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Objective: To determine the success rate of vaginal birth after caesarean (VBAC) in Indian women, identify the factors that predict its success, and assess the maternal and neonatal outcomes following a trial of labour after caesarean (TOLAC). Design: Prospective observational study Setting: Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India Sample: 124 women with previous LSCS who opted for TOLAC Methods: A prospective observational study involving women with one previous lower segment caesarean section (LSCS) who were admitted for TOLAC between January 2019 and June 2020. Main outcome measures and Results: During the study period, 124 women with previous LSCS who opted for TOLAC were included, of whom 68 (54.8%) had successful VBAC and 56 (45.2%) had failed TOLAC. The induction of labour (IOL) rate in the study was 69.4%, and 30.6% of women had spontaneous onset of labor. VBAC rates were significantly higher in women who went into labour spontaneously (84.2% vs. 15.8%). Maternal complication rates were comparable, whereas the neonatal complication rate was significantly higher in neonates born by CS (51.7% vs. 30.8%), with a greater incidence of low birthweight (LBW) and transient tachypnea in the newborn (TTNB). Conclusions: TOLAC can be considered a safe option for women with a previous caesarean when combined with vigilant and stringent labour monitoring, despite the use of IOL agents. Funding : Not applicable.

Phlebitis is the inflammation of a vein, typically in the legs, due to a blood clot or other causes. Risk factors for developing phlebitis include prolonged immobility, age, family history, obesity, smoking, and certain medical conditions, such as cancer, heart disease, and inflammatory bowel disease, which can increase the risk of phlebitis. Objective: To assess the knowledge regarding risk factors of phlebitis and its association with nurses’ education among nurses at a tertiary care Hospital in Karachi. Methods: This cross-sectional analytical study was conducted at a tertiary care hospital in Karachi from September to December 2022. A total of 53 nurses were part of the study, and a convenient sampling technique was used to approach the participants. The data were collected through a valid and reliable tool. Results: Study results show that Among 53 participants, the male participant 26(49.1%), whereas the female participant was 27 (50.9%). Study results also found that 17.0% of nurses have High-level knowledge, whereas 83.0% of the participants have moderate, level knowledge about the risk factors of phlebitis. Moreover, the study found no significant difference between the knowledge score and the nurses' education p-value of 0.794. Conclusions: These findings suggest that nurses may need further education and training regarding the risk factors of phlebitis, as most nurses have only a moderate level of knowledge. Investigating other factors impacting nurses’ knowledge may also be essential, such as work experience and training programs.

Petrochemical workers are exposed to many noxious substances present in their work places. The most dangerous effects are due to benzene which is mostly found in petrochemical vapours. The study was carried out in the Pathology department, Govt Medical College, Amritsar. 100 Petrol pump workers from different areas of the city were included as study group and 50 individuals from various departments in Government Medical College, Amritsar, were included as control group. Whole blood samples of the subjects were taken and analysed for complete blood count, liver function tests and renal function tests. The results showed statistically signicant increase in values of hematocrit, MCV, RDW, MPV, AST, ALT, ALP, GGT, Blood Urea, S. Creatinine, S. Uric Acid, Random blood sugar and statistically signicant decrease in values of MCH, MCHC, Platelet count, TSP, DSP with increased duration of exposure and in comparison to controls. However, there is seen statistically signicant increase in Hb, red blood cell count in initial years of exposure with subsequent decrease in their value after increased duration of exposure. There is seen neutropenia and lymphocytosis with PBF examination showing macrocytic RBC picture with no signicant difference in values of TLC, mid cell counts, PDW, PCT, S. Bilirubin (total and direct), S. Na+, PT, PTI with increased duration of exposure. The results of above parameters indicates that exposure to gasoline compounds over a long period of time may be the causative factor of hematotoxicity, hepatotoxicity and nephrotoxicity.

One of the essential elements of automated and intelligent machining processes is accurately predicting tool life. It also helps in achieving the goal of producing quality products with reduced production costs. This work proposes a computer vision-based tool wear monitoring and tool life prediction system using machine learning methods. Gradient-boosted trees and support vector machine (SVM) techniques are used to predict tool life. The experimental investigation on the CNC machine is conducted to study the applicability of the proposed tool wear monitoring system. Experiments are performed using workpiece material made of alloy steel and PVD-coated cutting inserts, and flank wear is monitored. An imaging system consisting of an industrial camera, lens, and LED ring light is mounted on the machine to capture tool wear zone images. Images are then processed by algorithms developed in MATLAB®. Boosted tree methods and the SVM methodology have 96% and 97% prediction accuracy, respectively. Validation tests are carried out to determine the accuracy of proposed models. It is observed that the prediction accuracy of boosted three and SVM is good, with a maximum error of 5.89% and 7.56%, respectively. The outcome of the study established that the developed system can monitor the tool wear with good accuracy and can be adopted in industries to optimize the utilization of tool inserts.

Pythium insidiosum is a parasitic oomycete that can cause keratitis and closely resembles fungus, both clinically and morphologically. It requires a trained microbiologist for its differentiation from fungal filaments and has poor response to antifungal therapy. We present a case of primary isolation of the organism from the vitreous cavity in a case of endophthalmitis. The infection spread quickly and involved all the ocular tissues. The eye had poor visual outcome despite a sequence of rapidly completed retinal and corneal surgeries along with initiation of anti-Pythium therapy.

PurposeThe purpose of this article is to revisit the mean reversion in profitability and earnings among Indian-listed firms, based on the idea that changes in profitability and earnings are somewhat predictable.Design/methodology/approachThe study used a sample of 445 Bombay Stock Exchange (BSE)-listed companies and 309 companies from the manufacturing sector in India for the period from 2007 to 2020. The study employed cross-sectional regressions. Both linear and non-linear Partial Adjustment Models (PAM) were used to forecast profitability and earnings.FindingsThe study revealed that profitability and earnings mean revert for both the BSE-listed companies and the manufacturing sector companies from 2007 to 2012. However, for the years from 2013 to 2020, it was found that there is no significant evidence of mean reversion in both the BSE-listed companies or the manufacturing sector companies.Practical implicationsThe findings have larger implications for security analysts who forecast future stabilisation or recovery of historically high or low growth rates. Investors and analysts would benefit from having a better understanding of how competitive attacks affect profitability as well as how the overall economic growth of a country affects earnings and valuations.Originality/valueMost of the empirical research in India has focused on mean reversion in stock prices or stock returns. The present study looked at the mean reversion of profitability and earnings in Indian firms.

To demonstrate the suitability of using decellularized SMILE (Small-incision Lenticule Extraction) lenticules for culturing and transplanting the corneal endothelium (CE). The SMILE lenticules, obtained during refractive surgery, were decellularized by incubating in CE culture medium and fetal bovine serum. Decellularization was confirmed by hematoxylin and eosin staining, DAPI staining, and gel electrophoresis. The amount of DNA per milligram of dry tissue weight was calculated to quantify the residual nuclear content. The transparency of the decellularized lenticules was determined by calculating the modulation transfer function. Immunostaining for stromal collagens and glycosaminoglycan was performed using specific antibodies. Engineered tissue was constructed by culturing the CE cells on lenticules and staining for ZO-1, Na/K ATPase, and N-cadherin. The functionality of the engineered tissues was assessed by transplanting them onto edematous human donor corneas and perfusing for 10 days ex-vivo. The residual DNA per milligram of dry tissue weight was found to be significantly reduced (p < 0.0001) in serum (0.255 µg/mg) and Opti-MEM (0.140 µg/mg) when compared to fresh lenticules (3.9 µg/mg). Decellularization did not alter the arrangement of the collagen fibers or the transparency of the lenticules. CE cells attached and matured to express ZO-1, Na/K ATPase, and N-cadherin at two weeks after seeding. The engineered tissue upon transplantation significantly reduced the corneal edema (p < 0.05) and the transplanted cells remained intact on the SMILE lenticule post-transplantation. This study demonstrates the suitability of using SMILE lenticules decellularized using a simple, chemical-free method for engineering the corneal endothelium for transplantation.

Introduction: Ventilator Associated Pneumonia (VAP), the nosocomial pneumonia developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second commonest nosocomial infection in the neonatal intensive care unit (NICU). VAP occurring within 96 hours of initiation of mechanical ventilation is termed as early VAP and later than that is known as late VAP. The aim of this study was to determine the incidence rate and risk factors of early and late ventilator associated pneumonia in NICU. Methods: The study was conducted from December 2015 to November 2017 in which 40 neonates were ventilated for more than 48 hours of which those who developed VAP as per CDC criteria were enrolled in the study. Birth weight, gestation age, reintubation if needed and number of days of ventilation were noted. Statistical associations were further evaluated between various parameters of VAP and time of development of VAP. Results: Incidence of Early VAP was 12.5% and that of Late VAP was 87.5%. 93.95% neonates who were reintubated developed VAP. Duration of mechanical ventilation and re-intubation were significantly associated with the time of development of VAP. Birth weight and gestation age were statistically insignificant factors in determining VAP. Conclusions: Re-intubation and duration of mechanical ventilation are a significant risk factor for development of late VAP. Gestation age and birth weight have been identified as additional risk factors. Early diagnosis is necessary for appropriate treatment and decreased hospital stay.

One of the essential requirements for intelligent manufacturing is the low cost and reliable predictions of the tool life during machining. It is crucial to monitor the condition of the cutting tool to achieve cost-effective and high-quality machining. Tool conditioning monitoring (TCM) is essential to determining the remaining useful tool life to assure uninterrupted machining to achieve intelligent manufacturing. The same can be done by direct and indirect tool wear measurement and prediction techniques. In indirect methods, the data is acquired from the sensors resulting in some ambiguity, such as noise, reliability, and complexity. However, in direct methods, the data is available in images resulting in significantly less chances of ambiguity with the proper data acquisition system. The direct methods, which provide higher accuracy than indirect methods, involve collecting images of worn tools at different stages of the machining process to predict the tool life. In this context, a novel tool wear prediction system is proposed to examine the progressive tool wear utilizing the artificial neural network (ANN). Experiments were performed on AISI 4140 steel material under dry cutting conditions with carbide inserts. The cutting speed, feed, depth of cut, and white pixel counts are considered as input parameters for the proposed model, and the flank wear along with remaining tool life is predicted as the output. The worn tool images were captured using an industrial camera during the turning operation at regular intervals. The ANN training set predicts the remaining useful tool life, especially the sigmoid function and rectified linear unit (ReLU) activation function of ANN. The sigmoid function showed an accuracy of 86.5%, and the ReLU function resulted in 93.3% accuracy in predicting tool life. The proposed model’s maximum and minimum root mean square error (RMSE) is 1.437 and 0.871 min. The outcomes showcased the ability of image processing and ANN modeling as the potential approach for developing a low-cost industrial tool condition monitoring system that can measure tool wear and predict tool life in turning operations.

Haemodialysis centres have conventionally provided maintenance haemodialysis using a standard dialysate temperature (eg, 36·5°C) for all patients. Many centres now use cooler dialysate (eg, 36·0°C or lower) for potential cardiovascular benefits. We aimed to assess whether personalised cooler dialysate, implemented as centre-wide policy, reduced the risk of cardiovascular-related death or hospital admission compared with standard temperature dialysate.MyTEMP was a pragmatic, two-arm, parallel-group, registry-based, open-label, cluster-randomised, superiority trial done at haemodialysis centres in Ontario, Canada. Eligible centres provided maintenance haemodialysis to at least 15 patients a week, and the medical director of each centre had to confirm that their centre would deliver the assigned intervention. Using covariate-constrained randomisation, we allocated 84 centres (1:1) to use either personalised cooler dialysate (nurses set the dialysate temperature 0·5-0·9°C below each patient's measured pre-dialysis body temperature, with a lowest recommended dialysate temperature of 35·5°C), or standard temperature dialysate (36·5°C for all patients and treatments). Patients and health-care providers were not masked to the group assignment; however, the primary outcome was recorded in provincial databases by medical coders who were unaware of the trial or the centres' group assignment. The primary composite outcome was cardiovascular-related death or hospital admission with myocardial infarction, ischaemic stroke, or congestive heart failure during the 4-year trial period. Analysis was by intention to treat. The study is registered at ClinicalTrials.gov, NCT02628366.We assessed all of Ontario's 97 centres for inclusion into the study. Nine centres had less than 15 patients and one director requested that four of their seven centres not participate. 84 centres were recruited and on Feb 1, 2017, these centres were randomly assigned to administer personalised cooler dialysate (42 centres) or standard temperature dialysate (42 centres). The intervention period was from April 3, 2017, to March 31, 2021, and during this time the trial centres provided outpatient maintenance haemodialysis to 15 413 patients (about 4·3 million haemodialysis treatments). The mean dialysate temperature was 35·8°C in the cooler dialysate group and 36·4°C in the standard temperature group. The primary outcome occurred in 1711 (21·4%) of 8000 patients in the cooler dialysate group versus 1658 (22·4%) of 7413 patients in the standard temperature group (adjusted hazard ratio 1·00, 96% CI 0·89 to 1·11; p=0·93). The mean drop in intradialytic systolic blood pressure was 26·6 mm Hg in the cooler dialysate group and 27·1 mm Hg in the standard temperature group (mean difference -0·5 mm Hg, 99% CI -1·4 to 0·4; p=0·14).Centre-wide delivery of personalised cooler dialysate did not significantly reduce the risk of major cardiovascular events compared with standard temperature dialysate. The rising popularity of cooler dialysate is called into question by this study, and the risks and benefits of cooler dialysate in some patient populations should be clarified in future trials.Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Ontario Renal Network, Ontario Strategy for Patient-Oriented Research Support Unit, Dialysis Clinic, Inc., ICES (formerly known as the Institute for Clinical Evaluative Sciences), Lawson Health Research Institute, and Western University.

Obesity has continued to emerge as a worldwide pandemic and has been associated with a significant increase in associated comorbidities. These include well-known conditions such as hypertension and diabetes, as well as lesser-known conditions such as obesity-related glomerulopathy (ORG). The main etiology of ORG is podocyte damage, but contributing theories include dysfunctional renin–angiotensin–aldosterone system activation, hyperinsulinemia and lipid deposition. Recent advances have made strides in understanding the complex pathophysiology of ORG. The key to treating ORG is weight loss and proteinuria reduction. Lifestyle modification, pharmacological interventions and surgery are mainstays of management. A special focus on obese children is required, as childhood obesity tracks into adulthood and primary prevention is key. In this review we discuss the pathogenesis, clinical features and established and newer treatment modalities of ORG.

Lupus nephritis (LN) has variable prevalence, severity, and outcomes across the world.This review compares the outcomes of childhood LN in low- and middle-income countries (LMICs) and high-income countries (HICs) and aims to summarize long-term outcomes of pediatric LN from LMICs.A systematic literature search, conducted in PubMed, EMBASE, and Cochrane database in the last 30-years from January 1992, published in the English language, identified 113 studies including 52 from lower (n = 1336) and upper MICs (n = 3014).Cohort studies or randomized controlled trials, of patients ≤ 18 years of age (or where such data can be separately extracted), with 10 patients with clinically or histologically diagnosed LN and outcomes reported beyond 12 months were included.Patients ≤ 18 years of age with clinically or histologically diagnosed LN; effect of an intervention was not measured.Two authors independently extracted data. We separately analyzed studies from developed countries (high income countries; HIC) and developing countries (LMICs). Middle-income countries were further classified as lower and upper MICs. Meta-analyses of data were performed by calculating a pooled estimate utilizing the random-effects model. Test for heterogeneity was applied using IKidney remission was similar across MICs and HICs with 1-year pooled complete remission rates of 59% (95% CI 51-67%); one third of patients had kidney flares. The pooled 5-year survival free of stage 5 chronic kidney disease (CKD5) was lower in MICs, especially in lower MICs compared to HICs (83% vs. 93%; P = 0.002). The pooled 5-year patient survival was significantly lower in MICs than HICs (85% vs. 94%; P 0.001). In patients with class IV LN, the 5-and 10-year respective risk of CKD5 was 14% and 30% in MICs; corresponding risks in HICs were 8% and 17%. Long-term data from developing countries was limited. Sepsis (48.8%), kidney failure (14%), lupus activity (18.1%), and intracranial hemorrhage/infarct (5.4%) were chief causes of death; mortality due to complications of kidney failure was more common in lower MICs (25.6%) than HICs (6.4%).The review is limited by heterogenous approach to diagnosis and management that has changed over the period spanning the review. World Bank classification based on income might not correlate with the standards of medical care. The overall quality of evidence is low since included studies were chiefly retrospective and single center.Challenges in LMICs include limited access to pediatric nephrology care, dialysis, increased risk of infection-induced mortality, lack of frequent monitoring, and non-compliance due to cost of therapy. Attention to these issues might update the existing data and improve patient follow-up and outcomes.PROSPERO 2022 number: CRD42022359002, available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022359002.

Utilizing a participation burden algorithm developed in a previous study, Tufts CSDD, in collaboration with ZS, led a workshop among 8 pharmaceutical companies to validate the methodology of benchmarking the participation burden of a set of retrospective protocols and comparing these data to a prospective protocol design.Eight participating companies collected data for 66 retrospective protocols and participation burden scores were calculated for each. Data from one prospective protocol was provided and prospective burden scores were compared to mean retrospective protocol burden for each company. Participating companies provided feedback on data collection process and final reports.Comparisons between retrospective and prospective burden scores revealed higher comparative burden in lab and blood procedures. Companies were able to gather most requested data, but some variables hypothesized to affect burden were not available to sponsors. Time constraints were reported as a challenge throughout the data collection process.Feedback indicated the need for establishing a larger database to enable comparisons between protocols with the same therapeutic area and indication. Investigating the impact of standard of care burden by indication on overall participation burden and encouraging sponsors to collect more accurate data contributing to participation burden at the site level are also important takeaways from this exercise.

The optimal perioperative management of antiplatelet therapy (APT) therapy in patients undergoing noncardiac surgery (NCS) following percutaneous coronary intervention (PCI) is unclear. We sought to identify predictors of APT cessation in a real-world cohort of patients undergoing NCS within 1 year of PCI.Consecutive patients undergoing PCI at a tertiary center between 2011 and 2018 were prospectively enrolled. Perioperative interruption of APT was defined as cessation of either aspirin or P2YA total of 1092 surgeries corresponding to 747 patients were identified. Overall, there were 487 (44.6%) preoperative antiplatelet interruptions: discontinuation of either P2YIn this contemporary cohort of post-PCI patients undergoing NCS, patient-, angiographic- and surgery-specific factors all affected decision-making regarding APT cessation. Our findings reflective of real-world practice, highlight the importance of a multidisciplinary team approach to individualize decision making in these patients.

Autosomal dominant polycystic kidney disease, also known as ADPKD, is the most common hereditary kidney disease, affecting different age groups. ADPKD can eventually lead to end-stage renal disease. The etiology of ADPKD is genetic, resulting in the formation of cysts containing fluids on the kidneys. Patients with ADPKD present a range of symptoms following a decline in kidney function. Pain, stones, proteinuria and osteoporosis are few of the many symptoms, resulting from decreased kidney function. Tolvaptan, a selective V2 receptor antagonist, is the etiological treatment used for ADPKD. In this paper, we conducted a systematic review of the literature between 2011 and 2021 to gather data regarding the tolerability and efficacy of tolvaptan use in ADPKD. A total of 22 trials were reviewed. Tolvaptan efficacy in the trials was measured using changes in eGFR or changes in total kidney volume. Results showed that tolvaptan use in ADPKD was associated with a slower decline in kidney function and a decrease in total kidney volume. Side effects of this drug include polyuria, nocturia and polydipsia along with hepatotoxicity. The two biggest trials, TEMPO and REPRISE, change in eGFR from pre-treatment baseline to post-treatment was 1.3 mL/min/1.73 for REPRISE and 1 mL/min/1.73 for TEMPO 3:4. A mean decrease of 49% in total kidney volume from baseline to post-treatment was found in the TEMPO 3:4 study.

Broader spectrum gram-negative antibiotics are commonly utilized empirically for central line-associated bloodstream infections (CLABSI) in febrile short bowel syndrome (SBS) patients receiving home parenteral nutrition compared to those used empirically for inpatient-acquired CLABSI. This analysis reports 57 CLABSI in 22 patients with SBS admitted from the community and 78 inpatient-acquired CLABSI in 76 patients over a 5-year period. Proportional gram-negative CLABSI was similar between the SBS and inpatient-acquired cohorts (43.8% versus 42.3%, respectively, p=0.78). 1.8% and 10.3% (p=0.125) of gram-negative CLABSI were non-susceptible to ceftriaxone and 0% and 3.8% (p=0.52) were non-susceptible to ceftazidime in the SBS and inpatient-acquired cohorts, respectively. In the SBS cohort, home ethanol lock therapy and prior culture results impacted gram-negative pathogen distribution. Broader empiric gram-negative coverage for CLABSI among SBS patients compared to inpatients is unnecessary. Third-generation cephalosporins represent appropriate empiric gram-negative agents for febrile SBS patients presenting from the community to our institution.

India is one of the few countries to legalize abortion since 1971. However, legalizing abortion has not translated into safe and affordable services. The birth sex ratio in India has been declining since the 1901. Despite the attempts by government to monitor radiologists and genetic laboratories, the Census of India 2011reported a dip in the child sex ratio in states like Maharashtra between 2001 and 2011.The present study was conducted as a cross-sectional questionnaire based study in clinics of participating doctors in a district in tribal region of central India. With the help of pre-validated questionnaire the knowledge and perception of registered gynaecologists were noted regarding the recent abortion laws.72% respondents were aware of the recent amendments in abortion laws but surprisingly only 54% participants have successfully enumerated them and 28% participants were unaware of the recent amendments in the Act.Only 24% participants said that amendments in MTP act was very good but still 12% doctors believed that there is a scope for further amendments.According to 64% participants the PCPNDT Act is acceptable but 12% said record keeping is very difficult and 6% felt that it needs lots of amendments.Majority of the respondents were aware about the MTP & PCPNDT Acts, surprisingly only 54% participants have successfully enumerated them. According to only 24% participants recent amendments was good, According to 12% they were necessary but still 12% believed that there is a scope for further amendments.

Today we see that yoga is being applied in not less than 20 fields quite successfully including other sports like Kabaddi then why not other sports. Remarkably it is also true that many top sports stars are already practicing yoga postures and taking the best advantage. Cricket is long duration playing game which needs mentally strong and tough players to win matches and championships. Due to paramount importance of mental toughness in sports and particular in cricket that present paper focused to compare. Yoga has both preventive and therapeutic benefits. It has been shown to offer both physical and mental benefits to the body and the mind. , the present study was based on a pre-test, post-test design, a total of 100 male subjects were randomly selected from various colleges of Agra university. The subjects were College level batsman, with minimum 5 years of playing experience. The age of the subjects ranged between 20 to 22 years, the mean age was found to be 20.8 years. A pre test was taken of all the selected sports persons on the selected variables of Attention level and stress level, thereafter a yogic Asana program was implemented for 8 weeks and a post test is taken. For the collection of the data mental toughness was checked by Dr. Alan Goldberg (2004) Mental Toughness Questionnaire and stress questionnaire developed by Dave Hompes (2001) were selected. . The collected data was analyzed by computing descriptive statistics followed paired sample t test. A significant difference has been found in the pre and post test values of mental toughness and stress level of the Cricket players due to the yogic practice.

Increased mortality has been observed in patients who develop acute kidney injury (AKI) in the setting of coronavirus disease 2019 (COVID-19), which has led to the approval of extracorporeal kidney support by the FDA. We analyzed the existing literature to compare the efficacy and therapeutic benefits of various extracorporeal modalities for the oXiris membranes and CytoSorb cartridge in high-flow continuous kidney replacement therapy (HFCKRT). AKI due to COVID-19 is mediated by a state of systemic inflammation (cytokine storm syndrome), leading to multiple organ dysfunction. Although there is no consensus on a protocol for providing kidney support therapy, clinically oriented studies have shown the capacities of oXiris and CytoSorb filters to effectively filter out pro-inflammatory components, leading to improved clinical outcomes in critically ill patients. In this review, we study the development of cytokine storm syndrome, important clinical evidence regarding the roles of various adsorption techniques in kidney support therapy in this setting, and a protocol influenced by FDA recommendations for oXiris and CytoSorb membranes.

No previous studies have investigated how political measures, opinions and views of people with dual diagnoses, organisational requirements and professional values are purposefully communicated, mediated and/or integrated in digital records in mental health care. It remains unclear how health records function as both clinical vehicles for documentation, audit and quality assurance in patient care as well as political vehicles of power to articulate and reproduce idealised relations among actors and their roles in mental health. Informed by Bacchi's 'What's the problem represented to be' (WPR) approach, we consider how problems of dually diagnosed persons with co-occurring mental health conditions and drug use (DDPs) are represented and how the tools required to fix the patients' problems are communicated and legitimised in 10 digital health records consisting of 3830 pages of data. In the discussion, we distinguish their multiple purposes by discussing how their structure is shaped by broader discourses in health care. Then, we consider how the structure of records delineates professionals' autonomy, discretionary action and service provision in ways that limit possibilities for including mental health patients' experiences and exclude service users' voices from care planning.

Hydatidiform mole (HM) is an abnormal human pregnancy characterized by excessive growth of placental trophoblasts and abnormal early embryonic development. Following a first such abnormal pregnancy, the risk for women of successive molar pregnancies significantly increases. To date variants in seven maternal-effect genes have been shown to cause recurrent HMs (RHM). NLRP7 is the major causative gene for RHM and codes for NOD-like receptor (NLR) family pyrin domain containing 7, which belongs to a family of proteins involved in inflammatory disorders. Since its identification, all NLRP7 variants have been recorded in Infevers, an online registry dedicated to autoinflammatory diseases (https://infevers.umai-montpellier.fr/web/). Here, we reviewed published and unpublished recessive NLRP7 variants associated with RHM, scored their pathogenicity according to the American College of Medical Genetics classification, and recapitulated all functional studies at the level of both the patients and the conceptions. We also provided data on further variant analyses of 32 patients and genotypes of 36 additional molar pregnancies. This comprehensive review integrates published and unpublished data on NLRP7 and aims at guiding geneticists and clinicians in variant interpretation, genetic counseling, and management of patients with this rare condition.

With rapid advancements in the technology, almost all the devices around are becoming smart and contribute to the Internet of Things (IoT) network. When a new IoT device is added to the network, it is important to verify the authenticity of the device before allowing it to communicate with the network. Hence, access control is a crucial security mechanism that allows only the authenticated node to become the part of the network. An access control mechanism also supports confidentiality, by establishing a session key that accomplishes secure communications in open public channels. Recently, blockchain has been implemented in access control protocols to provide a better security mechanism. The foundation of this survey article is laid on IoT, where a detailed description on IoT, its architecture and applications is provided. Further, various security challenges and issues, security attacks possible in IoT and their countermeasures are also provided. We emphasize on the blockchain technology and its evolution in IoT. A detailed description on existing consensus mechanisms and how blockchain can be used to overpower IoT vulnerabilities is highlighted. Moreover, we provide a comprehensive description on access control protocols. The protocols are classified into certificate-based, certificate-less and blockchain-based access control mechanisms for better understanding. We then elaborate on each use case like smart home, smart grid, health care and smart agriculture while describing access control mechanisms. The detailed description not only explains the implementation of the access mechanism, but also gives a wider vision on IoT applications. Next, a rigorous comparative analysis is performed to showcase the efficiency of all protocols in terms of computation and communication costs. Finally, we discuss open research issues and challenges in a blockchain-envisioned IoT network.

To examine the feasibility, efficacy, and safety of sustained low-efficiency dialysis (SLED) in hemodynamically unstable, critically ill children.Critically ill patients, 1-18 y old with hemodynamic instability (≥ 1 vasoactive drugs) and severe acute kidney injury (AKI) requiring kidney replacement therapy (KRT) in a tertiary care pediatric intensive care unit were prospectively enrolled. Patients weighing ≤ 8 kg or with mean arterial pressure 5Between November 2018 and March 2020, 18 patients with median age 8.6 y and vasopressor dependency index of 83.2, underwent 41 sessions of SLED. In 16 patients, SLED was feasible within 12 h of indication. No session was terminated prematurely. Ultrafiltration achieved was 4.0 ± 2.2 mL/kg/h, while URR was 57.7 ± 16.2% and eKt/V 1.17 ± 0.56. Hemodynamic scores did not change significantly. Asymptomatic hypokalemia was the chief adverse effect. Sessions were associated with a significant improvement in indices on ultrasound and left ventricular function. Fourteen patients died.SLED is feasible, safe, and effective in enabling KRT in hemodynamically unstable children with severe AKI.

Objective: To compare the buccolingual inclination of maxillary and mandibular posterior teeth among Angle’s Class I, Class II div 1 and class II div 2 malocclusion. Materials and methods: The sample comprised lateral Cephalometric radiographs and Dental Casts of 90 subjects in the age group of 15-25 years. The sample was divided into 3 groups of 30 samples each. The first group comprised of records from 5 female and 25 male subjects with an average age of 20.67 years and showing Class I malocclusion. The second group comprised of records from 12 female and 18 male subjects with an average age of 20.03 years having Class II division 1 malocclusion and the third group of 18 male and 12 female subjects with an average of 20.63-years showing class II div 2 malocclusion. Results: Similar buccolingual inclination was seen in Class II div 1 and div 2 malocclusions for both maxillary and mandibular at premolar and molars. The buccolingual inclination in maxillary arch was found to be lowest in class I malocclusion for all the posterior teeth.

Short bowel syndrome (SBS) of infancy is a cause of prolonged morbidity with intolerance to enteral feeding, specialized nutritional needs, and partial/total dependence on parenteral nutrition. These infants can benefit from individualized nutritional strategies to support and enhance the process of intestinal adaptation. Early introduction of enteral feeds during the period of intestinal adaptation is crucial, even though the enteral feedings may need to be supplemented with an effective, safe, and nutritionally adequate parenteral nutritional regimen. Newer generation intravenous lipid emulsions can be effective in preventing and treating intestinal failure-associated liver disease. Prevention of infection(s), pharmaceutical interventions to enhance bowel motility and prevent/mitigate bacteria overgrowth, and specialized multidisciplinary care to minimize the injury to other organs such as the liver, kidneys, and the brain can assist in nutritional rehabilitation and lower the morbidity in SBS.

BACKGROUND: Solid small renal masses (SRMs, ≤4 cm) represent benign and malignant tumors. Among SRMs, clear cell renal cell carcinoma (ccRCC) is frequently aggressive. Compared to invasive percutaneous biopsies, a proposed clear cell likelihood score (ccLS) aims to diagnose ccRCC non-invasively using multiparametric MRI (mpMRI), but lacks external validation. PURPOSE: To evaluate the performance of and interobserver agreement for ccLS to diagnose ccRCC among solid SRMs. MATERIALS AND METHODS: This retrospective, multicenter, cross-sectional study included patients with consecutive solid (≥25% approximate volume enhancement) SRMs undergoing mpMRI between December 2012 and December 2019 at five academic medical centers with histological confirmation of diagnosis. Masses with macroscopic fat were excluded. After a 1.5-hour training session, two abdominal radiologists per center independently rendered a ccLS for 50 masses. The diagnostic performance for ccRCC was calculated using random-effects logistic regression modeling. The distribution of ccRCC by ccLS was tabulated. Interobserver agreement for ccLS was evaluated with Fleiss Kappa. RESULTS: 241 patients (mean±SD age, 60 ± 13 years, 174 men) with 250 solid SRMs were evaluated. The mean ±SD size was 25±8 mm (range 10–39 mm). 48% (119/250) of SRMs were ccRCC. The sensitivity, specificity, and positive predictive value for the diagnosis of ccRCC (95% CI) when ccLS≥4 were 75% (68%, 81%), 78% (72%, 84%), and 76% (69%, 81%), respectively. The negative predictive value of ccLS≤2 was 88% (81%, 93%). The percentages of ccRCC according to the ccLS were 6% (range, 0%–18%), 38% (range, 0%–100%), 32% (range, 18%–53%), 72% (range, 20%–100%), and 81% (range, 50%–100%) for ccLS 1–5, respectively. The mean interobserver agreement was moderate (Kappa=0.58 [95% CI: 0.42, 0.75]). CONCLUSION: The clear cell likelihood score applied to multiparametric MRI had moderate interobserver agreement and differentiated clear cell renal cell carcinoma from other solid renal masses with a negative predictive value of 88%. SUMMARY: Clear cell likelihood scores provide a framework for standardized multiparametric MRI assessment of solid small renal masses with moderate diagnostic accuracy for clear cell renal cell carcinoma.

Introduction: Infertility is best defined as the inability to conceive after one year of unprotected regular intercourse or many couples, infertility and its treatment cause a serious strain on their interpersonal relationship, and cause disturbed relationships with other people. Diagnostic laparoscopy is generally not a part of initialinfertility evaluation, however, number of reports haveshown that it is effective procedure for evaluation of long- term infertility. Materials and Methods: A total of 207 patients were studied from at GMCH, Gondia, Maharashtra. Total 207 patients had primary/secondary infertility and 5 patients had primary amenorrhea were selected for study. Uterus, ovaries, tubes and cul de sac were inspected and findings noted. Next chromopertubation test was done with 10-15 ml of 1% aqueous methylene blue via the leech-Wilkinson cannula was inserted and findings noted and statistical Analysis was done. Results: India showed the mean age of infertility was 28.4years. 81.16% subjects had primary whereas 16.43% had secondary infertility. In the present study maximum 165 (79.7%) had normal size uterus. Out of which 8 (3.86%) had bicornuate uterus.6.28% subjects had large size uterus. Out of which 5.80% had fibroid and 0.48% had adenomyosis. Conclusion: Diagnostic Laparoscopy and hysteroscopy is a better modality for diagnosing uterine, tubal and ovarian causes of infertility compared to hysterosalpingography and ultrasonography. Most of the patients had normal ultrasonographic, hysterosalpingographic and laparoscopic findings. Out of the rest, Structural adhesions were the most common cause of infertility among women in reproductive group. Keywords: HSG, Infertility, Laproscopy in infertility.

Introduction: Preterm birth is a major cause of death and a significant cause of long-term loss of human potential amongst survivors all around the world. Complications of preterm birth are the single largest direct cause of neonatal deaths, responsible for 35% of the world’s 3.1 million deaths a year, and the second most common cause of under-5 deaths after pneumonia. In this study, an attempt has been made to evaluate the usefulness of cervical assessment by TVS in prediction of risk of preterm delivery in low risk pregnant women, thereby earlier management option can be planned and patients specific treatment can be given at the earliest. Materials and Methods: The present study was carried out in tertiary care teaching hospital for 1 year from 1 Jan 2019 to 31 Dec 2019. Total of 100 study participants who underwent TVS assessments of cervix regularly followed up who underwent TVS assessment of cervix and were regularly follow up and delivered. Result: The mean cervical length in all these women was 30±6.68 mm. It was observed that 51.72% of patients with short cervical length less than 25 mm had preterm labour compared to the patients with cervical length more than 25mm i.e. 4.22%. Conclusion: Cervical assessment by TVS is effective in predicting preterm labour. Keywords: Preterm labor, Cervical length, Trans-vaginal sonography.