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Background/Objectives: Drug-Induced Kidney Injury (DIKI) presents a significant challenge in drug development, often leading to clinical-stage failures. The early prediction of DIKI risk can improve drug safety and development efficiency. Existing models tend to focus on physicochemical properties alone, often overlooking drug–target interactions crucial for DIKI. This study introduces an AI/ML (artificial intelligence/machine learning) model that integrates both physicochemical properties and off-target interactions to enhance DIKI prediction. Methods: We compiled a dataset of 360 FDA-classified compounds (231 non-nephrotoxic and 129 nephrotoxic) and predicted 6064 off-target interactions, 59% of which were validated in vitro. We also calculated 55 physicochemical properties for these compounds. Machine learning (ML) models were developed using four algorithms: Ridge Logistic Regression (RLR), Support Vector Machine (SVM), Random Forest (RF), and Neural Network (NN). These models were then combined into an ensemble model for enhanced performance. Results: The ensemble model achieved an ROC-AUC of 0.86, with a sensitivity and specificity of 0.79 and 0.78, respectively. The key predictive features included 38 off-target interactions and physicochemical properties such as the number of metabolites, polar surface area (PSA), pKa, and fraction of Sp3-hybridized carbons (fsp3). These features effectively distinguished DIKI from non-DIKI compounds. Conclusions: The integrated model, which combines both physicochemical properties and off-target interaction data, significantly improved DIKI prediction accuracy compared to models that rely on either data type alone. This AI/ML model provides a promising early screening tool for identifying compounds with lower DIKI risk, facilitating safer drug development.

Abstract Background Atrial fibrillation (AF) is prevalent, especially in patients with heart failure. Their prevalence increases with age and both conditions are interrelated. Electrocardioversion (ECV) is considered a safe and effective procedure and is among one of the recommended therapies to terminate AF back to normal sinus rhythm. Our study highlights one of the rare complications following ECV. Case summary A 71-year-old female with a history of atrial fibrillation underwent electrocardioversion and developed sudden onset of ventricular stunning resulting in refractory cardiogenic shock. She was treated with mechanical cardiac support including IABP and Impella. Both provided minimal support then rapid clinical deterioration happened leading to imminent death. Conclusion Patients with atrial fibrillation and heart failure treated with electrocardioversion might develop refractory cardiogenic shock and death as a complication of this procedure.

The unintended modulation of nuclear receptor (NR) activity by drugs can lead to toxicities amongst the endocrine, gastrointestinal, hepatic cardiovascular, and central nervous systems. While secondary pharmacology screening assays include NRs, safety risks due to unintended interactions of small molecule drugs with NRs remain poorly understood. To identify potential nonclinical and clinical safety effects resulting from functional interactions with 44 of the 48 human-expressed NRs, we conducted a systematic narrative review of the scientific literature, tissue expression data, and used curated databases (OFF-X™) (Off-X, Clarivate) to organize reported toxicities linked to the functional modulation of NRs in a tabular and machine-readable format. The top five NRs associated with the highest number of safety alerts from peer-reviewed journals, regulatory agency communications, congresses/conferences, clinical trial registries, and company communications were the Glucocorticoid Receptor (GR, 18,328), Androgen Receptor (AR, 18,219), Estrogen Receptor (ER, 12,028), Retinoic acid receptors (RAR, 10,450), and Pregnane X receptor (PXR, 8044). Toxicities associated with NR modulation include hepatotoxicity, cardiotoxicity, endocrine disruption, carcinogenicity, metabolic disorders, and neurotoxicity. These toxicities often arise from the dysregulation of receptors like Peroxisome proliferator-activated receptors (PPARα, PPARγ), the ER, PXR, AR, and GR. This dysregulation leads to various health issues, including liver enlargement, hepatocellular carcinoma, heart-related problems, hormonal imbalances, tumor growth, metabolic syndromes, and brain function impairment. Gene expression analysis using heatmaps for human and rat tissues complemented the functional modulation of NRs associated with the reported toxicities. Interestingly, certain NRs showed ubiquitous expression in tissues not previously linked to toxicities, suggesting the potential utilization of organ-specific NR interactions for therapeutic purposes.

Background & Aims: Bladder carcinoma is the second common malignancy of the urogenital system. Bladder malignancy encompasses 5.2% of all forms of cancer. According to study, Her2/neu expression can be considered as a prognostic clinical biomarker for bladder cancer. Target therapy using novel and recombinant chemodrugs such as transtuzumab can be applied in Her2/neu positive cases. Current study aimed to evaluate urothelial neoplasms incidence, to assess Her2/neu expression, and to compare its expression with prognostic factors. Materials & Methods: The present study is a prospective study conducted in the Department of Pathology, Narayana Medical College and General Hospital, Nellore, India, for a period of 2 years from June 2019 to June 2021. All the urothelial neoplasm cases reported during the study period were included, and Her2/neu immunohistochemistry has been assessed for the cases. Results: Among 71 bladder specimens, 48 had urothelial carcinomas (54% of high grade and 46% of low grade), and 20 had benign neoplasms. Among high-grade carcinomas, 91% were muscle invasive and among low grade, 55% were non-muscle invasive. Lateral wall is the common site of urothelial carcinoma. The mean age for high-grade carcinomas was 61-70 years, and it was associated with higher grades and stages of the tumor. In high grade and low-grade carcinomas, males outnumbered females. A significant correlation observed between tumor grade and stage. A significant association was found between Her2/neu overexpression with the grade and size of the tumor. No association was found between Her2/neu expression and age, gender, stage, and invasion. Conclusion: It is concluded that identifying the expression of Her2/neu in urothelial carcinoma can help identify eligible candidates for targeted therapy.

Melanotic schwannoma (MS) is a rare peripheral nerve sheath tumor commonly found in the thoracic paraspinal region. It is present in an intracranial location rarely, with 18 out of 105 MS cases described in the literature. Trigeminal nerve was involved in only six of these cases. Fifty percent of psammomatous melanotic schwannoma (PMS) patients have Carney complex. Carney complex is an autosomal dominant disorder featuring peripheral nerve tumors (schwannomas), myxomas (heart, skin, and breast), skin pigmentation (lentigines and blue nevi), and endocrine tumors (adrenal, testicular, and pituitary). We present a case of left trigeminal nerve PMS as a part of Carney complex. Patient had diffuse lentiginosis. Magnetic Resonance Imaging revealed enhancing lesion along left trigeminal nerve with widened Meckel's cave and foramen ovale. Final diagnosis of PMS was derived on clinical, radiological, and histopathological findings with immunohistochemistry correlation. Key Message Trigeminal nerve can be rarely involved in melanotic schwannoma (MS). Knowledge of typical radiological features of MS is crucial for its diagnosis. Its association with Carney complex should be sought.

Candida vulturna is a newly emerging candida species belong to Candida haemulonii species complex of Metschnikowiaceae family. Numerous clinical samples have been reported to isolate C. vulturna since discovery. We report a case of catheter related blood stream infection in which C. vulturna was isolated from blood in patient after prolong antibiotic therapy for recurrent infection of retroperitoneal cyst. The blood isolate was identified to species level by molecular assay targeting D1/D2 regions of 26s rDNA gene. The patient improved with administration of intravenous micafungin despite lack of antifungal susceptibility breakpoints.

The Emergency Diesel Generator (EDG) is a critical and essential part of the Nuclear Power Plant (NPP). Due to past catastrophic disasters, critical systems of NPP like EDG are designed to meet high dependability requirements. Therefore, we propose a framework for the dynamic reliability assessment using the Fault Tree and the Dynamic Bayesian Network. In this framework, the information of the component's failure probability is updated based on observed data. The framework is powerful to perform qualitative as well as quantitative analysis of the system. The validity of the framework is done by applying it on several NPP systems.

Background: The optimal electrodes position for elective direct current (DC) cardioversion of patients with atrial fibrillation (AF) remains uncertain. Methods: An electronic search of MEDLINE, EMBASE and COCHRANE databases was performed through March 2022 for randomized trials that examined the outcomes of anterior-posterior (AP) versus anterior-lateral (AL) electrodes position during cardioversion of (AF). The main outcome was the success rate of cardioversion. Data were pooled using random effects model. Results: The final analysis included 10 RCTs with a total of 1677 patients. There was no difference in the rate of successful cardioversion between the AP versus AL groups (86.6 vs 87.9 %; RR 1.00; 95 % Confidence Interval (CI) 0.95 to 1.06). Subgroup analysis by the shock waveform showed no significant interaction between monophasic and biphasic waveforms (Pintercation = 0.23). meta-regression analyses showed no effect modification of primary outcome according to body mass index (p = 0.15), left atrial diameter (p = 0.64), valvular heart disease (p = 0.34), lone AF (p = 0.58), or the duration of AF (p = 0.70). There was no significant difference between the AP and AL electrode position groups in successful cardioversion at low energy (RR 0.94; 95 % CI 0.74 to 1.19), the number of the delivered shocks (standardized mean difference [SMD] −0.03; 95 % CI −0.32 to 0.26) or the mean energy of the delivered shocks (SMD −0.11 and 95 % CI −0.30 to 0.07). There was lower transthoracic impedance with AP versus AL electrode position (SMD −0.28; 95 %CI −0.47 to −0.10). Conclusion: Meta-analysis of randomized data showed no difference between AP and AL electrode positions in the success rate of DC cardioversion of AF. Either AP or AL electrode positions should be acceptable approaches for elective DC cardioversion of patients with AF.

Introduction: Brain lesions can be caused by varied etiological factors like neoplastic, infectious, inflammatory and vascular diseases. Accurate diagnosis in very important for correct neurosurgical treatment. A retrospective histopathological study of brain lesions is of utmost importance because as it can demonstrate the changes in the spectrum of brain lesions, burden of disease in the community, can reveal the possible risk factors and can suggest probable treatment methods for various neoplastic and non neoplastic brain lesions. Aim: To evaluate the incidence, age distribution, gender distribution, and histopathological spectrum of neoplastic and non neoplastic lesions of brain. Materials and Methods: This retrospective observational study was conducted in the Department of Pathology at Narayana Medical College, Nellore, Andhra Pradesh, India, from January 2019 to December 2021. Total 216 cases were studied. The tumours were classified under World Health Organisation (WHO) classification. To test the mean difference between the groups, Independent sample t-test was done. Results: Out of 216 cases, 180 (83%) were neoplastic and 36 (17%) were non neoplastic lesions. The male:female ratio was 1.03:1. Non neoplastic lesions were common in males (22, 61.11%), while neoplastic lesions were common in females (92, 51.11%). The most common age group affected was 41-50 years (55, 25.46%). Astrocytoma (41, 22.77%) followed by meningioma (40, 22.22%) were the common neoplastic tumours and haematoma (7, 19.44%) was the most common non neoplastic lesion in adults. Common tumour in children (

The process of discovering small molecule drugs involves screening numerous compounds and optimizing the most promising ones, both in vitro and in vivo. However, approximately 90% of these optimized candidates fail during trials due to unexpected toxicity or insufficient efficacy. Current concepts with respect to drug–protein interactions suggest that each small molecule interacts with an average of 6–11 targets. This implies that approved drugs and even discontinued compounds could be repurposed by leveraging their interactions with unintended targets. Therefore, we developed a computational repurposing framework for small molecules, which combines artificial intelligence/machine learning (AI/ML)-based and chemical similarity-based target prediction methods with cross-species transcriptomics information. This repurposing methodology incorporates eight distinct target prediction methods, including three machine learning methods. By using multiple orthogonal methods for a “dataset” composed of 2766 FDA-approved drugs targeting multiple therapeutic target classes, we identified 27,371 off-target interactions involving 2013 protein targets (i.e., an average of around 10 interactions per drug). Relative to the drugs in the dataset, we identified 150,620 structurally similar compounds. The highest number of predicted interactions were for drugs targeting G protein-coupled receptors (GPCRs), enzymes, and kinases with 10,648, 4081, and 3678 interactions, respectively. Notably, 17,283 (63%) of the off-target interactions have been confirmed in vitro. Approximately 4000 interactions had an IC50 of 50 of

Insulating Liquids are widely used for their electrical and thermal properties in power apparatuses, particularly at the level of liquid-filled transformers. With the shift in engineering aspects towards sustainable development, it is important to find a sustainable solution with ecofriendly nature. Therefore, alternative (biodegradable) liquids are of high importance in the global transformer communities. In the present study, the alternative dielectric fluids (ester-based) feasibility for potential regeneration with Fuller’s earth is investigated. The experimental results are confined to the reclamation temperature as well as the ratio of Fuller's earth (the sorbent) and the liquid. A suitable laboratory treatment apparatus is designed and is adopted in this study. Promising measurements to comment on the effectiveness of the treatment have been performed at controlled treatment temperature and sorbent-liquid ratio with the ASTM 7150-13 as a reference norm.The results of this study allowed 80°C and 1 g/30 ml as affirmative conditions for the present experimental conditions. Diagnostic measurements include turbidity, particle counter, and UV spectrophotometry before and after treatments. It is inferred that fuller’s earth is not a promising sorbent for the reclamation of ester liquids.

BackgroundDuring the second wave of the COVID-19 pandemic in India, the Ministry of Ayush conducted a community study to provide therapeutic care to patients with asymptomatic, mild, and moderate COVID-19 in home isolation based on the empirical evidence generated on the efficacy of AYUSH-64 in COVID-19.ObjectiveTo document disease characteristics, care-seeking behavior, and outcomes in patients with asymptomatic, mild, or moderate COVID-19 in home isolation who used AYUSH-64 for COVID-19.MethodsCross-sectional analysis of the data generated through a community study conducted in India from 08 May to 31 August 2021 was performed to study the disease characteristics, care-seeking behavior during home isolation, clinical outcomes, adverse events, and the association between various risk factors and clinical recovery during the study period. The data were collected through semi-structured questionnaires, available in electronic data collection format at the baseline, 7, 14, and 21 days. A logistic regression was performed to explore the relationship between relevant variables and clinical recovery.ResultsData from 64,642 participants were analyzed for baseline assessment, and final analysis was done for 49,770 participants. The mean age of the enrolled participants was 38.8 ± 11.7 years, and 8.4% had co-morbidities. AYUSH-64 was utilized as an add-on to the standard care by 58.3% of participants. Comparable clinical outcomes were observed in participants utilizing AYUSH-64 either as a standalone or as an add-on to standard care, in terms of clinical recovery, disease progression, the requirement for oxygen supplementation, hospitalization, ICU admission, and need for ventilator support. Younger age, having no co-morbidities or substance abuse, and having been vaccinated were associated with early clinical recovery than those who were older and not vaccinated.ConclusionsThe study findings suggest that AYUSH-64 use, either standalone or as an adjunct to standard care, in asymptomatic, mild, or moderate COVID-19 is associated with good clinical outcomes. Ayush services and interventions can be effectively integrated into the mainstream public health architecture to serve public health goals.

Background There is a paucity of data on the feasibility of same‐day discharge (SDD) following transcatheter aortic valve implantation (TAVI) at a national level. Methods and Results This study used data from the Nationwide Readmission Database from the fourth quarter of 2015 through 2019 and identified patients undergoing TAVI using the claim code 02RF3. A total of 158 591 weighted hospitalizations for TAVI were included in the analysis. Of the patients undergoing TAVI, 961 (0.6%) experienced SDD. Non‐SDDs included 65 814 (41.5%) patients who underwent TAVI who were discharged the next day, and 91 816 (57.9%) discharged on the second or third day. The 30‐day readmission rate for SDD after TAVI was similar to non‐SDD TAVI (9.8% versus 8.9%, P=0.31). The cumulative incidence of 30‐day readmissions for SDD was higher compared with next‐day discharge (log‐rank P=0.01) but comparable to second‐ or third‐day discharge (log‐rank P=0.66). At 30 days, no differences were observed in major or minor vascular complications, heart failure, or ischemic stroke for SDD compared with non‐SDD. Acute kidney injury, pacemaker implantation, and bleeding complications were lower with SDD. Predictors associated with SDD included age

Background: Detection of latent tuberculosis infection (LTBI) in children, exposed to tuberculosis (TB) infections, followed by appropriate treatment, could be instrumental in reducing TB burden. Interferon Gamma release assays (IGRA) have higher specificity than tuberculin skin tests (TST), hence are more effective option for diagnosis. Hence, the present study was aimed to diagnose the presence of latent TB in children with the help of a new Standard E TB-Feron Enzyme-Linked Immunosorbent Assay (TBF) and evaluating its efficiency as compared to TST and Quantiferon TB Gold plus (QFT Plus). Methods: Diagnosis of LTBI in participants,

This paper reviews relevant facts and statistics about the benefits and impacts of the growing use of chemical fertilizer with a focus on soil fertility, crop productivity, and alternative sources of biofertilizers. Agriculture in Ethiopia is the main source of the economy, and it is the key contributor of the export value and provider of raw materials to processing industries. However, Ethiopian agronomical production is characterized by low output, lack of infrastructure, and low level of technology and is enormously dependent on rainfall availability. In Ethiopia, soil fertility reduction is evolving as a serious contest causing low crop yields, and research findings reported that, at the country level, nutrient balance indicated a depletion rate of 122 kg N ha−1 yr−1, 13 kg P ha−1 yr−1, and 82 kg K ha−1 yr−1. To control soil fertility depletion, primarily fertilizers are used as the source of essential plant nutrients. In Ethiopia, the use of chemical fertilizers to increase crop production was low relative to other developing countries; however, now, it is steadily increasing. Urea and diammonium phosphate are common practices for maintaining soil fertility. Chemical fertilizer consumption increased from 12 kg/ha in 1996 to 36.2 kg/ha in 2018. The main cereals’ production increased from 16.5 quintal/ha in 2009 to 23.94 quintal/ha in 2018.

Abstract This study exclusively focused on the potential application of an inexpensive and sustainable waste macro-algal biomass as an adsorbent for biosorption of copper ions from aqueous medium. After extraction of agar from brown macro-marine algae Gelidiella acerosa, the residual biomass without any further treatment was used as an adsorbent for the expulsion of copper from wastewater. Physicochemical parameters of biosorption like initial pH, initial concentration of Cu(II) solution and biosorbent dosage were optimized using response surface methodology. The maximum copper biosorption potential of 96.36% was observed at optimum conditions of pH of 5.31, initial concentration of 23.87 mg/l and biosorbent dosage of 0.41 g/l. Adopting FTIR and SEM techniques, the surface morphological features of biosorbent were studied. The pseudo-second-order kinetic model was found to be a proper approach to describe biosorption kinetics. All these results confirmed that spent G. acerosa could be considered as an efficient, eco-friendly and economic alternative for Cu(II) removal from aqueous solution.

Introduction: Polymerisation shrinkage stresses developed during curing of adhesive resin cements may cause debonding at the margins of cavity leading to microgap formation with secondary caries and consequently restorative failure. Thus, a restoration should have good marginal integrity and wear resistance to obtain high success with clinical longevity. Aim: To compare the influence of thermo-mechanical stresses on marginal quality and wear of class II Mesio-Occluso-Distal (MOD) restorations filled with Solare Sculpt or Cention N. Materials and Methods: An in vitro study was conducted at GITAM Dental College and Hospital, Visakhapatnam on 80 human extracted mandibular molars by preparing mesioocclusal-distal class two cavities that restored either with Solare Sculpt or Cention N resin composites. Baseline evaluations were recorded for marginal gaps (in µm) through Scanning Electron Microscope (SEM), and the weights of the samples were recorded by an electronic balancing instrument to measure the amount of wear (in grams). Following thermo-mechanical cyclic loading, all the restored teeth were evaluated again to record the same parameters. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) programme for windows version 22.0 (IBM, NY) software. An independent t-test for intergroup comparison and a dependent t-test for intragroup comparisons were done to analyse the tested parameters with the significance level established at (p≤0.05). Results: In intergroup comparison, no difference in marginal adaptation was observed before thermo-mechanical loading between two materials with a p-value of 0.3625, but after thermomechanical loading Cention N exhibited significantly superior marginal adaptation with a p-value of 0.0374. Both the materials have shown a significant difference in the marginal adaptation after thermo-mechanical loading in the intragroup comparison with Cention N (0.0002) and Solare sculpt (0.0001) p-values. The wear rate was not different statistically between the materials with a p-value of 0.7144 before thermo-mechanical loading and 0.2285 after thermo-mechanical loading. Conclusion: Marginal adaptation of Cention N was superior to Solare Sculpt, whereas both the materials exhibited a similar wear rate.

Background: Inflammatory bowel diseases (IBD) associated-chronic inflammation and autonomic dysregulation may predispose to arrhythmias. However, its exact prevalence is unknown. Thus, we aimed to ascertain the prevalence of arrhythmias in patients with IBD. Methods: We queried the Nationwide Inpatient Sample (the largest publicly available all-payer inpatient USA database) from 2012 to 2014. We used the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) discharge codes to identify adult patients (⩾18 years) with IBD and dysrhythmias (supraventricular tachycardia (SVT), atrial fibrillation, atrial flutter, ventricular tachycardia (VT), or ventricular fibrillation). Furthermore, we identified risk factors for cardiovascular disease. We divided patients into 2 cohorts, IBD cohorts, and non-IBD cohort. The independent effect of a diagnosis of IBD on the risk of dysrhythmias was examined using a multivariable logistic regression model controlling for multiple confounders. Results: We identified 847 235 and 84 757 349 weighted hospitalizations among patients with IBD and non-IBD cohorts, respectively. Patients with IBD were less likely to be hospitalized for dysrhythmias than the non-IBD (9.7% vs 14.2%, P

Postpartum pulmonary hypertension (PPPHT) is an extremely rare disorder, with few reported cases. Late diagnosis and treatment are associated with significant morbidity and mortality. We present an 18-year-old female patient who presented four-week postpartum with a typical submissive pulmonary embolism picture subsequently diagnosed as postpartum pulmonary hypertension. The patient had an excellent response to treatment, with a dramatic improvement in her functional status. The authors aim to urge physicians to keep this rare disorder in mind as timely and accurate diagnosis is crucial for management—additionally, the importance of counseling patients about the imminent risks associated with planned future pregnancies.

Background. The spread of carbapenem-resistant A. baumannii (CrAb) is gaining worldwide attention. The spread of this pathogen is largely due to its ability to acquire various resistance genes of intrinsic and extrinsic origins that confer unpredictable susceptibility to β-lactams. The aim of this study was to analyze β-lactamase genetic compositions of CrAb in Malaysia. Methods. Whole-genome sequencing (WGS) was carried out on 13 CrAb isolates from clinical samples in Malaysia from 2011 to 2016. Results. Endotracheal aspirate was the dominant clinical sample source (n = 6), and only one isolate was obtained from wound swab. A total of 6 sequence types (STs) of the Oxford scheme were identified, including 4 reported STs and 2 novel STs. Eleven isolates were classified into clonal complex 92 (CC92/ICII), among which ST195 and ST208 were the most prevalent STs. All 13 CrAb isolates harbored multiple β-lactamase genes. blaOXA-23 (n = 13) and blaOXA-66 (n = 11) were the dominant carbapenemase gene families found in these isolates. All isolates harbor blaADC, blaOXA-51-like, and blaOXA-23-like genes. blaTEM (n = 7), blaNDM-1 (n = 3), blaCARB-8 (n = 1), and blaPER-3 (n = 1) are amongst other β-lactamase genes found in this study. ISAba1 was found upstream to blaOXA-23 (n = 13), blaOXA-66 (n = 1), and blaADC (n = 11). All blaNDM-1 isolates had ISAba125 (mobile genetic element) upstream to the genes. All isolates were positive for Tn2006/2008 and Tn2009 but were negative for Tn2007. Conclusion. Most of the isolates were grouped under the CC92 clonal complex which belongs to international clonal lineage 2. These findings predict that carriage of carbapenem-resistant genes possibly constitutes the underlying basis of high level of international clone II prevalence. Therefore, molecular surveillance and antimicrobial stewardship are essential in implementing policies to prevent and control the spread of CrAb in hospital settings.

Ochronosis is the deposition of homogentisic acid in connective tissues resulting in bluish black discolouration. Hereby a case of ochronosis over the palmar surface of hand in 41-year-old male patient has been reported. Histopathological examination revealed yellowish brown colouration of collagen bundles in reticular dermis over palm of hand.

Introduction. Leptospirosis is an acute febrile illness, known for its protean clinical manifestations and the challenge in differentiating from other infectious diseases. Standardized confirmatory test is antibody dependent and not accessible by the suburban community. This study measures efficiency of an immune-chromatographic assay, Leptocheck WB, in detecting acute leptospirosis. Methods. A total of 142 sera were used for kit evaluation. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated by comparing rapid kit results with gold standard laboratory, microscopic agglutination test (MAT). Results. We found this rapid kit to have a sensitivity and specificity of 66.6% and 78.9%, respectively, whereas the PPV and NPV of the kit appeared to be 73.3% and 73.2%, respectively. Discussion. Test efficiency of this rapid kit is reasonable. It is specific in detecting leptospiral antibody and assures clinician of accurate diagnosis by having higher PPV and NPV. It is prompt and efficient in comparison with conventional methods in assisting differential diagnosis. High sensitivity and specificity leptospirosis rapid test is indeed a crucial measure to assist the diagnosis of acute undifferentiated febrile illnesses.

A 26-year-old pregnant woman in her first trimester presented with progressive fatigue. Her Electrocardiogram showed second degree heart block (Mobitz type II) with intermittent complete heart block. We decided to proceed with dual-chamber permanent pacemaker implantation using CARTO mapping system to avoid fluoroscopy exposure. A mapping catheter was inserted through the right femoral vein. An electro-anatomical map of cardiac chambers was created using the mapping catheter. Through left axillary vein access, the two pacemaker leads were successfully positioned guided by the electro-anatomical map. No complications were noted post procedure. Pacemaker was functioning appropriately at follow-up visits.

Introduction: The restoration of structurally compromised endodontically treated teeth pose most challenging adhesive restorative procedure and controversies still exist about which material or technique are best for their restoration. Aim: To evaluate the push-out bond strength of two fiber post systems luted with self-etch adhesive after phosphoric acid conditioning of the root dentin at two different storage periods. Materials and Methods: Eighty mandibular premolars with single straight canals, decoronated at cementoenamel junction were endodontically treated and post spaces of 8 mm were prepared. Root samples were randomly divided into two groups; Groups 1 and 2 (n=40 each) according to the storage period and four subgroups (n=10 each) depending on the type of fiber post (subgroups A and C: glass fiber posts, B and D: carbon fiber posts) cemented. In subgroups A and B, fiber posts were luted with self-adhesive (Rely X U200) cement. In C and D subgroups, 37% phosphoric acid etching of the root dentin was done prior to cementation of the posts. After one month and 12 months storage period, uniform root slices were obtained for all the specimens with the help of a diamond saw and the slices were subjected to push-out test. The results were analysed with twoway ANOVA and Tukey’s multiple post-hoc test. Results: The 37% phosphoric acid etching significantly improved the bond strength of fiber posts luted with self-adhesive resin (p

Electrical discharge machining (EDM) is one of the earliest non-traditional machining processes, based on thermoelectric energy between the workpiece and an electrode. In this process, the material is removed electro thermally by a series of successive discrete discharges between two electrically conductive objects, i.e., the electrode and the workpiece. The performance of the process, to a large extent, depends on the material, design and manufacturing method of the electrodes. Electrode design and method of its manufacturing also affect on the cost of electrode. Researchers have explored a number of ways to improve electrode design and devised various ways of manufacturing. The paper reports a review on the research relating to EDM electrode design and its manufacturing for improving and optimizing performance measures and reducing time and cost of manufacturing. The final part of the paper discusses these developments and outlines the trends for future research work.

In this paper, a comparison for the effect of different arrangement of point masses on vibroacoustic behavior of parabolic tapered annular circular plate with different taper ratios are analyzed by keeping the total mass of the plate plus point masses constant. Three different arrangement of thickness variation are considered. The mathematical tool FEM using ANSYS is used to determine the vibration characteristic and both FEM and Rayleigh integral is used to determine the acoustic behavior of the plate. Further, Case II plate (parabolic decreasing increasing thickness variation) for all combination of point masses is found to have reduction in natural frequency parameter in comparison to other cases of parabolic tapered plate. In terms of acoustic behavior, sound power levels of different cases of plate with different point mass combination are observed. It is observed that the Case II plate with two point masses combination shows the highest sound power and the Case III plate for all cases of point mass combination is least prone to acoustic behavior. Furthermore, It is observed that at low forcing frequency average radiation efficiency of parabolic tapered plate for different arrangement of point masses is almost same, but at high forcing frequency average radiation increases for higher taper ratio. Finally, a brief discussion of peak sound power reduction and actuation for different arrangement of point masses with different taper ratios are provided.

Systemic sclerosis (SSc) is a chronic autoimmune multisystem disorder characterized by endothelial dysfunction and fibroblast dysfunction, which results in progressive fibrosis of the skin and internal organs more frequently the lungs and gastro intestinal tract. Pulmonary involvement is common in the course of SSc, with Interstitial Lung Disease (ILD) and Pulmonary Arterial Hypertension (PAH) being the leading causes of death. Here we report, case of an elderly female patient presenting with Diffuse SSc with multiple uncommon pulmonary manifestations like ILD with Usual Interstitial Pneumonia (UIP) pattern (usually less common), PAH and right sided pleural effusion.

Background: Bronchial asthma is a chronic disorder of the airways. Bronchial asthma can be broadly categorized into atopic and nonatopic based on the immunological status, which may be helpful to plan appropriate treatment. In this study, the cytokine profile of the blood was estimated to evaluate the difference between the atopic and the nonatopic asthmatics. Aim: The aim was to document the differences in cytokine (IL-6, TNF-α, and IFN-γ) imbalance in asthmatics with high serum immunoglobulin E (IgE) levels compared to those with normal serum IgE. Materials and Methods: Thirty confirmed bronchial asthmatics (17 men, 13 women) were included in this study. The serum levels of IgE, IFN-γ TNF-α, and IL-6 were measured using the enzyme-linked immunosorbent assay technique. They were divided into two groups based on serum IgE: asthmatics with normal serum IgE levels as group A (n = 7) and high IgE levels as group B (n = 23). Results : The differences in the mean values of IgE, TNF-α, and IFN-γ were statistically significant between the groups. These values were significantly higher in group B compared to group A. IL-6 was not significantly different between the groups. In group A, IL-6 was negatively correlated with IgE and IFN-γ. IgE and IFN-γ were positively correlated. In group B, IFN-γ and TNF-α showed a high correlation of +0.93. Conclusion : Two groups of asthmatics stratified according to their serum IgE levels were immunologically different showing different profiles of serum cytokine levels and the relationship between the cytokines.

This paper compares the vibroacoustic behavior of a tapered annular circular plate having different parabolic varying thickness with different combinations of rectangular and concentric stiffener patches keeping the mass of the plate and the patch constant for a clamped-free boundary condition. Both numerical and analytical methods are used to solve the plate. The finite element method (FEM) is used to determine the vibration characteristic and both Rayleigh integral and FEM is used to determine the acoustic behavior of the plate. It is observed that a Case II plate with parabolic decreasing⁻increasing thickness variation for a plate with different stiffener patches shows reduction in frequency parameter in comparison to other cases. For acoustic response, the variation of peak sound power level for different combinations of stiffener patches is investigated with different taper ratios. It is investigated that Case II plate with parabolic decreasing⁻increasing thickness variation for an unloaded tapered plate as well as case II plate with 2 rectangular and 4 concentric stiffeners patches shows the maximum sound power level among all variations. However, it is shown that the Case III plate with parabolically increasing⁻decreasing thickness variation with different combinations of rectangular and concentric stiffeners patches is least prone to acoustic radiation. Furthermore, it is shown that at low forcing frequency, average radiation efficiency with different combinations of stiffeners patches remains the same, but at higher forcing frequency a higher taper ratio causes higher radiation efficiency, and the radiation peak shifts towards the lower frequency and alters its stiffness as the taper ratio increases. Finally, the design options for peak sound power actuation and reduction for different combinations of stiffener patches with different taper ratios are suggested.

IntroductionData are limited on the degree of mild troponin I elevation and clinical risk factors in predicting myocardial ischemia.MethodsHospitalized adult patients who underwent myocardial perfusion imaging (MPI) from 2015 to 2016 at Rochester General Hospital and had mild troponin I elevation (>0.1 and