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Background: There is a paucity of data regarding the consequences of coronavirus disease 2019 (COVID-19) infection in patients with maintenance hemodialysis (MHD). Our objective was to identify the clinical manifestations and prognostic factors and to assess the impact of treatment schemes on the outcome. Materials and methods: Here we present retrospectively collected data from medical records of patients on MHD hospitalized with COVID-19 infection from 1st June to 30th November 2020. Result: Around 69 patients were admitted with a median age of 51 years. About 81% had hypertension, 41% had diabetes, and 24% had body mass index (BMI) ≥ 23 kg/m2 . Of all who died, 73.33% had dialysis vintage of

Diabetic retinopathy (DR) is considered one of the leading causes of vision loss globally. It principally causes upregulation of pro-angiogenic, proinflammatory, and vascular permeability factors such as vascular endothelial growth factor (VEGF), leading to neovascularisation. The advanced stage of DR or proliferative diabetic retinopathy (PDR) is of more concern, as it leads to vitreous haemorrhage and traction retinal detachment. Various risk factors associated with PDR include hyperglycemia, hypertension, neuropathy, dyslipidemia, anaemia, nephropathy, and retinal complications of drugs used for diabetes. Current management approaches for PDR have been stratified and involve pan-retinal photocoagulation, vitrectomy, and anti-VEGF agents. Given the emerging role of anti-VEGF agents as a favourable adjunct or alternative therapy, they have a critical role in the management of PDR. The review emphasises current management approaches for PDR focusing on anti-VEGF therapy. The review also highlights the risk/benefit evaluation of the various approaches employed for PDR management in various clinical scenarios.

Nutrition therapy during critical illness has been a focus of recent research, with a lot of publications accompanied by two updated international clinical guidelines. There have been many trials with conflicting results making the translation of this evidence into practice challenging. This review article aims to provide clinicians with a comprehensive summary of the latest nutritional practices in critically ill patients.

Many studies are conveying the potential of nature-based solutions (NBS) like forests and wetlands to improve the quality of air and water. However, for practical realization of these benefits with...

Background: To understand the clinical practice pattern of general ophthalmologists in the management of retinal diseases. Also, aimed to explore the ophthalmologist’s perspective towards patient compliance and unmet need in the management of neovascular age-related macular degeneration (nAMD). Materials and Methods: A total of 108 ophthalmologists participated in this cross-sectional questionnaire-based survey. A paper-based questionnaire with a tool of twelve questions, with response options ranging on a five-point Likert scale of ‘strongly agree’ to ‘strongly disagree’ was provided to participants. Results: Out of 108, 95.4% ophthalmologists confirmed that they were commonly consulted for nAMD amongst the different retinal disorders (RDs). The majority of respondents (87%) confirmed that 60% or fewer patients continue the treatment for a year. About 81.5% of ophthalmologists stated that fluid (Intra-retinal fluid, Sub-retinal fluid) on optical coherence tomography (OCT) was an extremely important parameter for disease activity. The survey revealed that injection frequency was the factor for non-compliance in majority of (>50%) patients. More than 64% of respondents opined that improved efficacy (70.4%), reduced treatment burden (64.8%), and longer acting agents/sustained delivery (64.8%) are the most critical unmet needs for nAMD patients. Conclusion: Based on the findings, it can be concluded that, in addition to functional outcomes i.e. visual acuity, ophthalmologists also considered retinal fluid and central retinal thickness as important parameters for treatment-related decisions. Ophthalmologists suggested that there is a need to develop longer-acting agents with improved efficacy which may help in reducing treatment burden in nAMD management. Key Message: Longer acting anti-vascular endothelial growth factor (VGEF) agents with improved efficacy may help in reducing the treatment burden in nAMD management. Keywords: Neovascular age- related ma

Background Macular edema secondary to retinal vein occlusion (RVO) is an important cause of loss of vision. Intravitreal injections (IVI) of anti-vascular endothelial growth factor (VEGF) are the standard of care in this disease, as shown in numerous randomized controlled trials. The purpose of this study was to study the efficacy and safety of ranibizumab, an anti-VEGF agent, in the real-world setting. Methods This was 48 weeks, open-label, prospective, multicentre, observational study. Patients diagnosed with ME secondary to RVO were treated with IVI of Ranibizumab 0.5 mg in real-world conditions. Efficacy was measured by improvement seen in best-corrected visual acuity (BCVA) in terms of Early Treatment of Diabetic Retinopathy Study (ETDRS) Letter Scores and change in central retinal thickness (CRT) measured by optical coherence tomography. Results One hundred eyes of 100 patients (79 with branch retinal vein occlusion and 21 with central retinal vein occlusion) were recruited in the study. The mean (standard deviation, SD) BCVA was 52.8 (21.99) letters at baseline and 62.3 (24.40) letters at week 48. From baseline, there was a significant improvement in BCVA by 7.7 letters (p = 0.001) at 48 weeks. The mean (SD) of CRT was 479.9 (216.25) μm at baseline and it decreased significantly to 284.9 (171.35) μm at week 48 (p Conclusions Ranibizumab is well tolerated and effective in treating macular edema secondary to RVO in real-world clinical settings. However, there is under-treatment compared to controlled clinical trials, and the gain in vision is sub-optimal with under-treatment. Trial registration Clinical Trials Registry - India: CTRI/2015/07/005985.

Introduction: In India, there have been only few published studies of Parkinson’s disease (PD) showing a wide range of prevalence. We conducted this study to determine the prevalence of PD in the rural population of Gujarat, in the western region of India. Methods: This cross-sectional descriptive study was conducted in the villages of Anand, a district of Gujarat, India, between September 2019 and February 2020. This study used a multistep approach including a screening questionnaire and video recording followed by clinical examination by a neurologist, laboratory evaluation, and brain imaging to evaluate patients with PD. Results: A total population of 18,896 was screened. The overall crude prevalence of PD was 42.3 per 100,000, and the prevalence over the age of 60 was 308.9 per 100,000 which showed the trend of increasing disease prevalence with age. Their mean duration of illness was 39.3 ± 27.3 months, and more than half of patients with PD had multiple associated nonmotor symptoms and nearly one-third had comorbid anxiety or depression. Environmental factors are important in the pathogenesis of PD, but there was no clear association between patients with PD and certain variables including consumption of well water, exposure to pesticides or other toxins, smoking cigarettes, and drinking alcohol or coffee in our study. Conclusions: The present study showed the current epidemiological data of PD from Gujarat, in western India. Further studies across different regions in India need to be encouraged for better understanding of PD prevalence in the Indian population.

Post weld heat treatment (PWHT) is applied to welded pressure vessels and piping to relieve residual stress built up during welding. During the PWHT, pressure vessel made of carbon steel is heated up to a minimum temperature of 595 °C for a holding period as required based on the thickness (Refer ASME Section VIII, Division 1, UCS 56) [1]. However, for equipment susceptible to carbonate stress corrosion cracking, PWHT is required irrespective of thickness at a temperature range of 649 °C to 663 °C as per WRC 452 [2]. A process column built in 1983 and operating in carbonate stress corrosion cracking environment was observed to have widespread corrosion under insulation at reboiler supports. Material of construction for the column was SM41B (Japanese Industry Standards Carbon Steel). Four Insert plates of various sizes were welded at same circumferential band during turnaround. The insert plate repair sizes were relatively large. Local PWHT was required to be performed with the equipment in vertical condition. Due to risk of uneven temperature distribution and resultant local thermal stresses, spot PWHT or Bulls-eye method of PWHT was not considered. Full circumferential local PWHT was considered for this equipment. During the actual PWHT process, localized overheating occurred, and some areas of deformation were observed in the equipment. A multi discipline review was performed to understand the root cause of the localized overheating and subsequent deformation. This paper describes the methodology and results of the fitness-for-service (FFS) assessments that were performed based on API 579-1/ ASME FFS-1, 2016 [3] to assess the integrity of the column. Based on the assessment performed, the equipment was found to be fit for service and continued safe operations.

Microstrip patch array antennas are widely used in satellite communication, because of its advantages compared to the conventional antennas. Literature study of previous years of patch array antenna (PAA) shows that several techniques were used for making the small size of patch array antenna. This paper presents the micro strip array antenna 2x2 operating at 12 GHz with a bandwidth equal to 693.6 MHZ (5.9 %), a gain equal to 8.98 dB, directivity equal to 10.83 dB and finally an efficiency equal to 83 %. A 2x2 linear array is designed for line feeding, the substrate used is FR4 with a thickness of 1.6mm and a dielectric constant of 4.4. This array antenna is made for satellite communication, X-band applications, and KU applications. The antenna array is designed by using HFSS 12 (High Frequency Structure Simulator) and also the simulation has been done by the same software.

Cohenâ s Kappa (confidence intervals) between algorithm predictions for adult automated assignment deaths (NÂ =â 4393). (DOCX 19 kb)

Cause of death counts, proportions, and rankings for child and neonate age groups with dual physician coding of the automated arm. (DOCX 27 kb)

Mean population-level concordance (%) comparison of verbal autopsy methods using non-randomized study data, by algorithm. (DOCX 111 kb)

Summary of cause list matches between all algorithm results and the cause of death categories used in this study. (DOCX 19 kb)

Comparison of population-level concordance in cause of death assignment for adults predicted between different algorithms for the automated assignment arm. (DOCX 19 kb)

Background Verbal autopsies with physician assignment of cause of death (COD) are commonly used in settings where medical certification of deaths is uncommon. It remains unanswered if automated algorithms can replace physician assignment. Methods We randomized verbal autopsy interviews for deaths in 117 villages in rural India to either physician or automated COD assignment. Twenty-four trained lay (non-medical) surveyors applied the allocated method using a laptop-based electronic system. Two of 25 physicians were allocated randomly to independently code the deaths in the physician assignment arm. Six algorithms (Naïve Bayes Classifier (NBC), King-Lu, InSilicoVA, InSilicoVA-NT, InterVA-4, and SmartVA) coded each death in the automated arm. The primary outcome was concordance with the COD distribution in the standard physician-assigned arm. Four thousand six hundred fifty-one (4651) deaths were allocated to physician (standard), and 4723 to automated arms. Results The two arms were nearly identical in demographics and key symptom patterns. The average concordances of automated algorithms with the standard were 62%, 56%, and 59% for adult, child, and neonatal deaths, respectively. Automated algorithms showed inconsistent results, even for causes that are relatively easy to identify such as road traffic injuries. Automated algorithms underestimated the number of cancer and suicide deaths in adults and overestimated other injuries in adults and children. Across all ages, average weighted concordance with the standard was 62% (range 79–45%) with the best to worst ranking automated algorithms being InterVA-4, InSilicoVA-NT, InSilicoVA, SmartVA, NBC, and King-Lu. Individual-level sensitivity for causes of adult deaths in the automated arm was low between the algorithms but high between two independent physicians in the physician arm. Conclusions While desirable, automated algorithms require further development and rigorous evaluation. Lay reporting of deaths paired with physician COD assignment of verbal autopsies, despite some limitations, remains a practicable method to document the patterns of mortality reliably for unattended deaths. Trial registration ClinicalTrials.gov, NCT02810366. Submitted on 11 April 2016.

Debranched unacetylated and acetylated potato starches with two degrees of substitution, 0.041 (low) and 0.078 (high), combined with or without β-amylase hydrolysis were prepared to form soluble and insoluble complexes with stearic acid. The effects of modifications on the complexation, thermal properties, and X-ray patterns of soluble and insoluble complexes were investigated. Acetylation decreased the recovery of insoluble complexes but increased that of soluble complexes. Low acetylated, β-amylase-treated starch had a significantly increased amount of complexed stearic acid (123.1 mg/g) for insoluble complexes; high acetylated, β-amylase-treated starch had the highest complexed stearic acid (61.2 mg/g) for the soluble complexes. The melting temperature of the complexes decreased with acetylation. All β-amylase-treated acetylated complexes displayed the V-type diffraction pattern with peaks at 2θ = 7.4°, 12.9°, and 20°. These results suggest that starch can be modified by acetylation, debranching, and/or β-amylase to produce significant quantities of soluble starch-stearic acid complexes.

Recent studies have shown that a 20 % trans,trans conjugated linoleic acid (CLA)-rich soy oil significantly reduces heart disease and diabetes risk factors in obese rats. Furthermore, trans,trans-CLA has been reported to have superior anti-carcinogenic activity than other CLA isomers. Therefore, a more concentrated source of trans,trans-CLA oil would be highly desirable. The objectives of this study were to (1) determine the yield of trans,trans-CLA isomers resulting from photo-irradiation of Tonalin® (BASF Global, Florham Park, NJ, USA) and identify trans,trans-CLA positional isomers; and (2) derive a mathematical model of kinetics of trans,trans-CLA TAG formation from Tonalin®. Fifty-five percent trans,trans-CLA rich oil was obtained in about 140 min when Tonalin® was photo-isomerized with 0.35 % iodine, which is almost three times more than is possible with photo-isomerized soy oil. Photo-isomerization of Tonalin® requires about 2 h, compared to 12 h for photo-isomerization of soy oil. This reaction is a first-order reversible reaction with the forward rate constant (k f) = 13.17 × 10−3min−1 and backward rate constant (k b) = 5.334 × 10−3min−1. The major isomers identified were trans-9,trans-11- and trans-10,trans-12-CLA.

Dear Sir: Predominant isomers of conjugated linoleic acid (CLA), cis-9,trans-11 and trans-10,cis-12 have been shown to improve body composition. In addition, there is preliminary evidence showing that these CLA isomers lower the risk of heart disease and cancer. Recently, trans,trans (t,t) CLA have been shown to decrease LDL cholesterol and liver lipids levels in obese rats. They have also been shown to act as a potent anti-carcinogen in mouse and rat models. However, the lack of commercial availability of t,t CLA isomers has limited its food use, particularly as foodoil triacylglycerides. Furthermore, there is little information on the health benefits of t,t isomers in vivo. This letter reviews the importance of t,t CLA, an overlooked CLA isomer.

A heterogeneous catalysis method to produce 20 % conjugated linoleic acid (CLA)-rich food-grade soy oil in 2 h without solvents or gases was recently developed. The objective of this study was to produce and characterize CLA-rich soy oil margarine relative to a soy oil control and commercial margarine. CLA-rich soy oil was used to prepare margarine. The samples were characterized for firmness, rheology, thermal behavior, solid fat content (SFC) and microstructure and compared with a soy oil control and commercial margarine. The CLA-rich oil margarine firmness and rheological properties were similar to commercial margarine and provided a better texture relative to the soy oil control margarine. However, SFC, droplet size distribution and melting behavior of CLA-rich oil margarine were similar to control soy oil margarine and dissimilar to the commercial product. This suggests that hardness and rheological properties of margarine are not solely dependent on SFC and melting behavior. Lipid composition, polymorphism and microstructure differences in CLA-rich oil margarine may play an important role on the texture and rheological properties. A 7-g typical serving of the CLA-rich oil margarine will provide 0.6 g CLA. Thus five servings will provide 3.2 g/day of CLA and 185 calories/day, which is well within the maximum recommended 700–980 fat calories/day.

A ~20% CLA-rich soy oil with low saturated fat and no cholesterol was produced by photoisomerizing soy oil linoleic acid. The oil is predominately trans,trans CLA, with the oil containing 17% trans,trans CLA. Recent studies have shown that trans,trans CLA-rich soy oil significantly reduces heart disease and diabetes risk factors in obese rats. However, the positional isomerism of these geometrical isomers has not been identified. The objectives of the study were to determine trans,trans CLA positional isomerism of CLA fatty acids in CLA-rich soy oil and determine the resolution of trans,trans CLA positional isomers by silver ion chromatography. GC–MS studies of 4-phenyl-1,2,4-triazoline-3,5-dione (PTAD) derivatives of CLA-rich oil showed that 9,11 CLA and 10,12 CLA were the major positional isomers. These were hypothesized to be the trans,trans CLA isomers, which was confirmed by silver ion chromatography and subsequent GC–FID fatty acid and ATR-FTIR geometrical isomer analysis of the collected fractions. The identification of 9,11 trans,trans CLA and 10,12 trans,trans CLA as the major CLA isomers in CLA-rich oil then allowed the deduction of the synthetic mechanism of the photoisomerism of soy oil linoleic acid to trans,trans CLA.

Malnutrition among 0-6 years is an impending problem, especially among economically backward communities in urban India. In an attempt to alleviate malnutrition, within the target community, the Foundation for Mother and Child, India, prepared a special food supplement, using cheap and locally available resources. A brief evaluation study was conducted to evaluate the impact of this food supplement on improvement in parameters like weight, height, and mental abilities among the participants. The study was conducted between August 2010 to October 2010 (n=51), with the participants divided in four different age groups. The height and weight parameters were compared to ICMR standards for the age to understand the impact of the program. The mean improvement in height was 0.84 cms (SD-0.6) while the mean improvement in weight was 0.57 kgs (SD-0.8). A significant variance was observed due to different consumption levels of the supplement and differing levels of under-nutrition. A strong correlation was observed between the consumption level and the improvement in height and weight parameters. In addition, a positive correlation was observed between the extent of deviation from ICMR standards and levels of improvement in height and weight parameters. No differential in terms of gender was observed within the community. No significant findings were observed with reference to improvement in mental ability, primarily as the study duration was short. The study has laid the roadmap for a larger and multifaceted study to be conducted to critically evaluate the effectiveness of the nutritional supplement.

This research paper attempts to collate literature from various sources, in an attempt to answer three pertinent questions related to healthcare in India. Firstly, what is it meant by ‘private sector’ in healthcare delivery system of India, secondly how has the private sector evolved over the decades and what has been the role of the government in propelling the growth. Finally, the paper tries to highlight some of the factors that have promoted the growth of private sector in India with specific reference to quality of medical care. The paper explicitly indicates that the deficiencies in the public health delivery system of India, was the key to growth of private infrastructure in healthcare.The shift of hospital industry for ‘welfare orientation’ to ‘business orientation’ was marked by the advent of corporate hospitals, supported by various policy level initiatives made by the government. Today, there are over 20 international healthcare brands in India with several corporate hospitals.However, a large section of the ‘private healthcare delivery segment’ is scattered and quality of medical care continues to remain a matter of concern. This paper tracks the various government initiatives to promote private investment in healthcare and attempts to explore the reasons for preference of the private sector. Surprisingly, in contrast to contemporary belief, quality of medical care doesn’t seem to be the leading cause for preference of the private sector. Except for a few select corporate and trust hospitals, quality of medical care in private sector seems to be poor and at times compromised.

This research paper attempts to collate literature from various sources, in an attempt to answer three pertinent questions related to healthcare in India. Firstly, what is it meant by ‘private sector’ in healthcare delivery system of India, secondly how has the private sector evolved over the decades and what has been the role of the government in propelling the growth. Finally, the paper tries to highlight some of the factors that have promoted the growth of private sector in India with specific reference to quality of medical care. The paper explicitly indicates that the deficiencies in the public health delivery system of India, was the key to growth of private infrastructure in healthcare. The shift of hospital industry for ‘welfare orientation’ to ‘business orientation’ was marked by the advent of corporate hospitals, supported by various policy level initiatives made by the government. Today, there are over 20 international healthcare brands in India with several corporate hospitals. However, a large section of the ‘private healthcare delivery segment’ is scattered and quality of medical care continues to remain a matter of concern. This paper tracks the various government initiatives to promote private investment in healthcare and attempts to explore the reasons for preference of the private sector. Surprisingly, in contrast to contemporary belief, quality of medical care doesn’t seem to be the leading cause for preference of the private sector. Except for a few select corporate and trust hospitals, quality of medical care in private sector seems to be poor and at times compromised.

Nowadays, Wikis are used as a tool to for collaborative writing and editing of documents. However, typical Wikis do not adequately address the assessment of individual contributions. To improve these aspects, we propose ClassroomWiki---a web-based collaborative Wiki writing tool. For the students, ClassroomWiki provides a web interface for writing and revising their group's Wiki and a topic-based forum for discussing their ideas during collaboration. When the students collaborate, ClassroomWiki tracks all student activities and builds detailed student models that represent their contributions toward their groups. For the teacher, ClassroomWiki provides a multiagent framework that uses the student models to form student groups to improve the collaborative learning of students. ClassroomWiki can improve the collaborative learning outcome of the students by its group formation framework and help the teacher better assess a student's contribution toward his or her group. It facilitates specific and precise teacher intervention with accurate and detailed tracking of student activities.

This paper presents charge sampling circuit using new high linearity transconductor (Gm) cell that has third order distortion cancellation. The proposed Gm-cell has almost constant transconductance value over ±200mV input voltage range. The charge sampling circuit has SNDR around 73 dB with ENOB of 11bits and it consumes 4.38mW power. Its input referred noise is 15.29nV/√Hz and noise figure is 24.67dB at 81MHz. This architecture is used to implement a programmable analog baseband filter for Bluetooth and UMTS. Simulations were carried out using the TSMC 0.18 µm CMOS technology with supply voltage of 1.6V.

Cause of death categories with corresponding ICD-10 codes. (DOCX 23 kb)

Implementation of automated assignment algorithms. (DOCX 26 kb)

Summary of limitations of PHMRC data. (DOCX 22 kb)

Percent of deaths by cause from the standard (physician assignment) arm compared to deaths (2010â 2013) in the Indian Million Deaths Study in the trial state by age groups. (DOCX 286 kb)

Cause of death categories with corresponding ICD-10 codes. (DOCX 23 kb)

Original study protocol. (DOCX 21 kb)

Cause of death counts, proportions, and rankings for child and neonate age groups with dual physician coding of the automated arm. (DOCX 27 kb)

Percent of deaths by cause for adults (12–69 years) and children (0–4 years) in the Indian Million Death Study (2001–2013) compared to deaths in the 3% Million Death Study resample. (DOCX 254 kb)

Percent population-level concordance in cause of death distribution between algorithms of the automated assignment deaths, by age groups. (DOCX 20 kb)

Percent of deaths by cause for adults (12–69 years) and children (0–4 years) in the Indian Million Death Study (2001–2013) compared to deaths in the 3% Million Death Study resample. (DOCX 254 kb)

Study method details. (DOCX 19 kb)

Cause of death counts, proportions, and rankings for adults with dual physician coding of the automated arm. (DOCX 27 kb)

Percent of sub-study deaths by cause from lay surveyor versus physician collected adult verbal autopsies. (DOCX 188 kb)

Geographic and age distribution of deaths below age 70â years used in analyses by study group. (DOCX 20 kb)

Cause of death counts, proportions, and rankings for adults with dual physician coding of the automated arm. (DOCX 27 kb)

Implementation of automated assignment algorithms. (DOCX 26 kb)

Original study protocol. (DOCX 21 kb)

Percent population-level concordance in cause of death distribution between algorithms of the automated assignment deaths, by age groups. (DOCX 20 kb)

Statistical tests for comparison. (DOCX 20 kb)

Statistical tests for comparison. (DOCX 20 kb)

Geographic and age distribution of deaths below age 70â years used in analyses by study group. (DOCX 20 kb)