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The increase in population led to a scarcity of water. There are lots of diseases and problems that are affecting the environment and human life. This is increasing day by day. This causes lots of hazards in our world. To treat wastewater, we have lots of methods. In spite of this, it is very expensive, not affordable to the masses, and also not properly treated; therefore, we use natural methods to treat the wastewater in a way that does not harm our environment. To avoid this situation, there is a solution: using vetiver grass and lemon grass to treat wastewater. As a result of this method, we are able to determine a number of parameters, such as pH, turbidity, conductivity, alkalinity, DO, BOD, COD, and T.T. The coliforms are analyzed to identify changes before and after treatment. With the rapid growth of urbanization and industrialization, there is a high intake of water and a great generation of wastewater. This study aims to find the most cost-effective method for wastewater treatment and compare it to the conventional method of wastewater treatment. The conventional method is not suitable in rural areas as it is highly expensive. The foundation and improvement of a healthy life through water are two of the most important fundamentals. Using vetiver and lemon grass for wastewater treatment has been proven to be a sustainable and cost-effective alternative to conventional wastewater treatment technologies. In this study, an attempt is made to find the effectiveness of vetiver grass and lemon grass in a laboratory for pollutant removal from wastewater. Various characteristics of wastewater before and after treatment have been checked to study the comparative effectiveness of these two plants. Removal efficiencies of parameters like pH, conductivity, chemical oxygen demand, biological oxygen demand, dissolved oxygen, total coliform, turbidity, and E. coli are analysed.

Background: Intravenous regional anaesthesia (IVRA) is a simple, effective method of anaesthesia for surgical procedures on the extremities. Major limitations are tourniquet pain, short duration of block and absence of post-operative analgesia. Buprenorphine is known to improve the quality of anaesthesia. Aim of this study is to evaluate the efficacy of buprenorphine as an adjuvant to lignocaine in IVRA. Methods: Sixty patients between 18-60 years age, belonging to the ASA grade 1, 2 undergoing upper limb surgeries were enrolled into the study. Patients belonging to group BL patients received 10 ml of preservative free lidocaine 2% diluted to 40 ml. Group BB-patients received 10 ml of preservative free lidocaine 2% mixed with 60 mcg of buprenorphine diluted to 40 ml. Onset of sensory and motor block; recovery time and postoperative analgesia were noted. Data were analyzed using chi-square test, independent ‘t’ test. Results: The onset time of both sensory and motor block were significantly shortened, the recovery of sensory and motor block was prolonged, the incidence of tourniquet pain was comparatively lesser and there was significantly increased duration of post-operative analgesia in the buprenorphine group. Haemo-dynamic parameters were similar in both groups Conclusions: Sixty mcg buprenorphine as an adjuvant to lidocaine in IVRA effectively enhances the anaesthesia and post-operative analgesia.

This tutorial review provides a general overview for the design of prodrugs and activatable phototherapeutics which enables the development of improved therapies.

A set of proline-diacylhydrazine hybrid molecules were designed and synthesized. Their conformational analyses showed a synergistic relationship between n → π* and nN → π*Ar interactions, which played a key role in Xaa–Pro trans amide bond stabilization.

Following COVID -19 infection people are prone for developing bacterial, viral and fungal infections. The main reasons highlighted for increased susceptibility to infection are severe COVID -19 infection and use of immune suppressants. We had 3 cases of cryptococcal meningitis where two patients had mild COVID -19 and one had asymptomatic COVID -19. Evaluation for immune suppression revealed persisting pan lymphocyte depletion in one patient, isolated CD4 depletion in second patient and underlying HIV infection in the third patient with a very low CD4 count of 11 which was totally asymptomatic till then. Cryptococci is a ubiquitous pathogen and both innate and adaptive immunity is important in eradicating infection. COVID -19 per se as well as the various treatment modalities given in COVID -19 infection disrupts the immune system making people vulnerable for opportunistic infections. Even mild COVID -19 infection can predispose such diseases. A brief description of innate and acquired immune mechanisms preventing cryptococcal infection and how this is altered in COVID -19 infection is highlighted in this article. Post COVID patients when come with infections, unusual pathogens also should be considered. Unusual infection when occur in immune competent people, asymptomatic COVID -19 infection should also be ruled out. Keywords: CD4 cytopenia, Pan lymphocyte depletion, Cryptococcal meningitis, Cryptococcus, Covid 19 infection

Renewable sources like biofuels have gained significant attention to meet the rising demands of energy supply. Biofuels find useful in several domains of energy generation such as electricity, power, or transportation. Due to the environmental benefits of biofuel, it has gained significant attention in the automotive fuel market. Since the handiness of biofuels become essential, effective models are required to handle and predict the biofuel production in realtime. Deep learning techniques have become a significant technique to model and optimize bioprocesses. In this view, this study designs a new optimal Elman Recurrent Neural Network (OERNN) based prediction model for biofuel prediction, called OERNN-BPP. The OERNN-BPP technique pre-processes the raw data by the use of empirical mode decomposition and fine to coarse reconstruction model. In addition, ERNN model is applied to predict the productivity of biofuel. In order to improve the predictive performance of the ERNN model, a hyperparameter optimization process takes place using political optimizer (PO). The PO is used to optimally select the hyper parameters of the ERNN such as learning rate, batch size, momentum, and weight decay. On the benchmark dataset, a sizable number of simulations are run, and the outcomes are examined from several angles. The simulation results demonstrated the suggested model's advantage over more current methods for estimating the output of biofuels.

Brain tumor is a deadly disease for which proper treatment should be given. Brain tumor detection is usually done with the help of analyzing MR images. Accurate brain tumor detection is important for effective treatment. VGG16 and DenseNet are two popular CNN algorithms used widely in medical fields in order to detect diseases from medical images. VGG-16 supports 16 layers. It has three fullyconnected layers.It is capable of classifying thousand images of thousand different categories. DenseNets are divided into different dense blocks in which there are dense connections between layers through dense blocks. All the layers are connected using matching feature- map sizes and it works in a feed-forward nature. Each layers obtain additional inputs from all preceding layers and passesits own feature-maps to all subsequent layers. The proposed system has five major stages, namely, image pre-processing, image enhancement, image segmentation, brain tumor image classifica- tion using VGG-16 and brain tumor image classification using DenseNet. This work compares the performances of both vgg- 16 and DenseNet algorithms and find out which algorithm gives better accuracy in detection. Pre-trained vgg-16 and DenseNet models are used and around 4000 MRI scan images are used for testing and training.

Fluorescent techniques have attracted significant attention in bioimaging, analyte sensing, and disease diagnosis in recent years. Conventional fluorescent chemosensors provide significant advantages in monitoring/detecting different analytes; however, physiological or experimental factors may influence the single-targeted fluorophore absolute intensity-dependent signal acquisition, which can be cause misleading and strong non-specific background signals in molecular sensing and imaging applications. The simple alternative to minimize these non-specific effects is a ratiometric measurement strategy. This is a self-calibration method for recording two or more analyte-induced signals, in which one signal is a reference factor to normalize other signals. Due to its self-calibrating internal standard system obtained from the ratio between two or more emission bands, ratiometric approaches have become the most effective fluorescence method for quantitative analysis measurements, compensating for a number of analyte-independent parameters and eliminating most ambiguities that may affect the fluorescence signal. In particular, by taking advantage of various photophysical/chemical sensing theories, ratiometric fluorophores successfully endow structural design for detection of biologically/environmentally important analytes. This chapter will highlight the basic principles and design strategies of ratiometric fluorescent chemosensors, including photophysical/chemical sensing mechanisms based on different molecular types (i.e., small molecules and nanoparticles) with appropriate examples.

Background : Recent clinical studies have identified a significant increase in the incidence and severity of ankle fractures in the elderly population. Kannus et al reported that between 1970 and 2000 there was a three-fold increase in the number of ankle fractures among Finnish patients over 70 years old [1]. In addition, the authors demonstrated an increase in the more severe Lauge-Hansen supination-eversion stage four fracture, compared to more stable ankle fracture patterns in this elderly patient population. In the data available from the United States, ankle fractures have been reported to occur in as many as 8.3 per 1000 Medicare recipients, a figure that appears to be rising steadily [2] . There continues to be controversy within the orthopaedic community regarding the optimal management of geriatric ankle fractures. Operative fixation has been proven to be a safe and effective method of managing unstable ankle fractures in younger patients [3 ] . However, certain authors have recommended conservative treatment in older patients, based on poor surgical outcomes secondary to osteoporosis, diabetes, peripheral vascular disease and skin issues commonly seen with advanced age [4, 5, 6, 7] . Recommendations on appropriate management also appear to differ based on geographical location, evidenced by a recent study by Koval et al [2] . The authors demonstrated that the percentage of ankle fractures in patients older than 65 treated with surgical stabilization varied considerably in various parts of our country. The current paper reviews the complex issues associated with ankle fractures affecting the geriatric patient population, focusing on risk factors for fracture and surgical versus nonsurgical management. 30 patientsMethods: with closed displaced bimalleolar ankle fractures presenting to Dr B R Ambedkar medical college casualty from September 2020 to February 2022 who underwent surgery were taken into the study . The maximum studyResults: population belonged to the geriatric age group .At the end of follow-up (64.8%) had excellent clinical result, (35.2%) had good clinical result, and no patient had a poor functional outcome. For the radiological assessment, there were 20 patients (66.6%) with excellent, 7 (23.3%) with good, 3(10.%) with fair, while none with poor resu :Conclusion Treatment bimalleolar ankle is challenging because of limited soft tissue cover, poor bone quality with osteoporosis and less vascularity. There are various treatment options for these fractures starting from closed reduction with casting to open reduction and internal fixation with a plate. The excellent functional results and lack of soft tissue complications suggest that a surgical management with CC screw and plating should be considered as an option in bimalleolar ankle fractures. A balance between anatomical reduction and soft tissue stripping is required to avoid any complications.

Background: Tibial plateau fractures are one of the commonest intra-articular fractures. They result from indirect coronal or direct axial compressive forces. This makes about 1% of all fractures and 8% of the fractures in elderly. Nevertheless, tibial plateau fractures challenging remain because of their number, variety and complexity. With advancements the treatment of each fracture type is still not defined hence we have taken up this study to analyze various fracture patterns and its outcome. : The study includes 40 patients having the fractures of the proximal tibialMethods metaphyseal; metaphyseodiaphyseal with or without intra-articular extension (including upper third fractures of tibia), closed fractures, fractures with Open grade-I wounds (Gustillo Anderson Classification).The study excludes compound fractures having grade II and III (Gustillo Anderson) and Paediatric patients. The treatment method was based on the type of fracture, the amount of displacement , the amount of depression and surrounding skin condition of the tibial plateau.We used the Schatzker classification because it is closest to describing the specific fracture type and it is easy to apply. In this study there were 40 patients with mean age of 39.18 (median 38.5 and min – max 25 to 55) with 25Results: male (62.5%) and 15 (37.5%) female with significant male preponderance. In this study road traffic accident was the commonest mode of injury (65%) and produced different types of fractures, followed by fall from height (22.5%), injury while playing sports (12.5%). The correct method of management of tibial condylar fractures depends onConclusions: good clinical judgment. If rational treatment is to be instituted the surgeon must have sound knowledge of the personality of the injury and a clear understanding of the knee examination, imaging studies and must be familiar with variety of techniques available at present for treating tibial condyle fractures.

Floppy baby is a non-specific and potentially serious multisystem disorder in the neonatal period. Diagnosing hypotonia in a newborn is very difficult as many disorders could manifest with diminished tone. In most cases, medical history and laboratory tests are useful for diagnosis, but they still require advanced research such as whole exome sequencing. The objective of this study was to know the presentation and how we evaluated hypotonia by using basic investigations to comprehensive molecular genetics tests which provides the advantage of the rapidity and diagnostic specificity as a part of the workup. Methods: This study was conducted on infants hospitalised in NICU at a tertiary care centre (Niloufer hospital), Hyderabad, Telangana, India. Clinical presentations, clinical examinations, laboratory tests, imaging, and genetic studies were reviewed. Clinical assessment includes evaluation of muscle tone, primitive reflexes, deep tendon reflexes, resting postures, and maneuvers. We used images and molecular genetic tests in the required cases. Results: Ten babies with hypotonia were studied. The male to female ratio was 6:4. The most common complaint was poor feeding, and other presentations were seizures, tachypnea, and icterus. On examination, all cases had hypotonia with absent DTR, and a few cases had dysmorphism.

Background: High-flow nasal cannula (HFNC) therapy is a relatively non-invasive new therapy for respiratory distress and has shown potential in reducing invasive ventilation. Recent studies have suggested that HFNC therapy can also be effectively and safely used in patients having respiratory distress with a wider age range of severity and etiologies. Aim: To assess the outcomes of patients placed on a high flow nasal cannula as a primary mode of treatment for children with respiratory distress. Methods: This is a prospective observational study was conducted on patients with acute respiratory distress who require hospitalization in Age groups from 1 month to 12 years old between August 2021 and December 2021 at Tertiary Pediatric Center in Hyderabad. The study was approved by the ethical committee and parental consent was obtained prior to initiation. We calculated a sample size of 350 using 0.05 alpha error and 90% power. Statistical analysis was performed using IBM SPSS23 version (IBM 2015) and significance was assessed at the 0.05 level. Results: A total of 362 children (176girls and 186boys) started HFNC therapy. The HFNC failure occurred in 20 (5.5%) children after a median (IQR) time of 2 (1.75-24) hours.

Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for children, elderly, debilitated or distressed patients. Nebulization therapy emerges as a good option in these cases besides being useful in the home care, emergency room and critical care settings. With so many advancements taking place in nebulizer technology; availability of a plethora of drug formulations for its use, and the widening scope of this therapy; medical practitioners, respiratory therapists, and other health care personnel face the challenge of choosing appropriate inhalation devices and drug formulations, besides their rational application and use in different clinical situations. Adequate maintenance of nebulizer equipment including their disinfection and storage are the other relevant issues requiring guidance. Injudicious and improper use of nebulizers and their poor maintenance can sometimes lead to serious health hazards, nosocomial infections, transmission of infection, and other adverse outcomes. Thus, it is imperative to have a proper national guideline on nebulization practices to bridge the knowledge gaps amongst various health care personnel involved in this practice. It will also serve as an educational and scientific resource for healthcare professionals, as well as promote future research by identifying neglected and ignored areas in this field. Such comprehensive guidelines on this subject have not been available in the country and the only available proper international guidelines were released in 1997 which have not been updated for a noticeably long period of over two decades, though many changes and advancements have taken place in this technology in the recent past. Much of nebulization practices in the present may not be evidence-based and even some of these, the way they are currently used, may be ineffective or even harmful. Recognizing the knowledge deficit and paucity of guidelines on the usage of nebulizers in various settings such as inpatient, out-patient, emergency room, critical care, and domiciliary use in India in a wide variety of indications to standardize nebulization practices and to address many other related issues; National College of Chest Physicians (India), commissioned a National task force consisting of eminent experts in the field of Pulmonary Medicine from different backgrounds and different parts of the country to review the available evidence from the medical literature on the scientific principles and clinical practices of nebulization therapy and to formulate evidence-based guidelines on it. The guideline is based on all possible literature that could be explored with the best available evidence and incorporating expert opinions. To support the guideline with high-quality evidence, a systematic search of the electronic databases was performed to identify the relevant studies, position papers, consensus reports, and recommendations published. Rating of the level of the quality of evidence and the strength of recommendation was done using the GRADE system. Six topics were identified, each given to one group of experts comprising of advisors, chairpersons, convenor and members, and such six groups (A-F) were formed and the consensus recommendations of each group was included as a section in the guidelines (Sections I to VI). The topics included were: A. Introduction, basic principles and technical aspects of nebulization, types of equipment, their choice, use, and maintenance B. Nebulization therapy in obstructive airway diseases C. Nebulization therapy in the intensive care unit D. Use of various drugs (other than bronchodilators and inhaled corticosteroids) by nebulized route and miscellaneous uses of nebulization therapy E. Domiciliary/Home/Maintenance nebulization therapy; publichealth care workers education, and F. Nebulization therapy in COVID-19 pandemic and in patients of other contagious viral respiratory infections (included later considering the crisis created due to COVID-19 pandemic). Various issues in different sections have been discussed in the form of questions, followed by point-wise evidence statements based on the existing knowledge, and recommendations have been formulated.

Depression in pregnancy is being recognized as a major contributor to adverse maternal and fetal outcomes. Recent years have seen significant research focused on the development of safe pharmacological methods to treat depression in pregnancy, resulting in the common use of selective serotonin reuptake inhibitors (SSRIs) as a first line of treatment. There have been a few reports of congenital birth defects associated with the consumption of SSRIs during pregnancy, particularly congenital heart defects. Several studies have attempted to evaluate the relationship between SSRI use and congenital heart defects in neonates, but they were inconclusive. In this report, a case where maternal SSRI intake during two consecutive pregnancies was associated with neonatal pulmonary valve stenosis, raising the possibility of a correlation between the usage of a certain SSRI, and a particular congenital heart defect has been described. Keywords: Congenital heart defects, Depression, Pregnancy, Pulmonary valve stenosis, Serotonin uptake inhibitors

Land degradation is one of the most important factors responsible for the alarming situation of food security, human health, and socioeconomic development in the country. Currently, 120.7 M ha of land in the country is affected by land degradation, out of which 85.7 M ha of land is affected by soil erosion caused by water and wind. Moreover, physical, chemical, and biological degradation are the major forms of land degradation in the country. Deforestation or tree cover loss (2.07 M ha) from 2001 to 2021, intensive rainfall (>7.5 mm ha−1), uncontrolled grazing (5.65 M ha), indiscriminate use of fertilizers (32 MT year−1), and shifting cultivation (7.6 M ha) are other major factors that further aggravate the process of land degradation. In order to alleviate the problem of land degradation, numerous agroforestry technologies have been developed after years of research in different agroclimatic zones of the country. The major agroforestry systems observed in the country are agri-horticulture, silvipasture, and agri-silviculture. This review indicates the potential of agroforestry in enhancing carbon sequestration (1.80 Mg C ha−1 year−1 in the Western Himalayan region to 3.50 Mg C ha−1 year−1 in the island regions) and reduced soil loss and runoff by 94% and 78%, respectively, in Northeast India. This can be concluded that the adoption of the agroforestry system is imperative for the rehabilitation of degraded lands and also found to have enough potential to address the issues of food, environmental, and livelihood security. This review’s findings will benefit researchers, land managers, and decision-makers in understanding the role of agroforestry in combating land degradation to enhance ecosystem service in India and planning suitable policies for eradicating the problem effectively.

The small, ubiquitin-like modifier (SUMO) is a post-translational modifier with a profound influence on several key biological processes, including the mammalian stress response. Of particular interest are its neuroprotective effects, first recognized in the 13-lined ground squirrel (Ictidomys tridecemlineatus), in the context of hibernation torpor. Although the full scope of the SUMO pathway is yet to be elucidated, observations of its importance in managing neuronal responses to ischemia, maintaining ion gradients, and the preconditioning of neural stem cells make it a promising therapeutic target for acute cerebral ischemia. Recent advances in high-throughput screening have enabled the identification of small molecules that can upregulate SUMOylation, some of which have been validated in pertinent preclinical models of cerebral ischemia. Accordingly, the present review aims to summarize current knowledge and highlight the translational potential of the SUMOylation pathway in brain ischemia.

Objective: The study aimed to compare the reliability of different cephalometric angles like the Beta, Yen, W and Pi angles to evaluate sagittal dysplasia in various skeletal patterns and assess the correlation between the variables. Materials and Methods: 135 pre-treatment lateral cephalograms were taken and further divided into Class I, Class II and Class III groups. Each group had equal samples of 45 (n=45), based on ANB angle using Nemoceph software. Cephalometric landmarks Pi, Yen, Beta and W angle were identified and measured. Statistical analysis was done using the ANOVA test followed by Correlation coefficient analysis. Results: Pi angle was highly predictable for differentiating class I cases, with 91.1% accuracy. Whereas in class II cases Pi and Beta angle were found to be most predictable with 73% and 66% accuracy respectively, while in class III cases Yen angle was found to be most predictable with 88% accuracy. Conclusion: Overall Pi angle is considered the most reliable for assessing anteroposterior jaw relationship, followed by Beta and Yen angle.

The heat transfer rate from the hot surface to the coolant flow increases by placing the ribs on the surface of the coolant flow passage. The effect of turbulence promoters with different angle of attack and with a fixed tapered angle on the heat transfer characteristics in a rectangular stationary duct is considered for this study. Here turbulence promoters increase the heat transfer in the duct. The examination has been conducted on the rectangular smooth duct and rectangular duct with inverted V-shaped ribs of a different angle of attack. The rib angle attack of 45º, 60º, 90º and tapered angle 20º (fixed) on the top surface of the rib are considered. The rib blockage ratio and pitch ratio are 0.0553 and 10 respectively. The heat transfer characteristics are compared with Reynolds number of 6000. The heat transfer and computational flow analysis are conducted by k-epsilon turbulence model in ANSYS FLUENT. The tapered angled cross-sectional inverted V-shaped ribs of 60º shown high average heat transfer coefficients among the 45º, 60º and 90º smooth duct.

Kidney transplant recipients (KTRs) are at an increased risk of severe disease and death caused by coronavirus disease 2019 (COVID-19) infection. There is a paucity of information on the evolution of graft function among hospitalized KTRs who overcome the infection.The study included adult KTRs at a single transplant institute who were diagnosed with COVID-19 and needed hospitalization between March 15, 2020, and January 15, 2021. We analyzed patient demographics, comorbid risk factors, and inpatient clinical courses for patients who were able to recover from the infection. Kidney function was analyzed pre-infection, during initial hospitalization, and up to 12 months post-infection.We identified 48 KTRs who were diagnosed with COVID-19 infection during the study period. Eighteen KTRs among these needed hospitalization for symptoms of fever and respiratory distress. Four patients died of COVID-19 infection-related complications and were excluded from the study. The 14 remaining patients in the study were predominantly of the Black race (85.7%), with a median time since transplant of four years. Of the patients, 64.3% developed acute kidney injury (AKI), with an average peak serum creatinine (sCr) of 2.6 mg/dl and a glomerular filtration rate (GFR) of 35. The mean sCr and GFR of the group were 2 mg/dl and 44 at baseline (prior to infection). This represented an increase in their sCr and GFR of 34% and 29%, respectively. The median follow-up post-infection was 14.5 months. sCr and GFR were 1.87 mg/dl and 47 at three to six months, and 1.89 mg/dl and 48 at nine to 12 months post-infection. New onset proteinuria was noted in five out of 14 patients (36%), with complete resolution of the same in all at three to six months follow-up. Of patients with AKI, 78% had complete recovery at three to six months follow-up. The mean baseline sCr and GFR of patients who had incomplete recovery was 2.35 and 31.5 with pre-existing proteinuria. Of our entire cohort, there was only one patient who experienced graft loss. This patient had a baseline sCr and GFR of 3.8 mg/dl and 22, existing proteinuria on urinalysis, and a history of biopsy-proven rejection.AKI is common among KTRs who are hospitalized with COVID-19 infection. Most of these recovered, although we noted that patients with baseline lower kidney function and existing proteinuria had a lower recovery rate.