradigm shift toward individualized, predictive, and transformative eye care. The advancements in technology address existing diagnostic challenges and mitigate the shortage of ophthalmologists by extending high-quality care to underserved regions. These developments pave the way for improved cataract management and broader accessibility.

Anaemia is a blood-related disorder that is sometimes a harbinger of a much more severe condition like cancer. WHO recommends context-specific diagnosing methods for anaemia in the case of in-feasibility of traditional diagnosing methods, including a haemoglobin colour scale method that is based on the colour of the blood. In this manifesto, we take it one step further and diagnose anaemia using images of lower palpebral conjunctiva captured in consumer-grade cameras. Data that include lower palpebral conjunctiva images, basic details, and haemoglobin values are collected from participants. Pixel parameters of collected conjunctiva images are extracted in various colour spaces and used as input features. An ensemble learning model was developed with K-Nearest Neighbour (KNN), Random Forest and Decision Tree algorithms which showed better classification performance in classifying anaemic and non-anaemic samples. This Ensemble Model-Based Anaemia Classifier (EMBAC) performed well with both training and test sets and produced 90.91% sensitivity, 89.06% specificity, 89.69% accuracy, and area under the Receiver Operating Characteristics(ROC) curve of 0.90 for the unseen test data. EMBAC also outperformed the conventional ensemble algorithms in terms of sensitivity and accuracy. EMBAC will classify the samples more correctly irrespective of the image acquisition device under any lighting conditions without any additional hardware. This research work attempts to lay the foundation for a smartphone application to detect anaemia in real-life conditions which will enable access to a mobile healthcare instrument to diagnose anaemia for the proletariat.

Background: Dyslipidemia, insulin resistance, hypertension, and abdominal obesity are important determinants of metabolic syndrome (MetS). Ample studies provide statistical data on the prevalence of MetS among the general public. Conversely, there is a paucity of data on the risk of MetS among different sedentary occupational groups. Objective: To assess the risk of MetS among female school teachers and to identify factors contributing to MetS. Methodology: The study was conducted among 256 female school teachers residing in Chennai city. A questionnaire was used to elicit information on the socio-demographic profile, diet pattern, physical fitness, and genetic history of lifestyle diseases. Anthropometric, biochemical, and clinical parameters were measured using standard methods. MetS was diagnosed using the harmonizing definition. Data analysis was done using Statistical Package for Social Sciences software. Results: Results evince that 39.45% of female school teachers were diagnosed with MetS, of which 26.56% had three components, 9.77% had four components, and 3.12% had all components of MetS. Abdominal obesity (99%) and low levels of high-density lipoprotein cholesterol (HDL-C) (96.04%) were the most predominant components. The least common component was diastolic hypertension (32.67%). MetS components were high among school teachers aged 36–45 years and 46–55 years. Age, fasting hyperglycemia, paternal history of hypertension, physical inactivity, eating out, and consumption of refined cereals significantly contributed to MetS ( P < 0.05). Conclusion: Results highlight the need to identify high-risk individuals and promote a healthy lifestyle through various intervention programs.

Background: To examine the effectiveness of a computer-assisted device (CAD) for diabetic retinopathy (DR) screening from retinal photographs at a vitreoretinal outpatient department (VR OPD), telecamps, and diabetes outpatient clinic by an ophthalmologist. In particular, the effectiveness of CAD in gradable and ungradable retinal images was examined. Methods: A total of 848 eyes of 485 patients underwent 45° retinal photographs at the VR OPD of a tertiary care hospital in southern India. A total of 939 eyes of 472 patients with diabetes were examined in the telecamps conducted in remote villages in Tamil Nadu, a state in southern India. A total of 2,526 eyes of 1,263 patients were examined in a diabetes clinic using 45° field retinal photographs. The algorithm was validated under physiological dilatation (without pharmacological dilatation) in all three arms. Results: Seventy-one percent of 848 eyes in VR OPD, 13% of 939 eyes in telecamps, and 7% of 2,526 eyes in diabetes clinic were diagnosed to have DR. The algorithm showed 78.3% sensitivity and 55.1% specificity for all images and 78.9% sensitivity and 56.8% specificity for gradable images in the VR OPD; 80.1% sensitivity and 79.2% specificity for all images and 84.8% sensitivity and 80.0% sensitivity for gradable images in telecamps; 63.0% sensitivity and 79.6% specificity for all images and 63.2% sensitivity and 78.1% specificity for gradable images in the diabetes clinic. The algorithm had an overall accuracy of 76.4%. The ungradable rate was variable. Conclusion: The algorithm performs equally well in identifying DR from gradable and ungradable photographs and may be used for DR screening in a rural setting with limited or no access to eye care.

BACKGROUND: Health and nutritional assessment of the institutionalized geriatric population is essential in providing better health care. OBJECTIVE: To assess the institutionalized geriatric population’s nutritional and mental health status. METHODOLOGY: One hundred elderly people aged 60 years and above residing at Little Drops – Old Age Home, Mangadu, Kanchipuram District, Tamil Nadu, were selected for the study. General information was obtained using a structured interview schedule. Nutrient intake was assessed using the three day dietary recall method. Standard methods were used to measure anthropometric, biochemical, and clinical parameters. Mental health was assessed using the Depression, anxiety, and Stress Scale (DASS-42) tool. RESULTS: Noncommunicable diseases such as hypertension (37%), osteoporosis (35%), and type 2 diabetes mellitus (25%) were reported by the participants. Walking and hand exercises were the most common form of physical exercise. The mean height, weight, and body mass index were 153.55 ± 11.83 cm, 55.49 ± 14.21 kg, and 23.83 ± 6.50 kg/m2, respectively. The mean systolic blood pressure and diastolic blood pressure were 128.61 ± 21.12 mmHg and 80.37 ± 10.70 mmHg, respectively. The mean hemoglobin value of male and female participants was 11.90 ± 2.33 g/dL and 11.09 ± 1.92 g/dL, respectively, thus indicating the presence of anemia. The intake of macro and micronutrients was less than the recommended dietary allowances. The decrease in food intake was due to tooth problems, xerostomia, difficulty in swallowing, nausea, and vomiting. Based on the scores obtained using the DASS-42 tool, most of the participants (70%) were depressed. CONCLUSIONS: The results specify the need to conduct periodical medical screening programs to improve the health status of geriatric people.

Abstract One health (“OH”) refers to integration of human, animal, and ecosystem health. An OH-based disease surveillance will enable early detection of zoonoses and ecosystem changes, instrumental for pre-empting future pandemics. Telehealth is used for preventive and curative remote care; telehealth can be instrumental for developing OH-surveillance but the barriers and levers in building such systems are unknown. We address this by conducting an innovation sprint with digital health experts at an international conference. We asked the participants how we might build a telehealth-driven OH surveillance system. They identified barriers, opportunities, and needs, and constructed empathy maps. Analyses of their responses revealed that they identified lack of a centralised system as a barrier. Networks, and centralised data systems would facilitate building telehealth-based OH surveillance. These findings are also consistent with existing approaches of OH surveillance without telehealth. This suggests implementing telehealth in OH surveillance will have similar issues to existing approaches.

Background:Healthy aging and well-being are largely influenced by nutrition. Objective:The objective of the study was to evaluate the risk of malnutrition in elderly women residing in institutional care and its contributing factors. Methodology:One hundred institutionalized women aged 60 years and above were screened for malnutrition using Mini Nutritional Assessment (MNA) tool. Details on sociodemographic profile, physical activity, medical conditions, and food habits were gathered through researcher administered survey method. Results:The study participants had an average height of 149.70 cm (±7.31), weight of 50.72 kg (±9.11), body mass index of 22.77 kg/m2 (±4.68), body fat percentage of 31.30% (±8.99), mid-arm circumference of 27.36 cm (±7.84), calf circumference of 30.11 cm (±7.51), MNA score of 10.42 (±4.06), and hand grip strength score of 18.69 kg/lbs (±3.80). Upon analyzing the MNA scores, it was found that 9% of elderly women were well nourished, 62% were at risk of malnutrition, and 29% were malnourished. A significant difference was observed in the mean MNA scores (P < 0.05). Age, education level, body fat percentage, appetite, and dental problems were significantly associated with malnutrition (P < 0.05). Conclusion:Geriatric residents in old-age homes require adequate nutrition to maintain health. This can be achieved by providing individualized meal planning, reducing barriers to eating, and incorporating nutrient-dense foods.

Diabetes mellitus is a condition that occurs when the glucose level in the blood goes high. The eye-related issues due to diabetes may include diabetic retinopathy and diabetic maculopathy. It also includes conditions such as Glaucoma and Cataracts. All these conditions can steer toward poor vision and blindness. Artificial intelligence (AI) is the latest methodology used for eye image analysis. It is all about intelligent programming with the help of intelligent algorithms that make intelligent machines do what a human does. Machine learning and deep learning techniques are subtypes of AI. In this paper, we have summarized the findings of studies that have detected diabetic retinopathy and diabetic maculopathy using various AI methods.

Background: India is home to the second largest number of adults living with diabetes after China. Although modern diabetic drugs treat the condition effectively, prolonged usage leads to adverse effects. Plants have been a good source of medicine from ancient time. Among spices, the inner bark of cinnamon is authenticated as traditional medicine. Objectives: To study whether cinnamon infusion improve blood glucose level in type 2 diabetes mellitus subjects. Materials and Methods: In the current study, the effectiveness of seventy five ml of Cinnamomum zeylanicum infusion on plasma glucose, serum fructosamine and serum insulin of the selected subjects with type 2 diabetes were studied for a period of 45 days. Within-subjects design was used for the supplementation intervention. Results: Cinnamon zeylanicum has shown to increase glucose uptake and glycogen synthesis. In addition, cinnamon zeylanicum aids in triggering the insulin receptor cascade system. After 45 days supplementation, fasting glucose decreased (p < 0.001) from 144.53 to 115.43 mg/dL. Post prandial glucose decreased (p<0.001) from 205.66 to 164.33mg/dL. Serum fructosamine and insulin also showed marked improvements. Conclusion: Supplementation with Cinnamomum Zeylanicum infusion for forty five days reduced fasting glucose, fructosamine and decreased insulin levels of subjects with elevated blood glucose.

This study aimed to investigate the effect of pumpkin (Cucurbita maxima) seed supplementation on the anthropometric measurements, biochemical parameters, and blood pressure (BP) of Indian women with metabolic syndrome (MetS). Initially, in vitro antioxidant activities of pumpkin seeds extract were assessed using standard methods. In vitro alpha-amylase, alpha-glucosidase, and dipeptidyl peptidase IV (DPP-IV) inhibition effects, along with glucose uptake assay using 3T3-L1 cell lines were performed to determine the antidiabetic effects of the seeds extract. Fatty acids and phytoconstituents were identified using gas chromatography-mass spectrometry (GC–MS). Indian women aged 30–50 years, having MetS were assigned either to intervention (n = 21) or control (n = 21) group on a random basis. Participants in the intervention group received 5 g of pumpkin seeds for 60 days. Participants in both intervention and control were advised to follow certain dietary guidelines throughout the study. Pumpkin seeds extract exhibited not only strong reducing power but also scavenged DPPH and ABTS●+ free radicals with low IC50 values. Pumpkin seeds inhibited alpha-amylase, alpha-glucosidase, and DPP-IV enzymes at varying concentrations with IC50 values of 138, 22, and 246 µg/mL, respectively. Furthermore, glucose uptake was enhanced by 213% at 300 ng/mL on the 3T3-L1 cell line. GC–MS analysis showed the presence of propyl piperidine, flavone, oleic acid, and methyl esters of fatty acids in the seed extract. On comparing the changes in mean reduction/ increment in the anthropometric measurements as well as biochemical parameters and BP between the groups, significant difference (P = 0.012) was observed only for fasting plasma glucose. Findings of the present study highlight the role of pumpkin seeds as a cost-effective adjunct in treating MetS.

Purpose: To examine the effectiveness of a computer-assisted algorithm for onsite screening for diabetic retinopathy (DR) at diabetic outpatient clinics. Methods: 1263 patients were examined over two years. Undilated fundus photographs were acquired at the clinic. Photographs were independently assessed by an ophthalmologist and optometrist in a darkened room in a masked fashion and also processed through the algorithm. DR was defined per the International Clinical Diabetic Retinopathy Disease Severity Scale and severity of diabetic retinopathy. Results: 2526 eyes of 1263 patients were assessed. The algorithm successfully graded 2153 (85%) images with 63.04% sensitivity and 79.63% specificity compared to an ophthalmologist; in comparison to an optometrist, sensitivity and specificity were 60.87% and 79.05%, respectively. The agreement between ophthalmologist and optometrist was kappa=0.835 for presence of DR, 0.835 for severity of DR. Conclusion: This algorithm may be a utilized in a diabetic clinic for a quick screening with only the retinal photographs.

OBJECTIVE:The goal of this paper is to provide a consensus review on telehealth delivery prior to and during the COVID-19 pandemic to develop a set of recommendations for designing telehealth services and tools that contribute to system resilience and equitable health.METHODS:The IMIA-Telehealth Working Group (WG) members conducted a two-step approach to understand the role of telehealth in enabling global health equity. We first conducted a consensus review on the topic followed by a modified Delphi process to respond to four questions related to the role telehealth can play in developing a resilient and equitable health system.RESULTS:Fifteen WG members from eight countries participated in the Delphi process to share their views. The experts agreed that while telehealth services before and during COVID-19 pandemic have enhanced the delivery of and access to healthcare services, they were also concerned that global telehealth delivery has not been equal for everyone. The group came to a consensus that health system concepts including technology, financing, access to medical supplies and equipment, and governance capacity can all impact the delivery of telehealth services.CONCLUSION:Telehealth played a significant role in delivering healthcare services during the pandemic. However, telehealth delivery has also led to unintended consequences (UICs) including inequity issues and an increase in the digital divide. Telehealth practitioners, professionals and system designers therefore need to purposely design for equity as part of achieving broader health system goals.

There are many options to choose from when considering the type of catheter through which to infuse fluids into our patient's circulatory system. These options range from standard peripheral intravenous catheters (termed PIV) to invasive central venous catheters (termed CVC). Somewhere in the middle lies a useful and intriguing device called a Rapid Infusion Catheter (R), or RIC line, manufactured by Arrow Inc. It involves a catheter-over-guidewire technique that requires an existing peripheral IV to be in place at the level of the antecubital fossa or higher, through which a guidewire is inserted for exchange with the RIC large bore catheter. The RIC line ranges in size, with typical sizes being 7 french (fr) and 8.5 fr. When functioning properly with large bore IV tubing, they can infuse volumes up to 1 liter per minute: an impressive volume without the associated risks of CVC insertion. The use of rapid infusion catheters in critical hypotension and trauma shock patients has never been reviewed in the emergency medicine literature in regards to flow rates, time to insertion and complications rates. An in-situ infusion rate study was conducted for common large-volume infusion catheters with the Level 1 infusion pump (R) (Smiths Medical) and thirteen different vascular catheters. The second experiment involved timed vascular access simulation with emergency medicine residents at all levels of training measuring time-to-insertion for Rapid Infusion Catheters and Multi-lumen Access Catheter (R) (Arrow brand). Thirteen different types of infusion catheters were compared in the infusion rate study. 8.5 french (fr) RIC line infusion rate (1000 ml/min) was superior to all other lines except the 9 fr sheath introducer to which it was equivalent. Fourteen emergency medicine residents participated in the time-to-insertion study, with RIC line insertion being completed faster than MAC line (mean time 0:28 vs 0:52, t-statistic = -4.2467, degrees of freedom = 13, p-value = 0.000953). Complication rates in the literature for RIC lines are 1.6% compared to 4-7% for central venous lines. We report for the first time in emergency medicine literature through this preliminary study and literature review that RIC lines have higher infusion rates, fewer complications, and require less time to insert than CVC lines. There will always be strong indications for obtaining central venous access, but we suggest that RIC lines be used more often in cases of critical hypovolemia and the resuscitation of shock patients. Additional studies are needed to determine if there are clinically different outcomes depending on the type of access obtained in these critical patients.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Objective: To validate an algorithm previously developed by the Healthcare Technology Innovation Centre, IIT Madras, India for screening of diabetic retinopathy (DR), in fundus images of diabetic patients from telecamps to examine the screening performance for DR. Design: Photographs of patients with diabetes were examined using the automated algorithm for the detection of DR Setting: Mobile Teleophthalmology camps were conducted in two districts in Tamil Nadu, India from Jan 2015 to May 2017. Participants: 939 eyes of 472 diabetic patients were examined at Mobile Teleophthalmology camps in Thiruvallur and Kanchipuram districts, Tamil Nadu, India,. Fundus images were obtained (40-45-degree posterior pole in each eye) for all patients using a nonmydriatic fundus camera by the fundus photographer. Main Outcome Measures: Fundus images were evaluated for presence or absence of DR using a computer-assisted algorithm, by an ophthalmologist at a tertiary eye care centre (reference standard) and by a fundus photographer. Results: The algorithm demonstrated 85% sensitivity and 80% specificity in detecting DR compared to ophthalmologist. The area under the receiver operating characteristic curve was 0.69 (95%CI=0.65 to 0.73). The algorithm identified 100% of vision-threatening retinopathy just like the ophthalmologist. When compared to the photographer, the algorithm demonstrated 81% sensitivity and 78% specificity. The sensitivity of the photographer to detect DR was found to be 86% and specificity was 99% in detecting DR compared to ophthalmologist. Conclusions: The algorithm can detect the presence or absence of DR in diabetic patients. All findings of vision-threatening retinopathy could be detected with reasonable accuracy and will help to reduce the workload for human graders in remote areas.

The present study was aimed to examine the therapeutic values of pulp and peel extracts of Hylocereus undatus by comparing the chemical compounds identified by using GC-MS. Antioxidant activities were measured using DPPH., ABTS(.+), superoxide radical, FRAP and phosphomolybdenum reduction assay. Antidiabetic and anti-inflammatory activities were determined using a-amylase inhibition method and heat induced hemolytic technique. The results showed that both the extracts reduced the oxidative stress with pulp extract showing stronger antioxidant activity. The antidiabetic and anti-inflammatory activities of pulp extract were greater than peel extract with IC50 values of 222.97 and 16.56 mu g mL(-1), respectively. GC-MS analysis showed the presence of phytosterols, steroids, triterpene, phenolic compounds and esters of fatty acids. The study shows the presence of bioactive compounds in H. undatus pulp and peel extracts with promising health benefits.

Recent research studies indicate the role of functional foods in preventing the development of complications associated with type 2 diabetes mellitus. Chia seeds are an excellent source of dietary fibre, essential fatty acids, micronutrients and non-nutritive components. The objective of the study was to evaluate the antioxidant, antibacterial, antidiabetic and anti-inflammatory potential of chia seeds. TPC and TFC were estimated using Folin-Ciocalteu Reagent and Alumininum Chloride method. The antioxidant activity was determined using DPPH● radical, ABTS●+ radical, Superoxide (O2-) radical, Fe3+ reducing and phosphomolybdenum reduction assay. Agar well diffusion method was used to determine the antibacterial activity against Escherichia coli, Proteus vulgaris, Shigella flexneri, Micrococcus luteus, Bacillus subtilis and Staphylococcus aureus. Antidiabetic and anti-inflammatory activities were evaluated using alpha amylase inhibition assay and heat induced haemolysis method. Volatile functional compounds were identified using Gas chromatography mass spectrometry. Upon quantification, TPC and TFC were found to be 850.67±14.14µg/mg GAE and 171.21±12.86µg/mg QE. Free radical scavenging activity of chia seeds was ranked in the order of DPPH● radical >ABTS●+ radical > Superoxide (O2-) radical. The capability of chia seeds to function as electron donors was evident through its strong reducing power. With regard to antibacterial activity, maximum inhibition was observed for Staphylococcus aureus, with a zone of inhibition of 31mm at 500µg/mL. Results of antidiabetic assay highlighted the alpha amylase inhibitory action of chia seeds with an IC50 value of 121.46µg/mL. The anti-inflammatory activity of chia seeds increased linearly in a dose dependent manner. GC-MS analysis showed the presence of functionally active compounds such as coumarine, napthoquinone, phytol, fatty acids, flavone and flavone derivatives. Findings of the study highlight that chia seeds have several essential therapeutic properties. Furthermore, clinical studies are required to validate the role of chia seeds in preventing the development of complications associated with type 2 diabetes mellitus.

Rationale: Nutrition plays a vital role in all the three phases (pre, peri, post) of liver transplantation (LT). This study was performed to ascertain the nutritional status of Indian adult end-stage liver disease patients, implement a nutrition protocol, & analyze the effect of nutritional support on perioperative LT outcomes.