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Abstract The article proposes a novel approach to assess rotor angle stability in microgrids by enhancing the Modified Galerkin Method (MGM), which is based on the Polynomial Approximation, using real-time RFID data acquisition. Due to their reliance on assumptions, traditional rotor angle stability methodologies frequently fail in online transient stability testing. MGM successfully captures the dynamic behavior of microgrids by approximating state variables using a sequence of polynomials and coefficients. Redundant data, like as vibrations or noise signals, can cause delays in defect diagnosis and decrease diagnostic accuracy. This problem is addressed by integrating RFID technology. RFID technology could potentially be used with a hybrid CNN-LSTM model to develop a sophisticated fault diagnostic system. This entails identifying fault characteristics through the use of signal processing techniques and feature extraction methods, such as the Fourier transform and time-domain statistical features. In addition, we use Total Harmonic Distortion (THD) to reduce superfluous data. The suggested techniques significantly increase fault detection efficiency and precision, outperforming existing techniques with a 0.94 classification accuracy. An extensive case study on an IEEE 3-machine 9-bus system is used to illustrate its efficacy, showing observable improvements in fault detection speed and accuracy that make microgrid operations safer and more dependable.

Abstract Therapeutic deep eutectic solvents (THEDES) are a type of deep eutectics that can be used as active pharmaceutical ingredients (APIs) by enhancing the drug bioavailability, by increasing the solubility of APIs in aqueous solutions or by increasing their permeability through biological barriers. In this study, we demonstrate the utility of designer THEDES, based on Quillaja Saponin (SAP), a triterpene natural product to unravel the antimicrobial potential of such THEDES. THEDES were prepared by gently mixing and heating five different α- hydroxy acids- malic, citric, tartaric, glycolic, lactic acids and SAP with water as a third component in the THEDES. The antimicrobial assays were performed with the as-prepared SAP-THEDES and among the panel of bacterial strains, saponin-malic acid THEDES [SMA-THEDES] displayed potent activity in disassembling PA biofilms, demonstrating that the SMA-THEDES can serve as therapeutic antibacterial biomaterials. To further optimize, a Box-Behnken- response surface methodology (RSM) experimental design was done and at the optimum conditions of SAP (1.014 m.mol), Malic acid (1.003 m.mol), Water (0.117 m.mol), SMA-THEDES exhibited maximum MIC of P. aeruginosa with the minimum absorbance at 590 nm of 0.105. The effectiveness of SMA-THEDES as antibiofilm agents on P. aeruginosa with the mechanism studies have been explored. The colony count from the in vivo infection zebrafish model in the treatment group showed a decline of > 2 fold for SMA-THEDES. Toxicity studies did not reveal any abnormality in liver and brain enzyme levels. Liver morphology images show no severe cytological alterations when treated with SMA-THEDES and were almost similar to the normal liver.

Abstract Bacteria invest significant resources into the continuous creation and tailoring of their essential protective peptidoglycan (PG) cell wall. Several soluble PG biosynthesis products in the periplasm are transported to the cytosol for recycling, leading to enhanced bacterial fitness. GlcNAc-1,6-anhydroMurNAc and peptide variants are transported by the essential major facilitator superfamily importer AmpG in Gram-negative pathogens including Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Accumulation of GlcNAc-1,6-anhydroMurNAc-pentapeptides also results from β-lactam antibiotic induced cell wall damage. In some species, these products upregulate the β-lactamase AmpC, which hydrolyzes β-lactams to allow for bacterial survival and drug-resistant infections. Here, we have used cryo-electron microscopy and chemical synthesis of substrates in an integrated structural, biochemical, and cellular analysis of AmpG. We show how AmpG accommodates the large GlcNAc-1,6-anhydroMurNAc peptides, including a unique hydrophobic vestibule to the substrate binding cavity, and characterize residues involved in binding that inform the mechanism of proton-mediated transport.

Introduction The Kayakalp guidelines for public healthcare facilities under the Swachh Bharat Abhiyan (Clean India Mission) focus on improving sanitation, cleanliness, and infection control at public hospitals in India. This study was conducted in a 960-bed tertiary-level teaching hospital in eastern India. Housekeeping has been a challenge in public institutions, with factors like overcrowding and resource constraints. Tobacco and betel nut chewing, spitting, poor sanitation practices, and open urination are major challenges in ensuring sanitation at the hospital. The research objective was to study the implementation of the Kayakalp guidelines for quality improvement in housekeeping services at the institution. Methods A pre- and post-interventional study was conducted using the Plan-Do-Check-Act (PDCA) quality tool. Plan phases included the gap assessment using the Kayakalp checklist with numerical scoring. Necessary interventions were done under three headings: structure, processes, and outcomes in the “Do” phase. The “Check” phase included monitoring of the activities followed by the “Act” phase, which included a review of the action plan. External experts nominated by the government conducted the final assessments and recommended it as one of the cleanest hospitals. Results A 360-degree improvement was observed in hospital services, with assessment score improvement from 73.68% to 95.0%. The institution received the first prize in 2020 and 2021 and runners-up Kayakalp National Award under category “B” (Institute of National Importance) Hospitals in 2019. Conclusion The implementation of Kayakalp guidelines of the Government of India proved to be efficient in the improvement of housekeeping and infection control practices in the institution.

The paper aims to introduce some fixed point results in the setting of sequential compact b-metric spaces to prove Eldeisten-Suzuki-type contraction for self-mappings‎. ‎These contributions extend the existing literature on fixed point for ordered metric spaces and fixed point theory‎. ‎Through illustrative examples‎, ‎we showcase the practical applicability of our proposed notions and results‎, ‎demonstrating their effectiveness in real-world scenarios‎.

Abstract While the proliferation of the Internet of Things (IoT) has revolutionized several industries, it has also created severe data security concerns. The security of these network devices and the dependability of IoT networks depend on efficient threat detection. Device heterogeneity, computing resource constraints, and the ever-changing nature of cyber threats are a few of the obstacles that make detecting cyber threats in IoT systems difficult. Complex threats often go undetected by conventional security measures, requiring more sophisticated, adaptive detection methods. Therefore, this study presents the Hybrid approach based on the Support Vector Machines Rule-Based Detection (HSVMR-D) method for an all-encompassing approach to identifying cyber threats to the IoT. The HSVMR-D employs SVM to categorize known and unknown threats using attributes acquired from IoT data. Identifying known attack signatures and patterns using rule-based approaches improves detection efficiency without retraining by adapting pre-trained models to new IoT contexts. Moreover, protecting vital infrastructure and sensitive data, HSVMR-D provides a thorough and adaptable solution to improve the security posture of IoT deployments. Comprehensive experiment analysis and simulation results compared to the baseline study have confirmed the efficiency of the proposed HSVMR-D. Furthermore, increased resilience to completely novel changing threats, fewer false positives, and improved accuracy in threat detection are all outcomes that show the proposed work outperforms others. The HSVMR-D approach is helpful where the primary objective is a secure environment in the Internet of Things (IoT) when resources are limited.

Abstract A plausible, but largely unexplored reason for many weed biocontrol agents failing to establish or being ineffective, could involve abiotically induced changes to an invasive plants’ biochemical phenotype and consequent enhanced herbivore resistance. Considerable literature demonstrates that chemically altered plant phenotypes can impair insect life history performance. Heather beetle, (Lochmaea suturalis), introduced to control invasive heather (Calluna vulgaris) in New Zealand (NZ) was difficult to establish and displays variable effectiveness. Using UHPLC-MS non-targeted metabolomics, we analysed primary and secondary metabolites of C. vulgaris from its native range (Scotland) and it’s introduced range (NZ), between which, differences in soil nutrients and ultraviolet light exist. We also explored secondary metabolite variation between sites within each range. New Zealand samples had the highest number of amplified metabolites, most notably defensive phenylpropanoids, supporting the concept of abiotically induced upregulation of key biosynthetic pathways. Analysis of secondary metabolite variation within each range revealed differences between sites but found little correlation of phenylpropanoid levels being influenced by variable soil nutrients. These results validate questions about the possibility of abiotically altered biochemical phenotypes in invasive plants, influencing weed biocontrol agent establishment and effectiveness, and show the potential for metabolomics in assisting future, or retrospectively analysing biological control programmes.

This paper introduces a novel Multi-Level Inverter (MLI) design which utilizes a single input and leverages capacitor voltages source to generate a four-fold increase in output voltage as the main problem that stays with the inverters is their low boost ability and efficiency while maintaining power quality at the same time. One capacitor is charged to match the input voltage magnitude, while the other two capacitors store twice this magnitude. Through a series-parallel combination with switching operations, all capacitors are effectively charged and discharged within each cycle, ensuring natural voltage balance. A comprehensive comparative analysis is conducted to highlight the advantages of this innovative approach, particularly in terms of component reduction and mitigation of voltage stress. Detailed assessment of power losses within the proposed circuit is undertaken, simulation studies are first carried out while extensive experimentation verifies its operational efficiency under diverse conditions such as varying modulation indices, loads, and supply-side fluctuations with an impressive maximum efficiency of 96.9 % at a 200 W power rating, our research contributes to advancing compact power converters, addressing crucial challenges in modern power electronics applications, and paving the way for enhanced performance and reliability in such systems.

The major clinical manifestations of heart failure (HF) are due to fluid retention and congestion, and thus, therapy targeting congestion plays a central role in HF management. Furosemide is by far the most commonly prescribed loop diuretic. However, data primarily derived from observational and small randomized trials point toward potential advantages with torsemide use including improvement in functional status, survival, and hospitalization for HF. The TRANSFORM-HF study aimed to answer a pragmatic query faced by physicians managing HF – Does the choice of loop diuretic matter in HF? There was no benefit of torsemide over furosemide in this large study of >2800 patients for mortality, hospitalization, and quality of life. Though, there were a few shortcomings of the study, the results are in sync with current HF guidelines which do not advocate the use of one loop diuretic or other. Hence, the focus in acute HF should be on optimizing the diuretic dose and other guideline-based therapies rather than the type of diuretics. Recent trials of acetazolamide and other diuretics have shown benefits when used in conjunction with loop diuretics. Since the primary care physician is often the first point of medical contact, the manuscript aims to provide insights into their practice. The message is clear that in acute heart failure, there is no benefit of choosing the type of loop diuretic and impetus should be on adding other class diuretics if needed as well as initiating other guideline-directed medical therapies.

SGLT-2 inhibitors are a class of antidiabetic drugs with additional cardiovascular benefits. Though initially developed for glycemic control, subsequent studies in the heart failure (HF) population also demonstrated positive outcomes. Currently, they are approved for use in HF with both reduced and preserved ejection fraction. More recently, encouraging data have emerged on acute HF. Following an episode of acute myocardial infarction, patients are also at high risk for developing HF and experiencing recurrent events despite optimal therapy. The PARADISE MI study failed to demonstrate any benefits of ARNI in this scenario. The EMMY trial explored the role of SGLT-2i in >450 odds patients with acute MI. At 26 weeks SGLT-2i (empagliflozin) use led to a higher fall in NT-pro-BNP levels compared to standard treatment. There was additional improvement in left ventricular echocardiographic parameters with empagliflozin too. However, it was a small trial, had a short follow-up and there were no clinical endpoints. But none the least, it attested to the safety of SGLT-2i in the post-MI scenario. Because the primary care physician frequently encounters patients in the post-MI scenario, the manuscript provides insights into their practice. Based on contemporary evidence, the universal use of SGLT-2 inhibitors in patients following acute MI is not warranted. A further role of these drugs in post-MI HF will be clarified in ongoing trials.

Context Each year, about 21 million girls aged 15–19 in developing regions experience pregnancy, posing significant challenges for their health, well-being, and economic stability due to its vast impact. Aim To identify the risk factors contributing to teenage pregnancy as compared to Pregnancy in pregnant women in the rural area of the Khordha district with the assessment of their knowledge and, health-seeking behaviour (Contraception and STDs) among teenage and adult pregnant women in the study area. Settings and Design Hospital-based case-control study conducted at Bhubaneswar’s Community Health Centre. Material and Methods The study, conducted from April to July 2022, recruited 138 participants using consecutive sampling and interviewed them using a pretested semi-structured questionnaire. Statistical Analysis Chi-square and logistic regression assessed association and strength. Results Factors contributing to teenage pregnancy include education below high school (AOR = 2.46; 95%CI 0.89–6.79), SC and ST caste (AOR = 2.34; 95%CI 0.94–5.82), having more than three siblings (AOR = 4.45; 95%CI 1.53–12.96), and lack of communication about sexual issues (AOR = 2.84; 95%CI 1.25–6.39). Awareness of contraceptive methods was 34.8% among cases and 56.5% among controls (p = 0.02). Regarding STD awareness and symptoms, 15.2% of cases and 42.4% of controls were knowledgeable and experienced symptoms (p < 0.01). Conclusions This study suggests that factors such as lower education, minority caste, having more than three siblings, and lack of communication about sexual issues contribute to early pregnancy. These findings could enhance existing ARSH platforms by integrating regular engagement and sensitization efforts.

Background Rabies, a zoonotic disease, poses a significant global public health challenge, and post-exposure prophylaxis (PEP) is crucial for prevention. Monoclonal antibodies (mAbs) have emerged as a promising alternative to rabies immunoglobulins due to their high efficacy and standardized manufacturing process. Materials and Methods A prospective, open-label post-marketing surveillance study was conducted with patients of WHO category-III suspected rabid animal bites. TwinRab™, a novel cocktail of docaravimab and miromavimab, was administered at a dosage of 40 IU/kg in and around the wound, along with the anti-rabies vaccine, which was administered intradermal as per Thai Red Cross regimen. Results In this study, 200 subjects received TwinRab™ with a 100% completion rate. Three (1.5%) patients showed solicited local AEs, and two (1%) patients showed solicited systemic AEs, which were resolved after appropriate treatment intervention. The overall tolerability assessment showed positive ratings from doctors (94%) and patients (74%). Conclusion The post-marketing surveillance study demonstrated the safety of TwinRab™ in patients who experienced category-III suspected rabid animal bites, thereby supporting its potential as an alternative option for PEP in the management of animal bite for the prevention of rabies.

Introduction Upper ureteric stricture is always a challenging case to treat for any urologist. Due to chronic inflammation and multiple interventions, it becomes a complex entity to treat. Buccal Mucosal Graft (BMG) Ureteroplasty is a reconstructive surgery used to treat upper ureteric stricture but the results and experience with this modality is less explored so far. We present here our study of 16 cases of BMG ureteroplasty and its outcomes done by the laparoscopic and robotic approaches. Patients and Methods We analysed 16 cases of BMG ureteroplasty, which were performed both laparoscopically and robotically. All these cases were long ureteric strictures, not amenable to excision or endoscopic intervention. We performed using an onlay BMG without complete mobilisation of the ureter. The omentum or nearby fat was used as a bed for onlay BMG. Results All 16 patients underwent onlay ureteroplasty. The reconstructed ureter was wrapped with omentum in nine of the cases, while in seven patients, nearby fat was used. The median stricture length was 5.28 cm, and the median operative time was 143.5 min. The mean operative time was 143.5 min. 15 of 16 (93.75%) cases were successfully clinically and radiologically on follow-up. Conclusion Long-segment upper ureteric strictures are a difficult entity to operate on. BMG ureteroplasty is a safe and effective way of managing such strictures. Robot-assisted ureteroplasty provides the benefits of improved ergonomics, easy manoeuvrability and precision surgery to the patients. Our experience with both laparoscopic and robotic ureteroplasty would encourage urologists all over to use BMG ureteroplasty as an effective long-term procedure for ureteral reconstruction.

Introduction: Retrograde intrarenal surgery (RIRS) is the standard treatment for renal calculi. Direct visualization and fragmentation are its major advantages. The variable stone clearance rates and the ergonomic challenges faced by urologists are a few limitations. Table tilt enhances stone clearance and improves surgical ergonomics by facilitating better access to stones and reducing procedural strain. Subjects and Methods: In this prospective study, patients with intrarenal calculi were randomized into standard lithotomy RIRS (S-RIRS) and table-tilted RIRS (T-RIRS) groups. Specified table tilts were suggested for each of the stone locations. The outcomes with regard to stone clearance, operative and lasing time, and ergonomics were studied. Results: About 100 patients were studied, with 50 in each group. The overall operating time and lasing time in the T-RIRS group were less than that in the S-RIRS group (P < 0.001). The complication rates were the same in both groups. Most surgeons felt that the surgical ergonomics was better in the T-RIRS group (P < 0.001). When stone-free status was analyzed, seven patients in the S-RIRS group and one in the T-RIRS group had residual stones. The mean Borg category-ratio 10 (CR-10) scores in the S-RIRS and T-RIRS groups were 4.18 and 2.20, respectively (P < 0.001). Conclusions: This is the first study to document the distinct advantages of T-RIRS and its benefits on surgical ergonomics. T-RIRS resulted in significantly shorter operative and lasing times, particularly for stones in lower calyces. Surgical ergonomics, assessed by the Borg CR-10 scale, were significantly better in the T-RIRS group. T-RIRS should become a standard of care for patients undergoing RIRS.

Abstract Green nanotechnology offers several possibilities to bridge the nano and sustainability domains and help us achieve the Sustainable Development Goals (SDGs) and address major global concerns. In this review, we detail the fundamentals and applications of GNT toward SDGs goals. This includes energy production, pollution abatement, water treatment, and eco-friendly agricultural practices. The discussion includes challenges related to legal, ethical and safety aspects as well as limits of the technology. Prospects call for collaborative efforts across various disciplines and policy guidelines in bridging eco-friendly nanotechnology with UN SDGs. We hope that the insights provided in this review can help guide future research and policies toward more environmentally responsible practices, improving global environmental stewardship with a special emphasis on nanotechnology. Graphical Abstract

Abstract This paper introduces the design and comprehensive performance evaluation of a novel Multi-Load and Multi-Source DC-DC converter tailored for electric vehicle (EV) power systems. The proposed converter integrates a primary battery power source with a secondary renewable energy source—specifically, solar energy—to enhance overall energy efficiency and reliability in EV applications. Unlike conventional multi-port converters that often suffer from cross-regulation issues and limited scalability, this converter ensures stable power distribution to various EV subsystems, including the motor, air conditioning unit, audio systems, and lighting. A key feature of the design is its ability to independently manage multiple power loads while maintaining isolated outputs, thus eliminating the inductor current imbalance that is common in traditional systems. Experimental validation using a 100 W prototype demonstrated the converter’s ability to deliver stable 24 V and 48 V outputs from a 12 V input, with output voltage deviations kept within ± 1%, significantly improving upon the ± 5% deviations typically seen in existing converters. Furthermore, the system achieved an impressive 93% efficiency under variable load conditions. The modular nature of the converter makes it not only suitable for EV applications but also for a broader range of industries, including renewable energy systems and industrial power supplies. This paper concludes by discussing optimization strategies for future improvements and potential scaling of the technology for commercial use in sustainable energy applications.

Abstract This paper presents a pioneering approach to bolstering network security and privacy by implementing chaotic optical communication with a hybrid optical feedback system (HOFS). The current baseline methods in network security are often less feasible for hybrid feedback systems, including limited robustness, compromised security, and synchronization challenges. Therefore, this paper proposes a hybrid approach to address these shortcomings by integrating the HOFS into chaotic optical communication systems (HOFS-COCS) to overcome the baseline challenges. This paper aims to improve network security while significantly maintaining efficient communication channels. Moreover, We designed two algorithms, one for chaotic maps generation and another for text encryption and decryption, to improve security in the hybrid feedback system. Our findings demonstrate through rigorous experimentation and analysis that the proposed (HOFS-COCS) method significantly improves network security by enabling reliable chaos generation, synchronization, and secure message transmission in chaotic optical communication systems. This research represents a significant advancement towards enhanced secrecy and synchronization in chaotic optical communication systems, promising a paradigm shift in network security protocols.

Abstract Background Strong research capacity and culture (RCC) within professional groups predict engagement in high-quality research and the integration of evidence into practice. However, factors affecting RCC participation and development are currently unknown in Australian Orthopaedic Surgeons. Study design Cross-sectional survey. Methods All Australian Orthopaedic Association members were invited to complete the individual domain of the validated Research Capacity and Culture tool. Results One hundred and sixty-three Australian Orthopaedic Association members (9%) provided survey answers. Survey findings indicated that AOA members scored moderate or high for most RCC domains (14 out of 15). Barriers to the completion of research included a lack of time, other work roles taking priority, and a lack of funds for research. Conclusion The Australian Orthopaedic Association members surveyed in this study demonstrated adequate research skills and experience, although reported they could benefit from additional support securing funding and navigating specific research tasks. Increasing future collaboration with academic institutions and clinician-researcher roles may enhance the output of high-quality orthopaedic research in Australia.

Abstract DC grid fault protection techniques have previously faced challenges such as fixed thresholds, insensitivity to high-resistance faults, and dependency on specific threshold settings. These limitations can lead to elevated fault currents in the grid, particularly affecting multi-modular converters (MMCs) vulnerability to large fault current transients. This paper proposes a novel approach that combines the disjoint-based Bootstrap Aggregating (Bagging) technique and Bayesian optimization (BO) for fault detection in DC grids. Disjoint partitions reduce variance and enhance Ensemble Artificial Neural Network (EANN) performance, while BO optimizes EANN architecture. The proposed approach uses multiple transient periods instead of a fixed time to train the model. Transient periods are segmented into multiple 1 ms intervals, and each interval trains a separate neural network. In this way, a robust local relay is created that does not require high-speed communication systems. Additionally, a discrete wavelet transform (DWT) is applied to select detailed coefficients of the transient fault current, measured at the DC line’s sending terminal for fault protection. EANN is trained in comprehensive offline data that considers noise impact. Simulation results demonstrate the scheme’s ability to detect faults as high as 400 Ω accurately. This makes it a robust, reliable, and effective solution for fault detection on high-voltage direct current (HVDC) transmission lines. Lastly, this research provides the first-ever scientometric analysis of HVDC transmission line fault protection using neural network algorithms, highlighting major research themes and trends. The scientometric analysis was based on a dataset of 136 available research articles from the Scopus database from the last ten years. Therefore, this research provides valuable insights into the use of ANN for HVDC transmission line fault protection.

Abstract We investigate the medium modifications in mass and decay width of $$\phi $$ ϕ meson in the presence of an external magnetic field. The in-medium mass of $$\phi $$ ϕ meson has been calculated using the decay process $$\phi $$ ϕ $$\rightarrow $$ → $$K {\bar{K}}$$ K K ¯ at one-loop level. The medium modifications are introduced by using a chiral SU(3) model employing a mean-field effective approach. Due to the introduction of the magnetic field, masses of charged $$K^+$$ K + and $$K^-$$ K - increases with advancing magnetic field values. A negligible change in the value of neutral $$K^0$$ K 0 and $${\bar{K}}^0$$ K ¯ 0 has been observed for varying magnetic fields. Due to electromagnetic interactions with charged K and $${\bar{K}}$$ K ¯ mesons, there is a gradual augmentation in the effective mass of $$\phi $$ ϕ meson. The probability of the mentioned decay process ceases to be zero for low density and strangeness fraction values at higher magnetic field values. Investigating the decay width and effective mass of $$\phi $$ ϕ meson under the influence of an external magnetic field is relevant to understanding the hadronic matter properties under extreme conditions achievable at heavy-ion collision experiments.

Abstract In this community effort, we compare measurements between 34 laboratories from 19 countries, utilizing mixtures of labelled authentic synthetic standards, to quantify by mass spectrometry four clinically used ceramide species in the NIST (National Institute of Standards and Technology) human blood plasma Standard Reference Material (SRM) 1950, as well as a set of candidate plasma reference materials (RM 8231). Participants either utilized a provided validated method and/or their method of choice. Mean concentration values, and intra- and inter-laboratory coefficients of variation (CV) were calculated using single-point and multi-point calibrations, respectively. These results are the most precise (intra-laboratory CVs ≤ 4.2%) and concordant (inter-laboratory CVs < 14%) community-derived absolute concentration values reported to date for four clinically used ceramides in the commonly analyzed SRM 1950. We demonstrate that calibration using authentic labelled standards dramatically reduces data variability. Furthermore, we show how the use of shared RM can correct systematic quantitative biases and help in harmonizing lipidomics. Collectively, the results from the present study provide a significant knowledge base for translation of lipidomic technologies to future clinical applications that might require the determination of reference intervals (RIs) in various human populations or might need to estimate reference change values (RCV), when analytical variability is a key factor for recall during multiple testing of individuals.

Abstract Aims Acute myocarditis, although a rare disease, can be associated with sudden cardiac death or the need for transplantation in both children and young adults. To date, there is no definitive evidence to support the routine use of immunosuppressive therapy or treatment targeting inflammation in patients with myocarditis. Animal models of cardiovascular (CV), as well as neurological diseases, have demonstrated that cannabidiol has significant anti‐inflammatory properties and may represent a promising therapy in acute myocarditis. This efficacy has been shown in a murine model of autoimmune myocarditis as well as in in vitro and in vivo models of heart failure (HF). Methods and results We present the rationale and design of the ARCHER Trial, an international multicentre, double‐blind, randomized, placebo‐controlled, phase II study examining the safety and efficacy of a pharmaceutically produced cannabidiol formulation, in patients with mild to moderate acute myocarditis. Eligible patients are those with acute myocarditis, randomized within 10 days of the diagnostic cardiac MRI (CMR), which has met defined diagnostic criteria for myocarditis. Oral treatment (cannabidiol or placebo) is titrated from 2.5 mg/kg of body weight up to 10 mg/kg of body weight b.i.d. (or highest tolerated dose) and taken for 12 weeks in addition to standard of care therapy for HF. The primary endpoints are defined as changes in global longitudinal strain (GLS) and extra cellular volume (ECV), measured by CMR at 12 weeks. Assuming 80% power, a 5% alpha risk and 25% missing CMR follow‐up data at Week 12, 100 patients are required to demonstrate the desired treatment effect of 18%. The change in left ventricular ejection fraction (LVEF) from baseline to Week 12 was selected as the secondary endpoint. Additional exploratory endpoints include changes in hs‐troponin, NT‐proBNP, markers of inflammation and endothelial function during the 12‐week treatment period. The trial is ongoing but is now more than 50% recruited. As enrolment in the trial continues, no interim data are available for inclusion in this Design paper. Conclusions The ongoing ARCHER Trial is an international, multicentre, double‐blind, randomized, placebo‐controlled phase II study, designed to determine the effect of a pharmaceutically produced cannabidiol formulation on CMR parameters in patients presenting with acute myocarditis. Enrolment of 100 patients is expected to conclude in Q3 2024. Study results will be available in early 2025.

The transport sector is experiencing a notable transition towards sustainability, propelled by technological progress, innovative materials, and a dedication to environmental preservation. This study explicitly examines the incorporation of electric vehicles (EVs) into the power grid, with a particular emphasis on passenger automobiles. Our analysis emphasises the vital importance of updated transport infrastructure in decreasing greenhouse gas emissions and aiding carbon reduction efforts in electricity networks. The analysis uncovers that adopting electric vehicles offers significant advantages, including enhanced grid efficiency and decreased emissions. However, it also brings issues concerning the design and operation of power systems at both the transmission and distribution levels. Key players are crucial in tackling these difficulties to improve electric vehicle integration into the grid. The study determines the most effective ways for distributing and providing electric vehicle charging infrastructure, and investigates the efforts made to establish common standards in order to solve current challenges. This research contributes to the advancement of sustainable mobility and energy systems by conducting a thorough examination of the impact of electric vehicles on power systems and offering appropriate integration solutions.

Aim: The aim of the questionnaire study was to determine the knowledge, attitude, and perception of orthodontists regarding the role of artificial intelligence in dentistry in general and orthodontics specifically, and to determine the use of artificial intelligence by the orthodontist. Methods: This cross-sectional study was done among the orthodontists of Northern India (clinicians, academicians, and postgraduates) through a web-based electronic survey using Google Forms. The study was designed to obtain information about AI and its basic usage in daily life, in dentistry, and in orthodontics from the participants. The options given were set specifically according to the Likert scale to maintain the correct format. The questionnaire was validated by one AI expert and one orthodontic expert, followed by pretesting in a smaller group of 25 orthodontists 2 weeks before circulation. A total of 100 orthodontists and postgraduate students responded to the pretested online questionnaire link for 31 questions in four sections sent via social media websites in a period of 3 months. Results: The majority of the participants believe that AI could be useful in diagnosis and treatment planning and could revolutionize dentistry in general. 84 % of the orthodontic academicians and clinicians, including PG students, consider AI a useful tool for boosting performance and delivering quality care in orthodontics, and 72 % see AI as a partner rather than a competitor in the foreseeable future of dentistry. 90 % of the participants believe that the incorporation of AI into CBCT analysis can be a valuable addition to diagnosis and treatment planning. 86 % of total participants agree that AI can be helpful in decision-making for orthognathic surgery, and 84 % find AI useful for bone age assessment. Conclusions: It was observed that academicians are more aware of AI terminologies and usage as compared to PG students and clinicians. There is a consensus that AI is a useful tool for diagnosis and treatment planning, boosting performance and quality care in orthodontics. In spite of these facts, 62.5 % of clinicians and 40 % of PG students are still not using AI for cephalometric analysis (p = 0.033).

Introduction: Acute appendicitis is a common surgical emergency in children, often requiring imaging for confirmation due to diverse presentations. While computed tomography scan is favored in many centers for its sensitivity, it comes with radiation exposure and higher costs. Ultrasonography, being radiation-free and cost-effective, is gaining popularity, especially in pediatric cases. However, its reported accuracy varies in the literature. This study aims to evaluate the diagnostic accuracy of ultrasonography in pediatric appendicitis cases and to determine its precision in distinguishing between simple and complicated cases of appendicitis. MATERIALS AND METHODS: A retrospective analysis was conducted on children with suspected appendicitis who presented to the department of pediatric surgery. All patients underwent ultrasonography followed by appendicectomy based on considered clinical decision. Ultrasonography findings were compared with intraoperative observations categorized as uncomplicated or complicated appendicitis. Results: Among 152 patients, ultrasonography accurately diagnosed appendicitis in 94.6% of cases, with 5.38% having nonvisualized appendices. In our group, the sensitivity and specificity of ultrasound to detect appendicitis were 94.62% and 95.65%, respectively. The diagnostic accuracy of the test is 95.63%. However, in our study, the sensitivity of the ultrasonography to correctly identify if it is a simple or complicated appendicitis was only 54.9% but had a specificity of 98.7%. Thus, ultrasonography showed a much lower sensitivity (54.9%) in distinguishing between simple and complicated appendicitis. Conclusion: Ultrasonography demonstrates high sensitivity and specificity in diagnosing pediatric appendicitis, making it a promising preoperative investigation. However, it may not accurately differentiate between simple and complicated cases. A comprehensive approach involving clinical and laboratory parameters alongside secondary imaging may be necessary for accurate diagnosis, especially in cases of perforated appendicitis.

Background and Aim: Haemolysis due to dapsone as a part of MDT in leprosy patients has been long recognized. However, the frequency and severity of this side effect and factors associated with it have not been well documented. We planned to determine the frequency of dapsone-induced haemolysis in leprosy patients on MDT and various risk factors associated with it. MATERIALS AND METHODS: This was a hospital-based retrospective analysis, conducted on 36 treatment completed or partially treated or on treatment leprosy patients in a tertiary care centre in Chhattisgarh. Results: Out of 36 patients, 83.3% showed a fall in haemoglobin from the baseline value (pre-treatment values). Dapsone was stopped in 33.3% of patients with a significant fall in haemoglobin. We found that the mean haemoglobin concentration for all patients fell from 13.05(+/−1.8) g/dl to 11.8(+/−1.9) g/dl (P < 0.05) which was statistically significant. A total of 25% of patients were labelled as confirmed cases of dapsone-induced haemolysis as per our definition. Conclusion: Our results underline the need to incorporate haematological investigations in leprosy management protocol, especially in primary care settings where the majority of leprosy patients are managed.

Background: Primary care physicians are not adequately trained to tackle mental health problems. The study aimed to evaluate undergraduate training in Psychiatry: An observational perspective of medical officers. Materials and Methods: It was a cross-sectional study conducted in North India. Participants were assessed on a self-designed questionnaire developed by the Indian psychiatric society to assess various aspects of undergraduate training. Other questionnaires measured residents’ satisfaction with the quality of training programs and perceived need for psychiatric training in undergraduate courses. Results: The participant’s mean age was 32.4 years; majorities were male medical officers. About one-tenth reported that there were no separate psychiatry departments and designated psychiatry consultants in their college. Approximately 50% reported: No regular supervision by any psychiatric faculty or having psychiatric disorders discussions in clinical rounds. More than half (50.9%) were not confident enough to identify common signs and symptoms of psychiatric problems. From one-third to half of the participants were unsatisfied with various aspects of the training program, like teaching skills, diagnostic interviews, clinical posting, etc. Majority (77.3%–83.7%) agreed that there is a need to improve the psychiatry training program; during the clinic rounds, psychiatric diagnosis should be discussed, and psychiatry should be a separate subject in under-graduation. Conclusion: Primary health-care physicians were unsatisfied with an undergraduate psychiatry training program. Hence, psychiatry should be an independent subject during the undergraduate training program, with dedicated theoretical and clinical hours for psychiatry training and a separate paper for evaluation.

Introduction: Postoperative sore throat (POST) is a common cause of distress and dissatisfaction after general anesthesia. POST is one of the most distressing symptoms after general anesthesia. Incidence of POST ranges from 14.4% to 90% following laryngoscopy and tracheal intubation. Various drugs with different routes are examined to prevent POST. We intended to compare the effectiveness of nebulized dexamethasone and magnesium sulfate (MgSO4) in decreasing the incidence and severity of POST. Materials and Methods: In this prospective double-blind study, adult patients with either sex undergoing laryngoscopy and intubation for surgery were randomly assigned into dexamethasone (Group D) and MgSO4 (Group M). The primary outcome was to assess incidence and severity of POST, and secondary outcome was to assess the incidence of hoarseness and cough. Continuous variables were presented as mean ± standard deviation, and t-test was applied for comparing the difference of means between the two groups. P ≤0.05 was considered statistically significant. Results: The incidence of POST in Group D was much lower as compared to Group M at 0 h (P = 0.0262), but after that, there was no significant difference between groups. Severity of POST was compared between Group D and Group M at 0, 4, 8, 12, and 24 h postoperatively. At 0 h, Group D had 22 patients with no pain at rest (Grade 0) whereas Group M had 12 patients. The secondary outcomes (pain at deglutition, hoarseness, and cough) at 0, 4, 8, 12, and 24 h were not statistically significant (P > 0.05). Conclusions: Preoperative MgSO4 nebulization is as effective as dexamethasone nebulization in decreasing the incidence and severity of POST without causing any adverse effect. Incidence of pain on deglutition, hoarseness, and cough are also reduced effectively by both drugs.

Abstract Background Sustainable crop production along with best nutrient use efficiency is the key indicator of smart agriculture. Foliar application of plant nutrients can complement soil fertilization with improved nutrient uptake, translocation and utilization. Recent developments in slow releasing, nano-fertilizers in agriculture, begins a new era for sustainable use and management of natural resources. This study aims to explore the effectiveness of nano-nitrogen usage on plant growth, yield attributes and sustaining rice production while optimizing fertilizer N application through conventional (prilled urea) and nano-N source under salt stress conditions. Results The strategic substitutions of traditional urea by nano-nitrogen was distributed from partial to complete with 33, 50, 66 and 100% applications. Further, the strategic substitutions were compared in saline (ECe ∼ 6.0 dSm− 1) and sodic stress (pH ∼ 9.1) conditions along with normal soils to dissect the beneficial response of nano-N in two rice varieties (CSR 30 and PB 1121). Salt stress affected the plant performance by decreasing leaf relative water content upto 10%, total chlorophyll content by 1.3–1.5%, leaf area upto 29.9%, gas exchange attributes by 10–39%, with concomitant yield reductions upto ∼ 4%. Collateral improvement in leaf greenness (SPAD index) crop growth rate and net assimilation rate was observed with foliar application of Nano-N. 0.2–1.64% enhancement in growth traits, 0.93–1.85% in physiological traits, and comparable yield gains with 100% recommended dose of prilled were comparative with nano-substitutions. Salt tolerant rice variety, CSR-30 performed better than PB 1121 with better expression of morphological, physiological and yield traits under stress conditions and nitrogen substitutions. Conclusions Overall, our experimental findings revealed agricultural use of nano-N in improving the plant physiological efficiency and optimizing rice yields with partial N substitution through nano fertilizers under salt stress conditions. These studies are further open for futuristic aspects of long term effects of nano-fertilizers on soil nutrient depletion in correlation to yield enhancement in salt affected soils.

Abstract Narrow-band imaging (NBI) is more efficient in detecting early gastrointestinal cancer than white light imaging (WLI). NBI technology is available only in conventional endoscopy, but unavailable in magnetic-assisted capsule endoscopy (MACE) systems due to MACE’s small size and obstacles in image processing issues. MACE is an easy, safe, and convenient tool for both patients and physicians to avoid the disadvantages of conventional endoscopy. Enabling NBI technology in MACE is mandatory. We developed a novel method to improve mucosal visualization using hyperspectral imaging (HSI) known as Spectrum Aided Visual Enhancer (SAVE, Transfer N, Hitspectra Intelligent Technology Co., Kaohsiung, Taiwan). The technique was developed by converting the WLI image captured by MACE to enhance SAVE images. The structural similarity index metric (SSIM) between the WLI MACE images and the enhanced SAVE images was 91%, while the entropy difference between the WLI MACE images and the enhanced SAVE images was only 0.47%. SAVE algorithm can identify the mucosal break on the esophagogastric junction in patients with gastroesophageal reflux disorder. We successfully developed a novel image-enhancing technique, SAVE, in the MACE system, showing close similarity to the NBI from the conventional endoscopy system. The future application of this novel technology in the MACE system can be promising.

Background: A higher occurrence of oral cancer is observed in South Asian and Southeast Asian countries when compared with other countries in the world. Cancer, a disease with complex pathophysiology, has been linked to chronic inflammation. Inflammation has been considered an important component of tumor initiation and progression. This is supported by the fact that many cancers arise at the sites of chronic inflammation, but the exact mechanism by which inflammation influences cancer is unknown. Purpose: This review article correlates single nucleotide polymorphisms (SNPs), chronic inflammation, and oral cancer. The article emphasizes the critical role that SNPs play in oral cancer susceptibility, progression, and prognosis. This involves discussing the impact of specific SNPs on oral cancer risk and patient outcomes. Review: Gene polymorphism has been documented in the molecular pathogenesis of various cancers, including oral cancer, and SNPs are the most common form of gene polymorphism. Genetic variation has been documented in the molecular pathogenesis of various cancers, including oral cancer, and SNPs are the most common form of gene polymorphism. SNPs have been documented in inflammatory conditions as well as in various diseases. Conclusion: SNPs have phenotypic consequences and therefore can serve as genetic fingerprints. The upregulation or downregulation of genes is able to drive oral carcinogenesis.

Abstract This paper introduces a novel design for a universal DC-DC and DC-AC converter tailored for DC/AC microgrid applications using Approximate Dynamic Programming and Artificial Neural Networks (ADP-ANN). The proposed converter is engineered to operate efficiently with both low-power battery and single-phase AC supply, utilizing identical side terminals and switches for both chopper and inverter configurations. This innovation reduces component redundancy and enhances operational versatility. The converter's design emphasizes minimal switch usage while ensuring efficient conversion to meet diverse load requirements from battery or AC sources. A conceptual example illustrates the design's principles, and comprehensive analyses compare the converter's performance across various operational modes. A test bench model, rated at 3000W, demonstrates the converter's efficacy in all five operational modes with AC/DC inputs. Experimental results confirm the system's robustness and adaptability, leveraging ADP-ANN for optimal performance. The paper concludes by outlining potential applications, including microgrids, electric vehicles, and renewable energy systems, highlighting the converter's key advantages such as reduced complexity, increased efficiency, and broad applicability.

Abstract This literature review examines the impact of orthopaedic trauma on patient mental health. It focuses on patient outcomes, available resources, and healthcare provider knowledge and education. Orthopaedic trauma represents a significant physical and psychological burden for patients, often resulting in long-term disability, pain, and functional limitations. Understanding the impact of orthopaedic trauma on patient mental health is crucial for improving patient care, and optimizing recovery and rehabilitation outcomes. In this review, we synthesize the findings of empirical studies over the past decade to explore the current understanding of mental health outcomes in patients with orthopaedic trauma. Through this analysis, we identify gaps in existing research, as well as potential avenues for improving patient care and mental health support for patients with severe orthopaedic injuries. Our review reveals the pressing need for collaboration between healthcare providers, mental health professionals, and social support systems to ensure comprehensive mental care for patients with traumatic orthopaedic injuries.

Portal hypertension, a known complication of liver cirrhosis, typically leads to variceal bleeding in the esophagus and stomach. However, ectopic varices can also occur outside the gastroesophageal region and may present with life-threatening massive bleeding. We report a case of bleeding ileal ectopic varices in a patient with cirrhosis that were not detected during routine endoscopy. These varices were ultimately diagnosed with the aid of abdominal computed tomography. A transjugular intrahepatic portosystemic shunt (TIPS) was created to decrease portal pressure, and the TIPS tract was then used to selectively embolize the bleeding ectopic ileal varices.

The widespread occurrence of Type 2 Diabetes Mellitus (T2DM) is a significant public health issue in India. Diabetes severely impedes the wound healing process. Delayed wound healing in diabetes is caused by a decrease in nitric oxide generation, the presence of Advanced Glycation End products (AGEs), and impaired epithelial cell motility. In this case, a 38-year-old diabetic male presented seeking Ayurvedic treatment for a wound on his right lower limb, which resulted from a prick injury sustained 10 days earlier. He also had varicose veins in both legs and had been living with diabetes for five years. His medical history included slow wound healing. The condition was diagnosed as “Dushtvrana” associated with “Prameha” and was treated with Ayurvedic medicines in addition to oral hypoglycaemics. The Ayurvedic treatment included Panchavalkala Kwatha Vranadhavan, followed by the local application of Yashtimadhu Ghrita every third day, along with the oral administration of Nishadhatri Yoga (5 g) twice daily. Additionally, he was prescribed a daily evening dose of 500 mg metformin tablets for 25 days. There was no pain or inflammation observed, and the wound fully healed. This case demonstrates the effectiveness of Ayurvedic treatment-Panchavalkala Kwatha Vranadhavan, Yashtimadhu Ghrita for local application, and oral Nishadhatri Yoga-as an adjunct to the oral hypoglycaemic drug metformin in treating diabetic wounds.

Bone metastasis of Follicular Thyroid Carcinoma (FTC) is an aggressive complication. Typically, follicular carcinoma remains confined to the thyroid gland, with distant metastasis occurring in 4-15% of cases. The lungs are the most frequent site of metastasis, followed by bone (2-13%). A peculiar clinical manifestation of FTC observed is the metastasis with the primary still remaining clinically occult. Solitary bone metastases are exceedingly rare and can easily be misdiagnosed as primary bone tumours on clinicoradiological assessment. This causes delays in the diagnosis and management. In these cases, the cytomorphology of cells on diagnostic Fine Needle Aspiration (FNA) was found to be useful in suggesting the primary origin of FTC. Distant bone metastases from follicular carcinoma on histopathological examination from biopsy specimens have been reported in the literature. The cytodiagnosis and cytomorphology of metastatic FTC by Fine Needle Aspiration Cytology (FNAC) are seldomly described in the literature. Involvement of the iliac bone in the metastasis of FTC is uncommon. The FNAC of such a bony lesion helps immensely not only in the diagnosis of the metastasis but also in suggesting the primary malignancy. Authors, hereby report a clinicopathological profile of one such rare case of a 74-year-old female with cytodiagnosis of FTC with no clinical thyroid swelling. The cytodiagnosis made from the primary lytic lesion involving the left iliac bone led to the retrospective radiological and histopathological work-up of the thyroid gland, confirming the occult primary carcinoma of the thyroid gland. The present case highlights the rare presentation and cytomorphological details of metastatic thyroid follicular carcinoma.

Background and Aims: Multimodal analgesia regimens for optimizing the postoperative pain following abdominal surgeries are a crucial component of enhanced recovery after surgery (ERAS), as it reduces postoperative opioid consumption along with their adverse effects. We compared the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block (QLB) versus posterior transversus abdominis plane block (TAPB) with respect to duration of analgesia, modified Defense and Veterans Pain Rating Scale (DVPRS) scores for pain, activity, sleep, stress, and mood, respectively, the total amount of rescue analgesic consumption, hemodynamics parameters and side effects, in patients undergoing total abdominal hysterectomy under general anesthesia. Materials and Methods: In this study, which was prospective, randomized, and double-blind, 60 patients of the American Society of Anesthesiologists Physical Status I and II, aged 18–65 years, undergoing abdominal hysterectomy, were randomized into two groups. Group QLB (n = 30) and Group TAPB (n = 30) received bilateral QLB and TAPB with 40 ml of 0.375% ropivacaine, respectively. The data were compared using standard qualitative and quantitative tests. Results: The duration of pain relief was longer in Group QLB compared to Group TAPB (981.83 ± 138.62 min vs. 637 ± 127.02 min, P < 0.0001). The DVPRS score for pain, activity, sleep, stress, and mood, respectively, were significantly lower in Group QLB (P < 0.05). The total rescue analgesic consumption was significantly lesser in Group QLB (103.33 ± 18.26 mg) compared to Group TAPB (150.00 ± 50.85 mg) (P < 0.0001). No significant hemodynamic changes or side effects were observed (P > 0.05). Conclusion: Bilateral QLB significantly prolonged the duration of analgesia with reduced rescue analgesic requirement compared with bilateral TAPB in patients undergoing total abdominal hysterectomy.

Abstract Groundwater is the most salient and utilitarian water resource for living organisms. However, major parts of the Ken River Basin (KRB) in Central India are grappling with the overexploitation of groundwater resources, primarily due to extensive agricultural activities, raising problems in achieving Sustainable Development Goals (SDGs) 2 and 6. This study focused on delineating groundwater potential zones (GPZ) by employing remote sensing and GIS-based thematic datasets, complemented by the application of the Analytic Hierarchy Process (AHP). The thematic layers consisting of geomorphology, precipitation, geology, soil texture, lineament density, slope, LULC, and drainage density were considered and further weights were allocated with respect to their water storing capacity and characteristics to groundwater occurrences to develop GPZs. The zones were generated by classifying overlayed maps into four categories namely, very low, low, moderate, and high. The key findings indicated that 13.84%, 62.34%, 23.37%, and 45% of areas were found under high, moderate, low, and very low GPZs respectively. Furthermore, the zonation map was validated with 48 boreholes’ yield, which revealed a noteworthy 77.08% borewells in concurrence with predicted zones. Area Under the Receiver Operating Characteristic (AUROC) curve showcased a commendable 70.1% accuracy using the ROC curve. These results were highly beneficial in formulating sustainable groundwater management plans and policies, contributing towards the attainment of targets outlined in SDGs 2 and 6, particularly in regions resembling the KRB.

Abstract The growing integration of renewable energy sources into grid-connected microgrids has created new challenges in power generation forecasting and energy management. This paper explores the use of advanced machine learning algorithms, specifically Support Vector Regression (SVR), to enhance the efficiency and reliability of these systems. The proposed SVR algorithm leverages comprehensive historical energy production data, detailed weather patterns, and dynamic grid conditions to accurately forecast power generation. Our model demonstrated significantly lower error metrics compared to traditional linear regression models, achieving a Mean Squared Error of 2.002 for solar PV and 3.059 for wind power forecasting. The Mean Absolute Error was reduced to 0.547 for solar PV and 0.825 for wind scenarios, and the Root Mean Squared Error (RMSE) was 1.415 for solar PV and 1.749 for wind power, showcasing the model’s superior accuracy. Enhanced predictive accuracy directly contributes to optimized resource allocation, enabling more precise control of energy generation schedules and reducing the reliance on external power sources. The application of our SVR model resulted in an 8.4% reduction in overall operating costs, highlighting its effectiveness in improving energy management efficiency. Furthermore, the system’s ability to predict fluctuations in energy output allowed for adaptive real-time energy management, reducing grid stress and enhancing system stability. This approach led to a 10% improvement in the balance between supply and demand, a 15% reduction in peak load demand, and a 12% increase in the utilization of renewable energy sources. Our approach enhances grid stability by better balancing supply and demand, mitigating the variability and intermittency of renewable energy sources. These advancements promote a more sustainable integration of renewable energy into the microgrid, contributing to a cleaner, more resilient, and efficient energy infrastructure. The findings of this research provide valuable insights into the development of intelligent energy systems capable of adapting to changing conditions, paving the way for future innovations in energy management. Additionally, this work underscores the potential of machine learning to revolutionize energy management practices by providing more accurate, reliable, and cost-effective solutions for integrating renewable energy into existing grid infrastructures.

Abstract Unpredictable fatal outcome of COVID-19 is attributed to dysregulated inflammation. Impaired early adaptive immune response leads to late-stage inflammatory outcome. The purpose of this study was to develop biomarkers for early detection of host immune impairment at first diagnosis from leftover RNA samples, which may in turn identify high risk patients. Leftover RNA samples of COVID-19 patients at first diagnosis were stored. Following prospective follow-up, the samples were shorted and categorized into outcome groups. Impaired adaptive T cell response (severity score) and Impaired IL-10 response (undetectable IL-10 in the presence of high expression of a representative interferon response gene) were determined by RT-PCR based assay. We demonstrate that a T cell response based ‘severity score’ comprising rational combination of Ct values of a target genes’ signature can predict high risk noncomorbid potentially critical COVID-19 patients with a sensitivity of 91% (95% CI 58.7–99.8) and specificity of 92.6% (95% CI 75.7–99) (AUC:0.88). Although inclusion of comorbid patients reduced sensitivity to 77% (95% CI 54.6–92.2), the specificity was still 94% (95% CI 79.8–99.3) (AUC:0.82). The same for ‘impaired IL-10 response’ were little lower to predict high risk noncomorbid patients 64.2% (95% CI 35.1–87.2) and 82% (95% CI 65.5–93.2) respectively. Inclusion of comorbid patients drastically reduce sensitivity and specificity51.6% (95% CI 33.1–69.8) and 80.5% (95% CI 64.0–91.8) respectively. As best of our knowledge this is the first demonstration of a metric-based approach showing the ‘severity score’ as an indicator of early adoptive immune response, could be used as predictor of severe COVID-19 outcome at the time of first diagnosis using the same leftover swab RNA. The work flow could reduce expenditure and reporting time of the prognostic test for an earliest clinical decision ensuring possibility of early rational management.

Abstract Intestinal barrier is a first line of defense that prevents entry of various harmful substances from the lumen into the systemic environment. Impaired barrier function with consequent translocation of harmful substances into systemic circulation (“leaky gut”) is a central theme in many gastrointestinal, autoimmune, mental, and metabolic diseases. Probiotics have emerged as a promising strategy to maintain intestinal integrity and address “leaky gut”. Using in silico, in vitro and avian in vivo analyses, we previously showed that two novel L. reuteri strains, PTA-126787 (L. reuteri 3630) and PTA-126788 (L. reuteri 3632), isolated from broiler chickens possess favorable safety profiles. Consistent with a recent study, here we show that L. reuteri 3630 and 3632 are phylogenetically similar to human L. reuteri strains. Daily administration of high doses of L. reuteri 3630 and 3632 to Sprague Dawley rats for 28 days was found to be safe with no adverse effects. More importantly, administration of L. reuteri 3630 and 3632 significantly reduced markers associated with alcohol-induced leaky gut, by downregulating inflammatory cytokines and upregulating anti-inflammatory cytokines in an alcohol model of leaky gut in mice. While L. reuteri 3630 cells and supernatant showed no activation, L. reuteri 3632 cells but not supernatant showed activation of AhR, a key transcription factor that regulates gut and immune homeostasis. L. reuteri 3630 is creamish white in morphology typical of Lactobacillus species and L. reuteri 3632 displays a unique orange pigmentation, which was stable even after passaging for 480 generations. We identified a rare polyketide biosynthetic gene cluster in L. reuteri 3632 that likely encodes for the orange-pigmented secondary metabolite. Similar to L. reuteri 3632 cells, the purified orange metabolite activated AhR. All together, these data provide evidence on the phylogenetic relatedness, safety, efficacy, and one of the likely mechanisms of action of L. reuteri 3630 and 3632 for potential probiotic applications to address “leaky gut” and associated pathologies in humans.

Abstract This research paper introduces an avant-garde poly-input DC–DC converter (PIDC) meticulously engineered for cutting-edge energy storage and electric vehicle (EV) applications. The pioneering converter synergizes two primary power sources—solar energy and fuel cells—with an auxiliary backup source, an energy storage device battery (ESDB). The PIDC showcases a remarkable enhancement in conversion efficiency, achieving up to 96% compared to the conventional 85–90% efficiency of traditional converters. This substantial improvement is attained through an advanced control strategy, rigorously validated via MATLAB/Simulink simulations and real-time experimentation on a 100 W test bench model. Simulation results reveal that the PIDC sustains stable operation and superior efficiency across diverse load conditions, with a peak efficiency of 96% when the ESDB is disengaged and an efficiency spectrum of 91–95% during battery charging and discharging phases. Additionally, the integration of solar power curtails dependence on fuel cells by up to 40%, thereby augmenting overall system efficiency and sustainability. The PIDC’s adaptability and enhanced performance render it highly suitable for a wide array of applications, including poly-input DC–DC conversion, energy storage management, and EV power systems. This innovative paradigm in power conversion and management is poised to significantly elevate the efficiency and reliability of energy storage and utilization in contemporary electric vehicles and renewable energy infrastructures.

Abstract As Europe integrates more renewable energy resources, notably offshore wind power, into its super meshed grid, the demand for reliable long-distance High Voltage Direct Current (HVDC) transmission systems has surged. This paper addresses the intricacies of HVDC systems built upon Modular Multi-Level Converters (MMCs), especially concerning the rapid rise of DC fault currents. We propose a novel fault identification and classification for DC transmission lines only by employing Long Short-Term Memory (LSTM) networks integrated with Discrete Wavelet Transform (DWT) for feature extraction. Our LSTM-based algorithm operates effectively under challenging environmental conditions, ensuring high fault resistance detection. A unique three-level relay system with multiple time windows (1 ms, 1.5 ms, and 2 ms) ensures accurate fault detection over large distances. Bayesian Optimization is employed for hyperparameter tuning, streamlining the model’s training process. The study shows that our proposed framework exhibits 100% resilience against external faults and disturbances, achieving an average recognition accuracy rate of 99.04% in diverse testing scenarios. Unlike traditional schemes that rely on multiple manual thresholds, our approach utilizes a single intelligently tuned model to detect faults up to 480 ohms, enhancing the efficiency and robustness of DC grid protection.

الملخص: أهداف البحث: تمثل الحليمات الكمئية الملونة في اللسان آفة مصبوغة نادرة التواجد وغير موثقة بشكل كاف في الدراسات المنشورة، مما يشكل تحديات في التشخيص وخطط العلاج اللاحقة. تهدف الدراسة إلى تحليل معرفة وفهم وموقف أطباء الأسنان تجاه أشكال الحليمات الكمئية الملونة في اللسان لتحديد التشخيص وخطط العلاج اللاحقة. طرق البحث: أجريت دراسة مقطعية بين أطباء الأسنان في جاوة الشرقية باستخدام استبانة عبر الإنترنت. تم تقديم أربع صور سريرية للحليمات الكمئية الملونة في اللسان، مع سبعة أسئلة لتقييم معرفة أطباء الأسنان بها، بما في ذلك نوع الآفة، وهياكل اللسان المتضمنة، وتصنيف هولزوانقر، ونمط الآفة، والتشخيص المشتبه به، وطبيعة الآفة (حميدة أو خبيثة). تضمنت أسئلة إضافية تجارب مع الآفة في الممارسة، والتحول المحتمل إلى الورم الخبيث، والتحقيقات التشخيصية، والعلاج المطلوب لتقييم المواقف. تم تحليل الفروقات في المواقف المرتبطة بالمعرفة إحصائيا باستخدام اختبار مان-ويتني. النتائج: شارك ما مجموعه 117 طبيب أسنان، وكانت الغالبية من الإناث (69.23%) ومن الفئة العمرية 26-30 سنة (44.44%). أظهر أطباء الأسنان الذين تتراوح أعمارهم بين 41-50 عاما معرفة متفوقة مقارنة بأولئك الذين تتراوح أعمارهم بين 20-30 عاما. أظهر الممارسون الذين لديهم 1-5 سنوات من الخبرة فروقات كبيرة في المعرفة حول هذه الحالة. لم يلاحظ تباين كبير بين مستوى المعرفة والموقف، خاصة فيما يتعلق بالعلاج والتحقيق الداعم. ومع ذلك، كان لمواجهة حالات الحليمات الكمئية الملونة تأثير كبير على قرارات العلاج والتحقيقات الداعمة. الاستنتاجات: يمتلك معظم أطباء الأسنان المشاركين مستوى جيد من المعرفة حول حالات الحليمات الكمئية الملونة. تتأثر معرفة أطباء الأسنان، كما يتضح من مواقفهم تجاه التحقيق والعلاج، بشكل ملحوظ بتجاربهم مع هذه الحالات. Abstract: Objective: Pigmented fungiform papillae of the tongue (PFPT) are infrequently encountered and inadequately documented pigmented lesions that pose challenges in diagnosis and subsequent treatment planning. The study was aimed at analyzing dentists' knowledge and attitudes regarding PFPT morphologies, to determine diagnosis and subsequent treatment planning. Methods: A cross-sectional study was conducted among dentists in East Java through an online questionnaire. Four clinical photographs of PFPT were presented, accompanied by seven questions assessing dentists' knowledge of PFPT, including lesion types, tongue structure involvement, Holzwanger classification, lesion patterns, suspected diagnoses and the nature of the lesion (benign or malignant). Additional questions to evaluate attitudes included prior experience with PFPT in practice, potential malignant transformation, diagnostic investigation and required treatment. Knowledge-associated attitude differences were statistically analyzed with the Mann–Whitney test with a threshold of p 0.05). However, prior encounters with PFPT cases were significantly associated with treatment decisions and supporting investigations for diagnosis (p

Introduction Radiography is the most often accessible and affordable imaging modality. Accurate assessments of wrist X-rays can aid in the diagnosis and prognostic evaluation of various wrist problems. This study aims to identify normal radiographic anthropometry reference values and variations of carpal bones and joints by gender and age in sample Indian population, with the potential to be clinically applicable.

Background: Gestational trophoblastic disease (GTD) represents a diverse group of conditions characterized by abnormal trophoblastic proliferation within the placenta. GTD includes benign and malignant lesions, ranging from complete and partial hydatidiform moles to more severe forms like invasive moles, choriocarcinoma, placental site trophoblastic tumors (PSTTs), and epithelioid trophoblastic tumors. Given that neoplastic GTD lesions respond remarkably well to chemotherapy, early and accurate histopathological diagnosis is crucial as it directly influences treatment and prognosis. Aim and Objectives: This study examined the histomorphological features of various types of GTD alongside key clinical factors such as age, parity, and gestational period. Materials and Methods: The study was conducted in the Department of Pathology over the course of10 years, from January 2014 to January 2024. All cases of GTD confirmed through histopathological examination of hematoxylin and eosin-stained slides were included in the analysis. Results: Out of 60 diagnosed cases of GTD, 34 (56.66%) were complete hydatidiform moles, 22 (36.67%) were partial hydatidiform moles, 1 (1.67%) was an invasive mole, 1 (1.67%) was choriocarcinoma, and 2 (3.33%) were PSTTs. The age of the affected patients ranged from 18 to 45 years, with the highest incidence observed in the 20–25 year age group (30 cases, 50%). Most cases (33, 55%) occurred during the first trimester, with a predominance among primigravida patients (28 cases, 46.66%). The most common clinical presentation was per vaginal bleeding, reported in 56 cases (93.33%). Conclusion: Although GTD can lead to serious complications, including metastasis, it is treatable. In this study, the complete hydatidiform mole was the most frequently encountered lesion and is associated with a higher risk of severe complications such as persistent GTD, invasive moles, and choriocarcinoma. Thus, early and accurate histopathological diagnosis is vital for the timely initiation of therapy, ultimately reducing the mortality rate. This study highlights the various categories and histomorphological features of GTD, emphasizing the importance of understanding its clinical presentation to mitigate disease burden and complications.

Introduction: We aim to share the experience of a single center in the management of eight cases of renal primitive neuroectodermal tumor (PNET) which are uncommon, aggressive tumors. The objectives were to study the presentation of the disease, the treatment offered and its outcomes, and the comparison of the treatment with published literature. Methods: The single-center renal PNET data of all patients were retrospectively reviewed from 2011 to 2022. Renal PNET was seen in eight patients. Minimum follow-up period of 1 year was required. Results: Male-to-female ratio was 7:1. The mean age was 26.5 years. All were locally advanced tumors on presentation. One patient had an inferior vena cava thrombus, one patient had metastases on presentation, and two patients had tumor extending to paranephric space. The diagnosis was made by histopathology supported by immunohistochemistry showing CD99 positivity. All patients were treated with radical nephrectomy, followed by chemotherapy in all and radiotherapy in three patients. Two patients expired at 3½ and 6 years after surgery, the remaining six are alive at a median follow-up period of 34.5 months. Conclusion: Renal PNET is an uncommon renal tumor which is aggressive and requires multimodal therapy for prolonged survival.