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A musculoskeletal disorder is an injury that affects the human body's movement or musculoskeletal system, including muscles, tendons, ligaments, nerves etc. Ayurveda understands the ailment in detail like etiological factors, marma-chikitsa, a traditional therapy for managing vital points and specific panchakarma to manage ailments effectively without any side effects. Acharyas said 107 marmas are classified into five varieties based on their structure, location, and effect of an injury. Anatomically marma is the junction point of mamsa, sira, snayu, asthi & sandhi; they are named as their dominancy. Marma is a special concept described in Sushruta Samhitas, knowing this, one can be a good physician and surgeon. Snayu is a vital structure that helps maintain joints' stability during movement, and all joints are bind together by snayu. Snayu is like the tendon, ligament, nerve, and muscle tissue. There is 27 snayu marma covered under ten names and scattered all over the body. They are Aani (4), vitap (2), kakshadhar (2), kurcha (4), kurchashir (4), vasti (1), and kshipra (4), amsa (2), vidhur (2), utkshepa (2). Injury to snayu marmas will cause shortening, debility of the body part, inability to perform their action, severe pain, causes more harm to the body than harm to these marma like asthi, sandhi, peshi, sira. It is necessary to have detailed knowledge of snayu marma and its structure to rule out causative pathophysiology behind the formation of such deformities and minimize their occurrence in future.

The pandemic of COVID 19 had tremendous impact on the physical, mental as well as the social well being of the people. It has affected the respiratory, cardiovascular as well as endocrine system. Menstruation which is a regular cyclical phenomenon seem in females of reproductive age group has also been affected because of COVID-19. A study was conducted in Dhiraj hospital to know about the affect of COVID on menstrual patterns of the women who were affected . At the end of the study we observed that the women who recovered from covid infection suffered from altered menstrual pattern in form of scanty menstrual blood flow and, prolonged cycles, few women experienced menorrhagia with excessive amount of blood loss. When followed up for 4 months almost all women regained their normal pattern of menstrual cycle suggesting that the covid 19 infection had transitory effect on menstrual pattern.

Background and Objective: A new pathogen of high contagious abilities named Corona virus was seen to target pregnant women due to physiologic changes in their immune system, cardiopulmonary and coagulation system leading to poor fetus-maternal outcome. Thus, to determine maternal and fetal outcome in pregnant women affected with COVID-19 and its frequency of vertical transmission is the main objective of the study. Methods: This is a prospective study of 50 pregnant women with RTPCR confirmed COVID-19 infection between 1st March 2021 and 1st August 2021. The foetal and maternal outcome, frequency of vertical transmission, mode of delivery, presenting symptoms and Level of serum markers such as LDH and CRP were noted. Results: Among 50 patients, 68% delivered through Caesarean section 34% delivered vaginally. The most common presenting symptom was fever in 50% patients. Other symptoms were running nose, headache, myalgia, loss of smell and taste.68% patients had raised Serum LDH level and 26% patient had raised Serum CRP level. The maternal condition was taken into account based on source of oxygen saturation by monitoring Spo2 level.

Headache is a prevalent annoying symptom in general practice. Migraine is a common type of headache experienced by the general population. It is a chronic debilitating third most prevalent disease. However, Ayurveda is preventive, and curative science postulates that migraine can be cured, or its episodes can be handled well with ayurvedic medications if the samprapti is adequately understood. Ayurvedic texts mentioned the detailed explanation of shirorooja and its treatment protocol. This review article gives an idea about the ayurvedic and the modern concept of the pathophysiology of migraine, summarises the possible causes for the migraine attacks, and treatment to be done based on understanding the systemic causes, i.e., doshavastha also.

High stillbirth and neonatal mortality are major public health problems, particularly in low-resource settings in low- and middle-income countries (LMIC). Despite sustained efforts by national and international organizations over the last several decades, quality intrapartum and neonatal care is not universally available, especially in these low-resource settings. A few studies identify risk factors for adverse perinatal outcomes in low-resource settings in LMICs. This review highlights the evidence of risk prediction for stillbirth and neonatal death. Evidence using advanced machine-learning statistical models built on data from low-resource settings in LMICs suggests that the predictive accuracy for intrapartum stillbirth and neonatal mortality using prenatal and pre-delivery data is low. Models with delivery and post-delivery data have good predictive accuracy of the risk for neonatal mortality. Birth weight is the most important predictor of neonatal mortality. Further validation and testing of the models in other low-resource settings and subsequent development and testing of possible interventions could advance the field.

Novel strong superacids HMF6 (M=Au, Ir, Os, Re, Ta, W) are proposed and are investigated with the help of DFT/B3LYP method and SDD basis set for 5d transition metals as well as 6-311++G (d) basis set for H and F atoms. These HMF6 superacids are composed with Bronsted/Lewis (MF5/HF). The stabilities of HMF6 are discussed with the help of structure, dissociation energy through HF channel, and normal mode analysis. The ΔEdisso>0 shows that all HMF6 superacids are energetically stable through HF dissociation channel. The gas phase acidity of HMF6 has been calculated by the Gibbs free deprotonation energy. All species of HMF6 belong to superacids having smaller deprotonation energy; 100% concentrated H2SO4 acids however predicted ΔGdep of HAuF6, is nearly equal to ΔGdep of HSbF6. The strength of acidity of HMF6 is closely related to vertical detachment energy (VDE) of their corresponding superhalogen anions $$ \kern0.5em {\mathrm{MF}}_6^{-} $$ . This study provide appropriate path to design new class of superacids which is more acidic than HSbF6. We have also modelled and discussed supersalt by the interaction of Li with MF6 superhalogen.

Infants with gestational age between 22 0/7 and 23 6/7 weeks (referred to as nano-preterm infants) are at very high risk of adverse outcomes. Noninvasive respiratory support at birth improves outcomes in infants born at 24 0/7 to 27 6/7 weeks' gestational age. Evidence is limited on whether similar benefits of non-invasive respiratory support at birth extend to nano-preterm infants.To evaluate the hypothesis that intubation at 10 minutes or earlier after birth is associated with a higher incidence of bronchopulmonary dysplasia (BPD) or death by 36 weeks' postmenstrual age (PMA) in nano-preterm infants.This observational cohort study included all nano-preterm infants at a level IV neonatal intensive care unit who were delivered from January 1, 2014, to June 30, 2021. Infants receiving palliative or comfort care at birth were excluded.Infants were grouped based on first intubation attempt timing after birth (10 minutes after birth and ≤10 minutes as noninvasive and invasive respiratory support at birth groups, respectively).The primary outcome was the composite outcome of BPD (physiological definition) or death by 36 weeks' PMA.All 230 consecutively born, eligible nano-preterm infants were included, of whom 88 (median [IQR] gestational age, 23.6 [23.4-23.7] weeks; 45 [51.1%] female; 54 [62.1%] Black) were in the noninvasive respiratory support at birth group and 142 (median [IQR] gestational age, 23.0 [22.4-23.3] weeks; 71 [50.0%] female; 94 [66.2%] Black) were in the invasive respiratory support at birth group. The incidence of BPD or death by 36 weeks' PMA did not differ between the noninvasive and invasive respiratory support groups (83 of 88 [94.3%] in the noninvasive group vs 129 of 142 [90.9%] in the invasive group; adjusted odds ratio, 2.09; 95% CI, 0.60-7.25; P = .24). Severe intraventricular hemorrhage or death by 36 weeks' PMA was lower in the invasive respiratory support at birth group (adjusted odds ratio, 2.20; 95% CI, 1.07-4.51; P = .03).This cohort study's findings suggest that noninvasive respiratory support in the first 10 minutes after birth is feasible but is not associated with a decrease in the risk of BPD or death compared with intubation and early surfactant delivery in nano-preterm infants.

Unique superhalogen properties of Pt(CN)n complexes (n = 1–6) have been investigated under the quantum chemical formalism. The study involves theoretical calculations for both neutral and anionic forms of Pt(CN)n using density functional theory (DFT) with the hybrid functional B3LYP. In order to improve the accuracy of calculations, 6–311+G(d) basis set was implemented for CN moieties, whereas SDD basis set supplemented with Stuttgart/Dresden relativistic effective core potential was used for Pt atom. Long-range electron correlations in the subject molecules have been accounted for by using Grimme’s dispersion with the D3 damping function. HOMO-LUMO energy band gaps, vibrational frequencies, and dissociation energies of Pt(CN)n complexes have been calculated to investigate their relative stability as well as reactivity. Salt-forming capability of Pt(CN)n complexes has also been analyzed. Reliable low-cost investigations on superacidity properties of associated protonated species have been carried out keeping their industrial applications in mind.

Objective The objective of the study was to assess the efficacy of immediate skin-to-skin care (SSC) versus swaddling in pain response to intramuscular injection of vitamin K at 30 min of birth in neonates. Methods Healthy full-term newborns were enrolled immediately after normal vaginal delivery and randomized in two groups, SSC and swaddling. Neonatal Infant Pain Scale (NIPS) was measured before, immediately after and at 2 min after the injection. Results Total 100 newborns were enrolled in the study (50 in each group). The mean (SD) birth weight of newborns in the SSC and swaddling group was 2668 (256) and 2730 (348) g, respectively. NIPS was comparable between the SSC and swaddling at before [1.78 (0.58) vs. 1.96 (0.83), p = 0.21], and immediately after the injection [4.82 (0.72) vs. 5.08 (0.75), p = 0.08]. NIPS at 2 min after the injection was significantly low in the SSC group compared to the swaddling group [1.38 (0.70) vs. 2.88 (1.00), p Conclusion Immediate SSC was more efficacious as compared to swaddling as a pain control intervention while giving vitamin K injection. Clinical Trial Registration The trial is registered with the Clinical Trial Registry of India with Registration number: CTRI/2020/01/022984.

Introduction: If the direction of the cervical canal is known, the commonly performed procedures as sono salpingography, embryo transfer, IUD insertion, cervical dilation etc. will be easier. The reported resultant trauma to the cervical canal and uterus during these procedures also can be avoided. As we know the cervical canal is tortuous in majority of cases, but the exact course is not yet reported or known. Objective: The objective of the present study was to try to identify the various directions of cervical canal while performing routine hysteroscopic surgeries. Methods: Four-point cervical canal direction was assessed while performing routine hysteroscopic procedures using 5fr Bettocchi operative assembly with 2.9 mm 12-degree telescope (Karl-Storz). The study group was patients with infertility who required hysteroscopy and laparoscopic evaluation as per infertility treatment protocol or else required hysteroscopy for AUB. The study was carried out at tertiary care referral hospital for minimal access surgeries for a period was of 2 yr. 9 months year from May 2017 to Feb 2020. Results: Down-right or left-up-straight combination of movement (DRUS, DLUS) was the most common cervical direction found in 72 % patients. If DURS (down-up-right-straight) movement is added these 3 movements together are seen in about 82% of patients. No cervical dilation is required when 5 fr hysteroscopic assembly was used in study group. No operative complications were found. Conclusion: DRUS and DLUS (down-right or left-up and straight) combination of movements are most frequent direction of cervical canal observed in 72% of patients.

To compare skin-to-skin care (SSC) and oral sucrose for preterm neonatal pain control. Preterm neonates (28–36 weeks gestation) requiring heel-stick were eligible. In group-A, SSC was given 15-min before first heel-stick, and sucrose was given 2-min before second heel-stick. In group-B, the sequence was reversed. Blinded premature infant pain profile (PIPP) score assessment was done at 0, 1, and 5-min of heel-stick by two assessors. A hundred neonates were enrolled. The inter-rater agreement for the PIPP score was good. The behavior state component was significantly lower in the sucrose group at all assessment points. The mean (SD) difference between 1-min and 0 min was similar [SSC 3.58(3.16) vs. sucrose 4.09(3.82), p = 0.24] between groups. The PIPP score attained baseline values at 5-min in both groups. Albeit sucrose indicated instantaneous action, SSC and sucrose have comparable clinical efficacy for preterm neonatal pain control. Multisensory stimulation with SSC may result in a higher behavioral state component of the PIPP score.

OBJECTIVE To assess outcomes and factors influencing outcomes in neonates requiring cardiac surgery in India. METHODS This study reports on review of hospital data from a tertiary care cardiac surgical institute from January-2009 to December-2015. RESULTS A total of 200 neonates were included; of them, 5% of the cases were antenatally diagnosed and most of them had unmonitored transport (111, 55.5%). The overall mortality rate was 13.5%, (n=27) and 178 (89%) underwent complete defect repair. There was a significant association of mortality with shock, the number of inotropes, intra-operative procedure, residual lesion, aortic cross-clamp and deep hypothermic circulatory arrest time (all P

The reference structure was simulated by SCAPS-1D simulator. The simulation result showed the effect of CIGS thickness, band gap and effect of EBR on the cell performance. From the simulation it could be seen that all parameters were sharply affected below CIGS thickness of 1000 nm due to increase of recombination velocity at back contact and poor absorption. Open circuit voltage was improved by CIGS thickness and band gap. Reference structure showed 18.78% efficiency after simulation with CIGS thickness of 3000 nm and band gap of 1.15 eV. The back electron reflector (EBR) had been inserted to reduce the effect of back contact recombination. With EBR cell performance was significantly improved. The proposed structure showed 19.30% efficiency with CIGS thickness of 1000 nm.

OBJECTIVES Our objective with this quality improvement initiative was to reduce rates of severe intracranial hemorrhage (ICH) or death in the first week after birth among extremely preterm infants. METHODS The quality improvement initiative was conducted from April 2014 to September 2020 at the University of Alabama at Birmingham’s NICU. All actively treated inborn extremely preterm infants without congenital anomalies from 22 + 0/7 to 27 + 6/7 weeks’ gestation with a birth weight ≥400 g were included. The primary outcome was severe ICH or death in the first 7 days after birth. Balancing measures included rates of acute kidney injury and spontaneous intestinal perforation. Outcome and process measure data were analyzed by using p-charts. RESULTS We studied 820 infants with a mean gestational age of 25 + 3/7 weeks and median birth weight of 744 g. The rate of severe ICH or death in the first week after birth decreased from the baseline rate of 27.4% to 15.0%. The rate of severe ICH decreased from a baseline rate of 16.4% to 10.0%. Special cause variation in the rate of severe ICH or death in the first week after birth was observed corresponding with improvement in carbon dioxide and pH targeting, compliance with delayed cord clamping, and expanded use of indomethacin prophylaxis. CONCLUSIONS Implementation of a bundle of evidence-based potentially better practices by using specific electronic order sets was associated with a lower rate of severe ICH or death in the first week among extremely preterm infants.

OBJECTIVE To test the hypothesis that an Apgar score at 10 minutes is independently predictive for death or moderate or severe disability. METHODS A secondary analysis of the Optimizing Cooling Trial (NCT01192776) including 347 infants with ≥36 weeks’ gestational age at birth and hypoxic-ischemic encephalopathy and 18- to 22-month outcomes from 18 US centers in the National Institute of Child Health and Human Development Neonatal Research Network. The primary outcome was the composite of death or moderate/severe disability at 18 to 22 months of age. Generalized estimating equation models were used to examine the relationship between Apgar scores and outcomes, controlling for center, hypothermia treatment, and severity of hypoxic-ischemic encephalopathy (HIE). Classification and regression tree analyses were conducted to identify combinations of variables available during resuscitation that were most predictive for the composite outcome and death. RESULTS The study revealed that 50% (13 of 26) of infants with a 10-minute Apgar score of 0 survived; 46% (6 of 13) had no disability, 16% (2 of 13) had mild disability, and 38% (5 of 13) had moderate or severe disability. The 10-minute Apgar score of 0 was independently associated with death or moderate or severe disability (adjusted relative risk = 1.72, 95% confidence interval 1.11–2.68, P value = .016), but the area under the curve analysis (AUC) was low (AUC = 0.56). The predictive accuracy improved when the 10-minute Apgar score was combined with other risk variables available during resuscitation by using a classification and regression tree analysis (AUC = 0.66). CONCLUSIONS A 10-minute Apgar score of 0 alone does not predict the risk of death or moderate or severe disability well. The current study provides evidence in support of the 2020 American Heart Association/International Liaison Committee on Resuscitation recommendation for continuing resuscitative efforts for infants who need cardiopulmonary resuscitation at 10 minutes after birth.

To determine the impact of neuroprotection interventions bundle on the incidence of severe brain injury or early death (intraventricular hemorrhage grade 3/4 or death by 7 days or ventriculomegaly or cystic periventricular leukomalacia on 1-month head ultrasound, primary composite outcome) in very preterm (27sup0/7/supto ≤ 29sup6/7/supweeks gestational age) infants.Prospective quality improvement initiative, from April 2017-September 2019, with neuroprotection interventions bundle including cerebral NIRS, TcCOsub2/sub, and HeRO monitoring-based management algorithm, indomethacin prophylaxis, protocolized bicarbonate and inotropes use, noise reduction, and neutral positioning.There was a decrease in the incidence of the primary composite outcome in the intervention period on unadjusted (N = 11/99, pre-intervention to N = 0/127, intervention period, p lt; 0.001) and adjusted analysis (adjusted for birthweight and Apgar scorelt;5 at 5 min, aOR = 0.042, 95% CI = 0.003-0.670, p = 0.024).Neuroprotection interventions bundle was associated with significant decrease in severe brain injury or early death in very preterm infants.

ImportanceActive postnatal care has been associated with center differences in survival among periviable infants. Regional differences in outcomes among periviable infants in the US may be associated with differences in active postnatal care.ObjectiveTo determine if regions with higher rates of active postnatal care will have higher gestational age-specific survival rates among periviable infants.Design, Setting, and ParticipantsThis cohort study included live births from 22 to 25 weeks’ gestation weighing 400 to 999 g in the US Centers for Disease Control and Prevention (CDC) WONDER 2017 to 2020 (expanded) database. Infants with congenital anomalies were excluded. Active postnatal care was defined using the CDC definition of abnormal conditions of newborn as presence of any of the following: neonatal intensive care unit (NICU) admission, surfactant, assisted ventilation, antibiotics, and seizures. Data were analyzed from August to November 2022.Main Outcomes and MeasuresRegional gestational age-specific survival rates were compared with rates of active postnatal care in the 10 US Health and Human Services regions using Kendall τ test.ResultsWe included 41 707 periviable infants, of whom 32 674 (78%) were singletons and 19 467 (46.7%) were female. Among those studied 34 983 (83.9%) had evidence of active care, and 26 009 (62.6%) survived. Regional rates of active postnatal care were positively correlated with regional survival rates at 22 weeks’ gestation (rτ[8] = 0.56; r2 = 0.31; P = .03) but the correlation was not significant at 23 weeks’ gestation (rτ[8] = 0.47; r2 = 0.22; P = .07). There was no correlation between active care and survival at 24 or 25 weeks’ gestation. Regional rates of both NICU admission and assisted ventilation following delivery were positively correlated with regional rates of survival at 22 weeks’ gestation (both P rτ[8] = 0.60; r2 = 0.36; P = .02).Conclusions and RelevanceIn this cohort study of 41 707 periviable infants, regional differences in rates of active postnatal care, neonatal intensive care unit admission, provision of assisted ventilation and antenatal corticosteroid exposure were moderately correlated with survival at 22 weeks’ gestation. Further studies focused on individual-level factors associated with active periviable care are warranted.

The perinatal and neonatal periods are the periods of considerable organ development and maturation. Perinatal and neonatal illnesses can result in mortality and morbidities that burden families and the healthcare system. Outcome prediction is essential for informing perinatal and intensive care management, prognosis, and post-discharge interventions. The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) research databases include hospital and neurodevelopment follow-up outcomes of infants with various underlying diseases and conditions receiving intensive care, providing a unique opportunity to assess outcome risk prediction. The NRN has developed outcome risk prediction tools for use in infants with various diseases and conditions that allow data-driven, transparent discussions to inform family-focused communications and clinical management. This review presents the published neonatal outcome risk prediction research from the NRN, their present clinical utility, and possible future directions for advanced individualized risk prediction.

To evaluate outcomes of preterm infants

Introduction: Knowledge of change in the duration of stages of labour would be an essential step to reduce the increasing rates of cesarean section reported worldwide. Objective: To study the rate of cervical dilation in the 1st stage of labour in spontaneous and induced labour and in primigravida and multigravida with singleton pregnancy. Methods: A prospective observational study conducted at a multispeciality hospital was carried out for a period of 3 years from Jan 2017 to Dec 2019. A total of 640 patients who were admitted with spontaneous and induced labour having singleton pregnancy with cephalic presentation and intact membranes after 34 weeks who delivered vaginally were included for analysis. Progression of labor in the 1st stage of labour was measured by the rate of cervical dilation as noted by serial per vaginal examination and findings were plotted in partograph. Result: The difference between mean rate of cervical dilation in the study group is statistically significant between 4 - 6 cm and 6 - 10 cm (P ). When primigravida & multigravida patients were compared for the cervical dilation rate, statistically significant difference was seen between 4 - 6 cm but not in 6 - 10 cm. Average rate of cervical dilatation was 3.44 (Standard Deviation (SD) = 1.84) in spontaneous labor while average rate of cervical dilatation was 2.69 (SD = 1.18) in induced labor between 6 - 10 cm of cervical dilatation. Conclusion: The active phase of labour starts at 6 cm of cervical dilation in the majority of the patients. In multigravida, cervix dilates at faster rate before 6 cm. In induced labour cervix dilates at a slower rate than spontaneous labour after 6 cm dilation.

Background: The use of barbed suture in laparoscopic surgery is increasing ever since 2008. Published reports of use of unidirectional barbed suture for vaginal vault closure following total laparoscopic hysterectomy (TLH), indicates it is safe. Despite of this many reports of adhesions and bowel obstruction are reported. This complication was never assessed in relation to amount of suture exposure at vaginal vault. We thought of quantifying the barbed suture exposure at vaginal vault and assess the risk of post-operative complications. Objective: The objective was to quantify the exposure of barbed suture at vaginal vault by adopting a uniform technique of vault suturing and assessing postoperative risk related to adhesions at vaginal vault. Method: In 30 patients who underwent TLH, a uniform new technique of vaginal vault closure using barbed suture was used and the portion of suture exposed at vaginal vault was quantified. The patients were followed up for a period of 6 months to assess post-operative risk of adhesions at vault and sequalae. Result: Mean length of suture exposed was 2.64 ± 1.65 mm only. Suture exposure at vaginal vault was seen in 23 (76.67%) out of 30 patients. The suture was exposed on average at 1.57 ± 1.20 places at vaginal vault. Conclusion and Recommendations: The study with an accepted relative error of 5% quantifies barbed suture exposure at vaginal vault. We had adopted a uniform new method of vaginal vault suturing to study and to quantify barbed suture exposure. It was observed that very minimal portion of suture was exposed at vaginal vault. It was exposed at only a couple of places at vaginal vault. Thus, decreasing suture exposure at vaginal vault will reduce its exposure related risk.

It has been observed that the lab-based calibration coefficients of a satellite instrument differ in the actual in-orbit operation due to different environmental conditions. The lab-based coefficients are measured when all the components of the satellite instrument are in thermal equilibrium, while during in-orbit operations, there may be significant variations in temperature between various components as well as the diurnal temperature gradients of subsystems, especially in the geostationary platform due to midnight sunray intrusion. This article proposes a new technique to measure the in-orbit calibration coefficients using the collocated matchup data at different electrooptical module temperatures of the INSAT-3D/3DR imager counts and hyperspectral sounder radiances such as Advanced InfraRed Sounder (AIRS) and Infrared Atmospheric Sounding Interferometer (IASI) that are considered as the reference instruments. The radiances generated by new calibration coefficients show less bias and standard deviations for all infrared (IR) channels of INSAT-3D and INSAT-3DR when compared with the convolved radiances generated from the AIRS and IASI radiances using the procedure established by the Global Space-based Intercalibration System (GSICS).

Unicentric Castleman’s disease (UCD) is localized lymphoproliferative disease and has favourable prognosis. Surgery offers complete cure of unicentric Castleman disease. Radiotherapy offers either complete response or variable clinical response and cure in selected patients. The present case report is of a young unmarried obese girl presented with pain in right iliac fossa for 2 months. On pelvic ultrasound and MRI performed for diagnosis only single enlarged right external iliac lymph node was the positive finding. The CT scan guided biopsy was performed and the histopathological finding was lymphoid lesion-reactive lymphoid hyperplasia is favoured over Hodgkin’s lymphoma. Successful laparoscopic complete excisional surgery was performed for this single enlarged external iliac lymph node. The final histopathological report of the lymph node removed was unicentric Castleman’s disease, hyaline vascular type. This is the 16th such reported case of pelvic retroperitoneal UCD of hyaline vascular type treated by surgical excision, and 3rd case treated by Laparoscopic excisional surgery. By now at the time of reporting this case 4 months of follow up has been completed and patient does not have any symptom nor not show any sign of residual disease locally on transabdominal ultrasound examination and whole-body PET CT scan is also normal.

Uterine myometrial arteriovenous malformations (AVM) are reported on color doppler ultrasonography as mosaic pattern of blood flow with different peak systolic velocities (PSV) at different places. High PSV within the AVM may require arterial embolization as treatment. However, we present a case of traumatic AVM with incomplete abortion managed by hysteroscopic cold knife evacuation. This case report is of a young patient with off and on vaginal bleeding for 3 1/2 months following 2nd trimester spontaneous abortion. She had undergone dilation and evacuation (D & E) for incomplete abortion. Now the bleeding was heavy and intermittent not responding to medications. The subsequent TVS examination shows incomplete abortion with myometrial AVM with high PSV. Hysteroscopic cold knife removal of products of conception resulted in immediate resolution of Uterine AVM.

The present work has been carried to analyze the changes in trend of temperature, water vapor and ozone profiles at different atmospheric layers, total column integrated methane (TCH4) and total column integrated carbon-monoxide (TCO) over the Indian region. The atmospheric column was divided into few atmospheric layers: surface-850 hPa, 850–500 hPa, 500–100 hPa, 100–50 hPa and 50–1 hPa. Monthly averages of these parameters were calculated from AIRS Level 2 Standard Products for a decade from 2003 to 2012. A non-parametric statistical test with seasonal modification was applied to check the trends of various parameters. Monthly means were used to examine the seasonal dependency in the trend, and allowing more information from the data to be used. The layer average temperature in surface-850 hPa layer has shown significant increase in overall annual trend over eastern part, southern part and averaged over whole India with an increase of 0.041 K/year, 0.034 K/year and 0.034 K/year, respectively. The overall trend was decreasing over all but southern parts in 100–50 hPa layer at the rate of 0.079 K/year over whole India. For water vapor trends, it has been found that layer integrated water vapor (LIWV) in surface-850 hPa layer has significant overall increasing trend over western part, southern part and averaged over whole India with the rate of increase of 0.555%/year, 0.598%/year and 0.486%/year respectively. For LIWV (850–500 hPa), only western part has significant increasing trend at a rate of 0.879%/year. However, LIWV in 500–100 hPa layer does not show any significant trend. Total water vapor (TWV) has shown significant annual increasing trend over all the parts except over the central part. The increasing trend has been estimated as 0.962%/year over whole India. The layer integrated ozone (LIOZ) in surface-850 hPa has significant increasing trend over western part (0.062%/year) and southern part (0.071%/year). In 500–100 hPa layer, the LIOZ has statistically significant decreasing trend over whole India at a rate of 0.112%/year. For LIOZ averaged over whole India in 100–50 hPa, there is significant decreasing trend with a rate of 0.273%/year. Overall, the ozone concentration is increasing near surface, whereas it is decreasing in lower stratosphere. The total column ozone (TOZ) has not shown any significant trend. The column integrated methane has shown an increasing trend (0.366%/year) over all parts of the country, whereas, TCO has not shown any significant trend.

Molecular Docking and complete quantum chemical studies of 1-{[(Z)-Cyclopentylidene] amino}-3-phenylthiourea have been done by using DFT/ B3LYP method and 6-311 G (d, p) as the basis set. We have compared optimized geometry of title molecule with experimental data. A detailed interpretation of the vibrational assignments of title molecule is reported. Molecular Electrostatic Potential (MESP) generated by a chemical species is widely used as a tool for exploring its properties and locating potential sites for interaction with other moieties. Nonlinear optics (NLO) is the branch of optics that describes the behavior of materials in nonlinear media. In quantum chemistry, a natural bond orbital or NBO is a calculated bonding orbital with maximum electron density. Time-dependent density functional theory (TDDFT) is a quantum mechanical theory used in physics and chemistry to investigate the properties and dynamics of many-body systems in the presence of time-dependent potentials, such as electric or magnetic fields.The electronic properties of title molecule are discussed with help of molecular FHOMO, FLUMO composition, band gap, and MESP plots. The NLO, NBO, UV spectra of title molecule also calculated with same level of theory. Some biological parameter Log P and Log S are also calculated which suggests that the title molecule have good ability to deliver drugs in various diseases.

The majority of perinatal and neonatal mortality occurs in low-resource settings in low- and middle-income countries. Access and quality of care at delivery are major determinants of the health and survival of newborn infants. Availability of basic neonatal resuscitation care at birth has improved, but basic neonatal resuscitation at birth or high-quality care continues to be inaccessible in some settings, leading to persistently high perinatal and neonatal mortality. Low-resource settings of high-income countries and socially disadvantaged communities also suffer from inadequate access to quality perinatal healthcare. Quality improvement, implementation research, and innovation should focus on improving the quality of perinatal healthcare and perinatal and neonatal outcomes in low-resource settings. The current review presents an update on issues confronting universal availability of optimal resuscitation care at birth and provides an update on ongoing efforts to address them.

Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease that occurs in preterm infants, usually those receiving substantial respiratory support with either mechanical ventilation or supplementation with oxygen. The pathogenesis of BPD is multifactorial, and the clinical phenotype is variable. BPD is associated with substantial mortality and short- and long-term morbidity. The incidence of BPD has remained stable or increased, as advances in neonatal care have led to improved survival of more extremely preterm infants. Extensive basic science, translational, and clinical research focusing on BPD has improved the current understanding of the factors that contribute to BPD pathogenesis. However, despite a better understanding of its pathophysiology, BPD continues to be challenging to prevent and manage adequately. The current review aims to provide a clinically useful synopsis of evidence on the prevention and management of BPD in preterm infants.

We demonstrate silicon-based integration of an optical pulse waveform analyzer using a pulse-induced nonlinear spectral change which succeeded in reconstruction of an optical pulse waveform reflected by a slight chirp change in an optical pulse.

Background: Word hemi-hysterectomy and removal of rudimentary functional horn may be used interchangeably in published data. The same term may be used when a non-obstructive hemi-uterus is removed when there is an associated pathology. The article tries to standardise classification of Mullerian dysgenesis where this procedure is required according to ESHRE ESGE classification, preoperative diagnosis and discuss the operative details. Objective: The objective was to study the demographic profile, symptoms, association of endometriosis, variation in the anatomy, accuracy of preoperative diagnosis, to classify according to ESHRE ESGE classification and to standardize the laparoscopic surgical steps of hemi-hysterectomy. Study Design: This is a retrospective case series of cases of Mullerian dysgenesis with obstructive hemi-uterus or non-obstructive hemi-uterus with pathology treated by laparoscopic hemi-hysterectomy. (Canadian task force classification III). Methods: Data from hospital electronic records of all cases tagged with word laparoscopic hemi-hysterectomy were collected for 9 years from Jan 2009 to Dec 2018. Results: Total 19 patients of hemi-hysterectomy were analysed. Pre-operative diagnosis was made in 100% of patients. 100% patients with obstructive horn had dysmenorrhoea. ESHRE ESGE class U4aC3V0 was more frequently seen followed by U5aC4V4 and U3bC3V2 as obstructive and U4bC3V0, as non-obstructive. Associated endometriosis along with other pathology was seen in 74% of the patients. 3 patients with HWWS had ipsilateral renal agenesis. Laparoscopic hemi-hysterectomy was offered to all such patients. The operative steps & variants were studied. Post-operative outcome was uneventful in all. Conclusion: An experienced surgeon should deal with these problems of Mullerian dysgenesis discussed in this study. The other variants diagnosed also must be treated by an experienced surgeon only. Laparoscopic hemi-hysterectomy is almost the most standard surgical method to treat pelvic pain in cases with rudimentary non-communicating horns or in cases of non-obstructive horns with other associated pathologies. Post-operative recovery is uneventful, and all patients reported pain free periods as well as they are free of chronic pain which they had before surgery.

The paper focusses on providing the awareness of smart manufacturing utilizing simulation through modelling in order to facilitate data analytics. Data analytics related to manufacturing will prove its noteworthy benefits to processes involved in industry. Models simulated for manufacturing techniques can be utilized to facilitate data analytics in numerous ways. The provision offered in Mastercam offer programmers to support models simulated to various sectors like logistics, management, transportation, health systems and manufacturing making simulation tool a popular one. It provides three types of stages of process knowledge namely a machine level, a shop level and a universal level. The universal level is related to the knowledge of a process independent of machine or individual shop which facilitates the process. Furthermore, analogous process knowledge like shape capabilities of machining and manufacturing processes offers to progress processes involved in manufacturing through Mastercam.

In this paper a complete quantum chemical study of [1,2,4]-triazolo [3,4-b][1,3,4] thiadiazole has been done with the combination of DFT/B3LYP method and 6-311G(d, p) basis set. The vibrational assignments are calculated with the help of PED. By using quantum theory of atoms in the molecule (QTAIM) we have calculated topological parameters at BCP point by which the nature of several intermolecular hydrogen bondings are studied. Electronic properties are calculated with the help of HOMO-LUMO plot. Chemical active sites of title molecule are described by FF, chemical hardness, chemical softness etc. UV spectra are calculated with the help of TDDFT using optimized parameters. NBO analysis gives idea about transfer of charge between bonding and antibonding electrons. Biological activity analysis suggests that the molecule can be used in anti- inflammatory drugs to explore new drugs. The molecule is docked with MBNL1 receptor with the help of Swiss-Dock online server with Full fitness score of −541.58 a.u. Keywords: QTAIM, DFT, TDDFT, HOMO, LUMO, MESP, UV, MBNL1, NBO

To compare the efficacy of SSC with oral Sucrose for pain management in preterm neonates. Parallel-group, assessor-blinded randomized control trial conducted from February-June 2017 at a level 3B-NICU. Hundred preterm neonates (29-0/7 to 36-6/7 weeks gestational age) requiring heel-stick were randomly assigned (1:1), to SSC (50, Group-A) and Sucrose (50, Group-B). In Group-A, SSC was provided at least 10 min before the procedure. In Group-B, 0.2 ml of oral Sucrose was provided 2 min before the procedure. Blinded assessment of Premature Infant Pain Profile (PIPP) score was done 30 s post-procedure using recorded videos. Baseline variables were [Mean(SD)] gestational age [32.79(2.34) weeks], age [14.04(11.10) days] and birth weight [1.62(0.35) kilograms]. PIPP score was less in group- A vs. B but could not achieve statistical significance [Mean(SD): 7.74(2.43) vs. 8.1(2.82), p = 0.50 CI of the difference: (−1.40,0.68)]. SSC and Sucrose have comparable efficacy in managing pain in premature neonates.

HIV-associated nephropathy (HIVAN) is an AIDs-related disease of the kidney. HIVAN is characterized by severe proteinuria, podocyte hyperplasia, collapse, glomerular, and tubulointerstitial damage. HIV-1 transgenic (Tg26) mouse is the most popular model to study the HIV manifestations that develop similar renal presentations as HIVAN. Viral proteins, including Tat, Nef, and Vpr play a significant role in renal cell damage. It has been shown that mitochondrial changes are involved in several kidney diseases, and therefore, mitochondrial dysfunction may be implicated in the pathology of HIVAN. In the present study, we investigated the changes of mitochondrial homeostasis, biogenesis, dynamics, mitophagy, and examined the role of reactive oxygen species (ROS) generation and apoptosis in the Tg26 mouse model. The Tg26 mice showed significant impairment of kidney function, which was accompanied by increased blood urea nitrogen (BUN), creatinine and protein urea level. In addition, histological, western blot and PCR analysis of the Tg26 mice kidneys showed a downregulation of NAMPT, SIRT1, and SIRT3 expressions levels. Furthermore, the kidney of the Tg26 mice showed a downregulation of PGC1α, MFN2, and PARKIN, which are coupled with decrease of mitochondrial biogenesis, imbalance of mitochondrial dynamics, and downregulation of mitophagy, respectively. Furthermore, our results indicate that mitochondrial dysfunction were associated with ER stress, ROS generation and apoptosis. These results strongly suggest that the impaired mitochondrial morphology, homeostasis, and function associated with HIVAN. These findings indicated that a new insight on pathological mechanism associated with mitochondrial changes in HIVAN and a potential therapeutic target.