Search

Author(s): Revathy Menon [1]; T. K. Jayakumar [2]; Shubhalaxmi Nayak [1]; Rahul Saxena [1]; Avinash S Jadhav [1]; Kirtikumar J. Rathod (corresponding author) [1]; Manish Pathak [1]; Arvind Sinha [1] [...], Aim: This prospective single-center study aimed to evaluate the nonhepatobiliary applications of indocyanine green fluorescence-guided surgery (ICG FGS) in pediatric patients, assessing its utility as an adjunct for intraoperative imaging. Materials and Methods: Over a 30-month period from January 2021 to July 2023, pediatric patients undergoing various surgical procedures, excluding hepatobiliary cases, were included in the study. ICG (Aurogreen™) was administered intravenously or directly injected in tissue, and fluorescence imaging was conducted using specialized equipment (KARL STORZ GmbH and Co. KG). Patient demographics, diagnoses, surgical procedures, ICG protocols, intraoperative findings, and perioperative outcomes were analyzed. Results: The study included seventeen pediatric cases including Hirschsprung disease, anorectal malformations, undescended testes, varicocele, Mayer-Rokitansky-Kustner-Hauser syndrome, ovarian torsion, chylous ascites, chylothorax, and Wilms' tumor. ICG aided in the real-time assessment of vascular, intestinal perfusion in Hirschsprung disease, anorectal malformations, delineation of lymphatics from vessels in varicocele, confirmation of preserved vascularity after detorsion of ovary, identification of lymphatics for ligation in chylothorax, and chylous ascites. ICG thus aided in precise dissection and confirming tissue viability without reported adverse events. Conclusion: ICG FGS demonstrates significant potential as a tool for enhancing surgical outcomes in pediatric surgeries including indications beyond hepatobiliary cases. The findings suggest that ICG FGS can improve surgical precision by providing real-time assessment of tissue perfusion, and lymphatic mapping, thereby potentially reducing intraoperative complications. Further research and prospective studies are essential to validate its efficacy and establish standardized protocols, aiming to integrate ICG FGS as a routine adjunct in pediatric surgical practice. Keywords: Fluorescence, indocyanine green, lymphangiography

Author(s): Shreyas Krishnamurthy [1]; Arvind Sinha (corresponding author) [1]; Siva Kamesh [1]; Kirtikumar J. Rathod [1]; Rahul Saxena [1]; Manish Pathak [1] INTRODUCTION Congenital lobar emphysema (CLE) is a rare [...], Management of bilateral congenital lobar emphysema (CLE) is challenging and only a few isolated cases are available in the literature for guiding surgeons in managing such cases. We recently managed a child with bilateral CLE and realized that there is an extreme dearth of data available in the literature to guide a surgeon on the management of children with bilateral CLE. We performed a systematic review of the available literature and share our understanding from the same. A 10-month-old child presented to our emergency room with intermittent episodes of tachypnea and respiratory distress since birth. Computed tomography of the chest was suggestive of CLE of the left upper and the right middle lobe (RML) with mediastinal shift toward the right. Left posterolateral thoracotomy and left upper lobectomy were performed and the child was kept in follow-up for RML pathology. After 4 uneventful months, the child was readmitted with respiratory distress. Repeat imaging demonstrated continued RML hyperinflation with atelectatic changes in the adjacent lobes and he subsequently underwent RML ctomy. Our literature review suggests that the infants tolerate sequential thoracotomies better than the single-staged bilateral thoracotomies. Literature suggests that up to a fifth of the patients might not require the second surgery based on the clinical condition of the child on careful follow-up. Our case report and review support staged and a response-based approach to bilateral CLE has a promising outcome. Keywords: Bilateral congenital lobar emphysema, congenital lobar emphysema, staged approach

Purpose: To compare the corneal biomechanical parameters, visual outcome, and epithelial remodeling after small-incision lenticule extraction (SMILE) and photorefractive keratectomy (PRK) for low to moderate myopia. Design: Prospective, interventional, randomized, comparative study. Methods: Eighty eyes of 40 patients undergoing bilateral SMILE or PRK for low to moderate myopia ( Results: At 6 months follow-up, the corrected distance visual acuity as well as the postoperative spherical equivalent of both the groups were comparable (P = 0.13 and P = 0.32, respectively). The biomechanical parameters like deformation amplitude ratio (P < 0.01), inverse concave radius (P = 0.006), integrated ratio (P < 0.01), stress-strain index (P < 0.01), Ambrosio's relational thickness (ArTH) (P < 0.01), and corneal biomechanical index-laser vision correction (P = 0.02) were altered more in the SMILE group than in the PRK group, while the biomechanically corrected intraocular pressure (P = 0.16) was comparable. Epithelial remodeling (P = 0.59), higher-order aberrations (P = 0.53), and stromal keratocyte loss (P = 0.16) in both the groups were comparable. Conclusion: Both SMILE and PRK are comparably effective procedures for correction of low to moderate myopia in terms of visual outcomes; however, the corneal biomechanical stability in PRK is superior than that in SMILE. Keywords: Corneal biomechanics, myopia, PRK, SMILE, Author(s): Shivani Joshi [1]; Aafreen Bari [1]; Chetan Shakkarwal [1]; Tushar Agarwal [1]; Tanuj Dada [1]; Rajesh Sinha [1]; Jeewan Singh Titiyal [1]; Namrata Sharma (corresponding author) [1] There are [...]

Purpose: To compare the visual outcomes of implantable Collamer lens (ICL) with small incision lenticule extraction (SMILE) in cases of moderate-high myopia. Methods: A prospective comparative study was conducted on 60 eyes of 30 patients with moderate-high myopia (-3D to -8D with astigmatism ≤1 D) at a tertiary eye care center. Patients underwent either SMILE or ICL in both eyes and had a postoperative follow-up of 1 year. Results: The manifest refractive spherical equivalent was -5.22 ± 1.05 D and -5.4 ± 1.17 D in the SMILE and ICL groups, respectively (P = 0.53). The mean sphere and cylinder were comparable between the groups. The mean uncorrected visual acuity improved from 1.18 ± 0.19 logMAR to 0.03 ± 0.07 logMAR in SMILE and 1.14 ± 0.25 logMAR to 0.011 ± 0.04 logMAR in the ICL group. The efficacy for SMILE was 83.3% and that for ICL was 93.3%. Safety and predictability (±0.5D) for both was 100%. A significant increase was observed in ocular aberration with a decrease in modular transfer function in the eyes that underwent SMILE, whereas no significant change in the eyes that underwent ICL. A significant difference was observed in all parameters of ocular aberration except corneal trefoil, corneal astigmatism, and PSF between the two groups at the final follow-up. The contrast sensitivity at final follow-up was higher in ICL cases when compared to SMILE. The quality of vision (QoV) score suggested a better QoV with ICL; however, the difference was not statistically significant. Conclusion: Both SMILE and ICL are safe in patients with moderate-high myopia. The efficacy, contrast sensitivity, and postoperative ocular aberration profile are better in cases undergoing ICL. Keywords: Higher order aberrations, ICL, implantable Collamer lens, moderate myopia, refractive surgery, small incision lenticule extraction, SMILE, Author(s): Rajesh Sinha (corresponding author) [1]; Juhi Daga [2]; Pranita Sahay [3]; Vinay Gupta [1]; Tushar Agarwal [1]; Namrata Sharma [1]; Prafulla K Maharana [1]; Sudarshan K Khokhar [1]; Jeewan [...]

Background: Consent is never truly exercised in children as parents act as their proxy and often do not understand the advantages, disadvantages, risks, and benefits of the procedure. Their high anxiety state is mirrored in the child, leading to slower recovery. Hence, this study was designed to understand if an intervention can impact the effect of consent on parents' anxiety, satisfaction, and knowledge. Methodology: A two-arm, parallel design, randomized controlled trial was conducted from March 2020 to March 2022 to analyze the effect of an educational video in comparison to an informational leaflet in parents giving proxy consents for various listed pediatric surgical procedures. Results: Parents in the video group had a higher mean knowledge score (6.97 vs. 6.77, P = 0.40), comparable satisfaction scores (27.45 vs. 27.58, P = 0.88), and statistically insignificant difference between anxiety scores. We noted highest score of satisfaction (28.5/40) in the parents educated up to High School level or less. Knowledge scores were lowest in pelvic-ureteric junction obstruction (5.1/10) patients. Conclusions: Our study done over a period of 2 years included a variety of diagnoses, and the videos and information leaflets were self-designed. It showed comparable anxiety, knowledge, or satisfaction in parents. Studies with more participants would be needed to take this research forward. Keywords: Anxiety, educational video, information leaflet, knowledge, satisfaction, Author(s): Shreyas Dudhani (corresponding author) [1]; Bindey Kumar [1]; Amit Kumar Sinha [1]; Amit Kumar [1]; Rashi Rashi [1]; Gaurav Shandilya [1] INTRODUCTION A consent is considered truly informed only [...]

Author(s): Arvind Sinha (corresponding author) [1]; Somya Bhatt [1] [Please download the PDF to view the inline graphics] Artificial intelligence (AI) is a paradigm-shifting technology that gives robots and computer [...]

ABSTRACT Introduction: Acute appendicitis is a common surgical emergency in children, often requiring imaging for confirmation due to diverse presentations. While computed tomography scan is favored in many centers for its sensitivity, it comes with radiation exposure and higher costs. Ultrasonography, being radiation-free and cost-effective, is gaining popularity, especially in pediatric cases. However, its reported accuracy varies in the literature. This study aims to evaluate the diagnostic accuracy of ultrasonography in pediatric appendicitis cases and to determine its precision in distinguishing between simple and complicated cases of appendicitis. Materials and Methods: A retrospective analysis was conducted on children with suspected appendicitis who presented to the department of pediatric surgery. All patients underwent ultrasonography followed by appendicectomy based on considered clinical decision. Ultrasonography findings were compared with intraoperative observations categorized as uncomplicated or complicated appendicitis. Results: Among 152 patients, ultrasonography accurately diagnosed appendicitis in 94.6 of cases, with 5.38 having nonvisualized appendices. In our group, the sensitivity and specificity of ultrasound to detect appendicitis were 94.62 and 95.65, respectively. The diagnostic accuracy of the test is 95.63. However, in our study, the sensitivity of the ultrasonography to correctly identify if it is a simple or complicated appendicitis was only 54.9 but had a specificity of 98.7. Thus, ultrasonography showed a much lower sensitivity (54.9) in distinguishing between simple and complicated appendicitis. Conclusion: Ultrasonography demonstrates high sensitivity and specificity in diagnosing pediatric appendicitis, making it a promising preoperative investigation. However, it may not accurately differentiate between simple and complicated cases. A comprehensive approach involving clinical and laboratory parameters alongside secondary imaging may be necessary for accurate diagnosis, especially in cases of perforated appendicitis. Keywords: Accuracy, appendicitis, children, pediatric, ultrasound, Author(s): Ayushi Vig [1]; Arvind Sinha (corresponding author) [1]; Taruna Yadav [1]; Shreyas Krishnamurthy [1]; Somya Bhatt [1]; Kirtikumar J. Rathod [1]; Manish Pathak [1]; Rahul Saxena [1]; Pushpinder Singh [...]

ABSTRACT Need and Purpose of Review: Approximately 75 of patients with classic malrotation and midgut volvulus present in neonatal age-group; another 15 may present up to one year. In these, the diagnosis is made because of typical presentation. However, there are many cases in which malrotation has been detected after infancy. In-spite of the variable case reports and studies in literature, there is no specific data on the incidence of malrotation after infancy, its presentation and management guidelines. With this systematic review, we aim to coalesce these findings from various individual case reports and studies. Methods Used for Collecting and Analysing Data: This systematic review was performed as per the PRISMA (preferred reporting items for systematic review and meta-analyses) guidelines. The authors conducted thorough searches in databases like PubMed/MEDLINE, SCOPUS, Google Scholar and Web of Science for relevant articles. Studies were reviewed for clinical presentation and outcome for malrotation diagnosed beyond infancy. Main Conclusions: Clinical presentation of malrotation after infancy can be acute as well as chronic; acute presentation being common under 2 years of age and chronic symptoms present as age increases. Sudden onset of abdominal pain and bilious vomiting are commonest acute symptoms and intermittent episodes of recurring vague abdominal pain associated with vomiting and diarrhoea are the commonest chronic symptoms. The diagnostic modalities vary from UGI Contrast series to USG with colour Doppler and CECT scan. Management is operative open as well as laparoscopic Ladd's procedure is being favoured. Key Messages Presentation of malrotation beyond infancy is infact more than that reported in literature. Timely and appropriate diagnosis of malrotation is essential to avoid gangrene and subsequent gut loss and morbidity. Keywords: After infancy, delayed, malrotation of gut, presentation, Author(s): Charu Sharma [1]; Nitinkumar Bhajandas Borkar (corresponding author) [1]; C. Ashwin [1]; Chandrasen Sinha [2] INTRODUCTION Intestinal malrotation is a rare congenital abnormality, and symptomatic cases are estimated to [...]

Author(s): Shreyas Dudhani (corresponding author) [1]; Amit Kumar Sinha [1]; Rashi Rashi [1]; Keerthana Bachala [1]; Amber Parwaiz [2] INTRODUCTION Neonate with a perineal mass may include a wide variety [...], Neonate with a perineal mass may rarely present with a rectal duplication cyst. The index case presented with a perineal located mass which on evaluation revealed an exstrophied variant of a duplication cyst neonate associated with supernumerary kidney. She was subsequently managed surgically with the resection of mass and a diversion colostomy. It is understood that these extrophic variants are neither cystic nor tubular and maybe attached to the rectum or vagina but do not communicate with it. Previous reports of such rectal cysts are less than ten in number with this being the only one reported with supernumerary kidney. Keywords: Congenital Anomalies of the Kidney and Urinary Tract (CAKUT), enteric duplication cyst, neonate

Author(s): Apurva Gupta [1]; Arvind Sinha (corresponding author) [1]; Kirtikumar J. Rathod [1]; Rahul Saxena [1]; Manish Pathak [1] INTRODUCTION Surgical repair of Morgagni hernia (MH) is recommended due to [...], This case report describes the successful robotic-assisted repair of a large Morgagni hernia in an 8-month-old infant. Using the da Vinci Xi system, the hernial sac was excised, and the patient recovered without complications. It highlights the advantages of robotic surgery, including enhanced optics and precision, for complex hernia repairs in infants. Keywords: Hernia, infant, laparoscopic, Morgagni, robotic

ABSTRACT Background: This study reports the psychometric properties of OUTPASAT-35RT questionnaire from a large Indian cancer cohort treated with ambulatory radiotherapy (RT) at a tertiary-care comprehensive cancer center. Materials and Methods: Adults with a pathologically proven diagnosis of cancer undergoing fractionated RT (≥10 fractions) with the ability to read and understand English, Hindi, or Marathi were accrued after written informed consent. Patients were administered a language-appropriate version of OUTPATSAT-35RT along with European Organization for Research and Treatment of Cancer (EORTC) generic quality-of-life questionnaire (QLQ-C30) at conclusion of RT (±3 days). Psychometric properties of OUTPATSAT-35RT were analyzed. Results: A total of 314 patients were accrued between 2018 and 2020. A negligible floor effect (15) was observed for OUTPATSAT-35RT. Multi-trait analysis revealed satisfactory validity and reliability of the questionnaire. Pearson&apos;s correlation coefficient (PCC) of individual item score with own scale was >0.4 suggesting good convergent validity. Discriminant validity was satisfactory as the PCC with its own scale/own domain was greater than with other scales of the same domain and other domains of OUTPATSAT-35RT, respectively. Correlation of scales of OUTPATSAT-35RT with scales of QLQ-C30 demonstrated acceptable divergent validity (all values of PCC 0.7 suggesting good internal consistency. Test-retest reliability was good with intra-class coefficient being >0.7. Economic status was the only socio-demographic factor correlating significantly with OUTPATSAT-35RT scores; satisfaction of patients with the delivery of care increased with increasing family income. Conclusion: The psychometric properties of OUTPATSAT-35RT were found to be acceptable and satisfactory during validation testing in a large Indian cohort. Keywords: Psychometric, questionnaire, radiotherapy, satisfaction, validation, Author(s): Jifmi J. Manjali [1]; Geyata Keluskar [2]; Ruchi Patel [3]; Nazia Bano [3]; Farnaz Shaikh [3]; Rahat Malhotra [1]; Shaktivel Mani [1]; Anuj Kumar [1]; Shwetabh Sinha [1]; Revathy [...]

Purpose: To compare the changes encountered in corneal biomechanics and aberration profile following accelerated corneal collagen cross-linking (CXL) using hypo-osmolar and iso-osmolar riboflavin in corneal thicknesses of 400 microns, respectively. Methods: This is a prospective, interventional, comparative study involving 100 eyes of 75 patients with progressive keratoconus. Eyes were divided into two groups based on corneal thickness: group 1 included eyes with a corneal thickness of 400 microns who underwent iso-osmolar CXL. Corneal biomechanical and aberration profiles were evaluated and compared between groups. Results: In group 1, all higher-order aberrations (HOA) except secondary astigmatism significantly decreased from baseline; however, in group 2, only coma and trefoil decreased. The corneal resistance factor and corneal hysteresis significantly improved in both groups, which was significantly greater in group 2 than in group 1. The change in inverse radius, deformation amplitude, and tomographic biomechanical index was significantly improved in group 2 as compared to group 1. Conclusion: Improvement in corrected distance visual acuity and decrease in HOA were significantly better in the hypo-osmolar CXL group; however, the improvement in biomechanical strength of the cornea was significantly better in the iso-osmolar group. Keywords: Accelerated collagen cross-linking, corneal biomechanics, higher-order aberration, hypo-osmolar riboflavin, iso-osmolar riboflavin, keratoconus, Author(s): Manumuraleekrishna [1]; Mohamed Ibrahime Asif [1]; Prafulla Kumar Maharana [1]; Ritu Nagpal [1]; Tushar Agarwal [1]; Rajesh Sinha [1]; Jeewan Singh Titiyal [1]; Namrata Sharma (corresponding author) [1] Introduction [...]

The effect of biodeterioration on the structural connection performance of timber for conventional framing and mass timber has been investigated recently, but there is a need for additional data as well as for the development of analytical models to utilize these data. An empirical material model (seismic analysis of wood frame shear walls) was fitted to cyclic connection test data of four species of cross-laminated timber at different levels of biodeterioration by two brown-rot fungi. These model inputs were then analyzed to account for trends between wood species and fungal species. Weak trends were most prominent for initial stiffness, intercept load, and displacement at peak force. Correlations were poor with postyield and postpeak stiffness modifiers. These relationships were consistent both as a function of time and as a function of mass loss, but additional data are needed to more accurately predict the effects. The limited relationships likely reflect the variations in fungal decay across the test members., One of the most used materials in the shift to mass timber construction has been cross-laminated timber (CLT). Substantial research has gone into structural characterization and design with CLT, ranging [...]

Many companies have siloed customer data and an incomplete suite of capabilities, making it impossible for their customer-facing teams to access real-time, synchronized data—and to provide the personalized and seamless experience that business customers crave. Authors Prabhakant Sinha, Arun Shastri, and Sally Lorimer—principals at the global professional-services firm ZS and coauthors of The Harvard Business Review Sales Management Handbook: How to Lead High-Performing Sales Teams (Harvard Business Review Press, 2024), from which this article is adapted—describe how a digital customer hub (DCH) can help. It integrates customer data from various systems into a linked platform, enhancing a company's digital engagement capabilities. The DCH uses analytics and AI to create actionable insights, helping customer-facing teams work smarter and in sync. This article explains how a DCH can "transform the way businesses manage and interact with customers." It also examines the structural choices companies must make when creating one and highlights the potential costs and return on investment. [ABSTRACT FROM AUTHOR]

INTRODUCTION I. BACKGROUND A. The History of Psychedelics B. Psychedelics as Treatment for Mental Illness C. The Psychedelic Renaissance--Recent Push for Psychedelic Reform II. REGULATORY FRAMEWORK FOR PSYCHEDELIC REGULATION A. [...]

Byline: Amit. Raj, Prabhakar. Singh, Kaushik. Sadhukhan, Bhawesh. Chandra, Bhavana. Kranti, Subhash. Kumar, Upasna. Sinha, Pratyusha. Kokkayil, Punam. Bhadani, Prerna. Sinha, Sravani. Sanepalli, Pragati. Tiwari, Jayadev. Nanda Purpose: There has [...]

Although the author’s grandfather founded the largest pharmaceutical company in Bangladesh, she never expected to follow in his footsteps. Raised in Roanoke, Virginia, she studied international development and law before working first as a corporate lawyer and then in the Obama administration. But when her mother fell seriously ill during a family wedding in Bangladesh—and Sinha discovered how difficult it was to get access to quality health care in that country even for well-off, well-connected families—she found a new mission. She developed a business plan for a state-of-the-art, full-service primary-care facility in Dhaka, Bangladesh’s capital city, and moved there—where she’d never lived before—to launch it. She focused on hiring a great team and building a culture around the distinctive service they would offer. Five years later, Praava Health has served 600,000 patients, is cash-flow positive, and continues to grow. INSET: SMILE: Praava's Five Values. [ABSTRACT FROM AUTHOR]

Byline: BY ANTARA SINHA RECIPE BY SHILPA USKOKOVIC PHOTOGRAPHS BY ISA ZAPATA Pepper Party A closer look at a spice that has so much more to offer than heat TEST [...]

Background: Accessible measures specific to the Canadian context are needed to support health system planning for older adults living with frailty. We sought to develop and validate the Canadian Institute for Health Information (CIHI) Hospital Frailty Risk Measure (HFRM). Methods: Using CIHI administrative data, we conducted a retrospective cohort study involving patients aged 65 years and older who were discharged from Canadian hospitals from Apr. 1, 2018, to Mar. 31, 2019. We used a 2-phase approach to develop and validate the CIHI HFRM. The first phase, construction of the measure, was based on the deficit accumulation approach (identification of age-related conditions using a 2-year look-back). The second phase involved refinement into 3 formats (continuous risk score, 8 risk groups and binary risk measure), with assessment of their predictive validity for several frailty-related adverse outcomes using data to 2019/20. We assessed convergent validity with the United Kingdom Hospital Frailty Risk Score. Results: The cohort consisted of 788 701 patients. The CIHI HFRM included 36 deficit categories and 595 diagnosis codes that cover morbidity, function, sensory loss, cognition and mood. The median continuous risk score was 0.111 (interquartile range 0.056-0.194, equivalent to 2-7 deficits); 35.1% (n = 277 000) of the cohort were found at risk of frailty ([greater than or equal to] 6 deficits). The CIHI HFRM showed satisfactory predictive validity and reasonable goodnessof-fit. For the continuous risk score format (unit = 0.1), the hazard ratio (HR) for 1-year risk of death was 1.39 (95% confidence interval [CI] 1.38-1.41), with a C-statistic of 0.717 (95% CI 0.715-0.720); the odds ratio for high users of hospital beds was 1.85 (95% CI 1.82-1.88), with a C-statistic of 0.709 (95% CI 0.704-0.714), and the HR of 90-day admission to long-term care was 1.91 (95% CI 1.88-1.93), with a C-statistic of 0.810 (95% CI 0.808-0.813). Compared with the continuous risk score, using a format of 8 risk groups had similar discriminatory ability and the binary risk measure had slightly weaker performance. Interpretation: The CIHI HFRM is a valid tool showing good discriminatory power for several adverse outcomes. The tool can be used by decision-makers and researchers by providing information on hospital-level prevalence of frailty to support system-level capacity planning for Canada's aging population., Health systems need to make concerted efforts to strengthen care for their aging populations. (1) A particular challenge that jurisdictions face is in the identification and management of age-related conditions, [...]

Byline: Sangam. Jha, Jayanti. Sinha, Ruchi. Sinha Hidradenoma papilliferum (HP) is a rare benign tumor of the apocrine gland and is commonly seen at the anogenital region. A 32-year-old post-hysterectomy [...]

Baaraan Ijlal completed her graduate degree in literature from Bhopal, the former princely state in the center of India, that prides itself on a hundred-year unbroken rule by the Begums [...]

To the Los Angeles Times, March 18, 2024 Your article on the rise of far-right extremists and religious Zionists in Israel explained more than just the age-long settlement goals of [...]

Objectives: This study examines the role of tumor texture on computed tomography (CT) images as a complement to clinical prognostic factors in predicting survival in patients of non-small cell lung carcinoma (NSCLC) treated with radical chemo-radiation (CRT). Methods: A total of 93 patients with confirmed NSCLC treated with CRT accrued in a study approved by the institutional ethics committee were analyzed for CT-based radiomic features. Pretreatment CT images were used to contour the primary tumor and texture features were computed by the image filtration method to differentially highlight fine to coarse textures. Texture parameters included mean intensity, entropy, kurtosis, standard deviation, and mean positive pixel and skewness. Optimal threshold cut-off values of the above tumor texture features were analyzed. These features were explored as imaging biomarkers to predict survival using Kaplan-Meier and Cox proportional hazard model. Results: Median follow-up of the entire cohort was 23.5 months [Interquartile range, IQR: 14-37] while for alive patients, median follow-up was 31 months (IQR: 23-49), 47 (50.6) patients had died at the last follow-up. Univariate analysis revealed certain features like age, gender, response to therapy, and texture features like mean and kurtosis in CT images to be significant predictors of survival. In multivariate analysis, age (P = 0.006), gender (P = 0.004), treatment response (P < 0.0001), and two CT texture parameters: mean (P = 0.027) and kurtosis (P = 0.002) were independent prognostic factors of survival. Interpretation and Conclusion: CT-derived tumor heterogeneity (mean and kurtosis) complements clinical factors for predicting survival in NSCLC patients treated with CRT. Tumor radiomics warrants further validation as potential prognostic biomarkers for these patients. Keywords: Chemo-radiation, computed tomography, imaging biomarker, lung texture analysis, non-small cell lung carcinoma, Author(s): Prashant Nayak [1,2]; Shwetabh Sinha [1,2]; Jayant S. Goda (corresponding author) [1,2]; Arpita Sahu [2,3]; Kishore Joshi [1,2]; Oindrilla Roy Choudhary [2,4]; Ritesh Mhatre [1,2]; Naveen Mummudi [1,2]; Jai [...]

Mass ply panels (MPP), a relatively new mass timber product, has been utilized in several construction projects as diaphragm and wall panels. Connection for MPP is a crucial structural component that requires a better understanding. This article presents an experimental investigation into elevated temperature exposure--driven property degradation of MPP nailed connections, which is important for both the design of new structures in terms of fire resistance and the rehabilitation of structures partially damaged by fire. One control group and 32 exposure groups, which were combinations of eight elevated temperatures and four exposure durations, were investigated. The failure modes and yield strength of the nailed connection were analyzed as a function of elevated temperature and exposure time and compared with the prediction from the National Design Specification and existing literature. The results show a decrease of up to 45 percent in initial stiffness and ultimate load; meanwhile, there was no statistical evidence for the change in yield load in the majority of testing groups. Two analytical models, namely, multilinear regression and first-order kinetics model, were proposed to model the degradation of initial stiffness and ultimate strength. The kinetics model provided a better prediction and suggested that the initial stiffness and ultimate strength of the nail connection degraded over time at rates depending on the exposure temperature., An increasing interest in renewable and sustainable materials and recent advances in engineered wood products have driven the applications of mass timber in mid-rise to tall buildings. Mass ply panel [...]

Byline: Sony. Sinha, Prateek. Nishant, Ranjeet. Sinha Dear Editor, We read with interest the biography of Dr. Dukhan Ram and congratulate the authors for celebrating this stalwart from the Indian [...]

Byline: Prateek. Nishant, Prabhakar. Singh, Amit. Raj, Sony. Sinha Dear Editor, We read with interest the article by Khadia et al .[1] and congratulate the authors for providing important information [...]

Byline: Sony. Sinha, Prateek. Nishant, Arvind. Morya Surgical education is known to follow the master-apprentice paradigm, with the trainee graduating through the 'see one, do one, teach one' method.[1] Resident [...]

Byline: Aprajita. Sinha, Arvind. Morya, Vinita. Gupta, Ripunjay. Prasad Purpose: The goal in developing new techniques of cataract surgery is to provide a safer, more efficient surgical experience with the [...]

Byline: Rupesh. Sikchi, Arvind. Sinha, Manish. Pathak, Kirti. J. Rathod, Avinash. Jadhav, Rahul. Saxena Aim: Patients with hypospadias often present with voiding difficulties after successful repairs. We sought to analyze [...]

Byline: Shreya. Shah, Renu. Sinha, Sana. Hussain, Amit. Kumar, Anju. Gupta Background: Preoperative anxiety (PA) in children is a common phenomenon associated with various negative patient outcomes. Allaying PA is [...]

Byline: Keerthana. Bachala, Bijay. Suman, Shreyas. Dudhani, Ram. Singh, Amit. Sinha Enteric duplication cysts are rare anomalies with an incidence of 1 in 4500.[1] A 2-year-old female child presented with [...]

Byline: Rakhi. Kusumesh, Anita. Ambastha, Lalan. Arya, Anita. Kumari, Neha. Kumari, Bibhuti. Sinha, Nilesh. Mohan, Namrata. Kumari Purpose: To determine the demography, risk factors, and causative organisms of microbial keratitis [...]

Byline: Sony. Sinha, Prateek. Nishant, Arvind. Morya Kim et al . presented an innovative approach to phaco-emulsification in eyes with cataracts and coexisting iris challenges.[1] They demonstrated the use of [...]

Byline: Anand. Vinekar, Archana. Nair, Shivani. Sinha, Tanuja. Vaidya, Rohit. Shetty, Arkasubhra. Ghosh, Swaminathan. Sethu Purpose: To measure the levels of inflammatory factors in tear fluid of pre-term infants with [...]

Byline: Abhilasha. Kumari, Alok. Ranjan, Prateek. Nishant, Sony. Sinha, Ranjeet. Sinha Purpose: The second wave of coronavirus disease 2019 (COVID-19) pandemic triggered a mucormycosis epidemic in India. Diabetes mellitus and [...]

AbstractLymphatic filariasis (LF) caused by the vector borne parasitic nematode Wuchereria bancroftiis of major concern of the World Health Organization (WHO). Lack of potential drug candidates worsens the situation. Presently available drugs are promising in killing the microfilaria (mf) but are not effective as adulticidal therapeutics. Previous studies have revealed that routine administration of the available drugs (albendazole, ivermectin and albendazole) sometime is associated with severe adverse effects (SAEs) in co-infection state. Therefore, potential and safe therapeutics are still required. Earlier studies on filarial thioredoxin reductase (TrxR) have shown that successful inhibition of it can lead to apoptotic death of the parasites. TrxR in filarial parasites plays a significant role in disease progression and pathogenesis, hence efficient non-reversible inhibition of TrxR can be a good strategy to treat LF. In this research, inhibitory potential of Scytonemin, a cyanobacterial metabolite on filarial TrxR was evaluated viadifferent in silicomethods and validated through in vitroexperiments. Parasite death upon exposure to Scytonemin can be correlated with the TrxR inhibiting capacity of the compound. Therefore, this cyanobacterial-derived compound may possibly be used further as novel and safe therapeutic candidate against filarial infection.Communicated by Ramaswamy H. Sarma

Analysis of cyclic voltammetry data has become essential to gain kinetic insights into electrocatalytic reactions, particularly in the field of small molecule activation. In such studies, the shapes of redox waves of the cyclic voltammograms are informative to distinguish between the catalytic and noncatalytic reactions. Kinetic parameters such as turnover frequencies (TOFs), rate constants, etc. can be extracted from the catalytic current–potential profiles. “Foot-of-the-wave” analysis (FOWA) is one such analysis, proposed by Savéant and Costentin, that provides kinetic information on electrocatalytic reactions. Although FOWA has been explained by many others, performing such analysis in practice, especially for new learners, is often intimidating. We present our recently developed web interface that provides a more flexible, reliable, and user-friendly platform for performing FOWA. We also provide step-by-step guidelines and training modules for studying FOWA that could help learners find the rate constant of the electrocatalytic reaction. Furthermore, our web design also provides opportunities to construct comparative catalytic Tafel plots, which are typically used to compare the TOF-overpotential relationship among the catalysts. We have also put efforts into building a database of the kinetic information for reported molecular electrocatalysts; primarily for the electrochemical carbon dioxide reduction reaction and hydrogen evolution reaction. The database can be further extended to other disciplines in electrocatalysis in the future. Overall, we believe that this web platform would benefit the global electrochemistry community, especially aspiring FOWA learners.

The ultraviolet (UV) photodissociation of pyruvic acid through the absorption of solar actinic flux generates methylhydroxycarbene (MHC) in the atmosphere. It is recognized that isolated MHC can undergo unimolecular isomerization to form acetaldehyde and vinyl alcohol. However, the rates and mechanism for its possible bimolecular reactions with atmospheric constituents, which can occur in parallel with its unimolecular reaction, is not well understood. Here we investigate the energetics, kinetics, and mechanism of the reaction of MHC with three ubiquitous atmospheric molecules N2, O2, and H2O over the 160 K-380 K temperature range. Our study, at the CCSD(T)/6-311++G(3df,3pd)//M06-2X/6-311++G(3df,3pd) level, reveals that the MHC + N2encounter is nonreactive, while the MHC + O2reaction, which leads to CH3CO + HO2formation, has a rate that is significantly different from previous estimates. For the MHC + H2O reaction, we find that a single H2O molecule is very effective in catalyzing the isomerization of MHC to form predominantly acetaldehyde. An analysis of the computed rate for this reaction indicates that it will be an important source of tropospheric acetaldehyde ̵ a major pollutant and precursor for atmospheric reactive intermediates. Our findings are in sharp contrast to current assessments in the literature that the MHC + H2O reaction is minor. Furthermore, in the MHC + H2O reaction system, we find that due to the presence of the OH group on MHC, the concerted insertion mechanism, which is typically dominant in reactions involving singlet carbenes, is suppressed relative to a hydrogen bond mediated double hydrogen atom transfer mechanism.

This article introduces the term augmented artificial intelligence (A2I) to emphasize the integration of AI with human judgment and ethical considerations, proposing that if AI underpins the Fourth Industrial Revolution, then A2I should serve as the technology paradigm for the Fifth Industrial Revolution.

Among different natural fibres, Himalayan nettle is gaining importance as reinforcement, an alternative to synthetic fibre, for polymer composite synthesis due to its wide availability, low price, and sustainable production. In this study, untreated (raw) and chemically treated nettle fibres were characterized by standard testing methods to find the best chemical type and concentration for surface modification, as there is not a single chemical treatment equally effective for all kinds of natural fibre. Alkali (3 and 5%), silane (1 and 3%), and hydrogen peroxide (3 and 5%) solutions were used for chemical treatment. The fibres were characterized by compositional analysis, XRD, FTIR, SEM, AFM, single fibre mechanical strength, and physical properties like diameter and fibre density. Among all chemical treatments, 3% alkali–treated fibre showed the maximum tensile strength (571.06 MPa), high cellulose content (83.8 wt%), high crystallinity index (82.55%), lower crystallite size (11.25 nm), highest roughness parameters (788 nm Rmax), lower fibre width, lowest microfibril angle, and higher elongation at break. The tensile strength of 571.06 MPa observed for 3% alkali–treated fibre was significantly high and suitable for reinforcement with polymer matrices. The 3% alkali–treated fibre exhibited the lowest weight loss (61.0%) in 2nd stage thermal degradation and the maximum residual weight (24.31%) at 800°C, indicating improved thermal stability than the other studied fibre samples. Thus, this study justifies the suitability of the 3% alkali treatment for surface modification of the nettle fibre to be utilized in polymer composite synthesis.

The transportation sector has been aiming to reduce the carbon emissions by promoting the use of low emission vehicles. Although the Indian electric vehicle market is dominated by electric two-wheelers and three wheelers, various governmental schemes have boosted the inclusion of electric buses within the urban bus fleet. However, it is essential for the transport authorities to understand the acceptability of the electric buses among the commuters who are not using public transport currently. This paper aims at understanding the preferences of non-public transport users, to assess the probability of them shifting their modal choice towards public transport, and electric buses in particular, within the Indian context. The data has been collected through a Stated Choice experiment from 414 individuals in Ahmedabad. It has been observed that the low-income individuals are found to prefer public transit if the buses are electric with an affordable fare. The results indicate that electrification of urban bus fleet can improve the image of the existing bus services thereby facilitating modal shift towards public transit among the low-income individuals who have shifted to other modes of transport due to the deterioration of the service quality of the existing transit system.

This article presents an integrative review and synthesis of the corporate accelerators (CAs) literature. CAs are a growing phenomenon in the literature on corporate-startup engagements. CAs are cohort-based, time-limited programmes run/sponsored by large established corporations to fuel their open innovation agendas. By participating in these programmes, startups accelerate the commercialisation process of their innovative initiatives. In contrast, large corporations run these programmes to speed up their innovation outcomes and build a creative and entrepreneurial culture within their organisations, empowering them with increased competitive advantage to face rapidly changing business environments. This review tracks the progress of this new and emerging research domain in a timely manner and directs future research. We review 41 articles and create an integrated 'antecedent-phenomenon-outcome' framework summarising the extant literature on CAs. Based on this state-of-the-art literature review, we provide theoretical and methodological research gaps for future research.

AbstractAt present, the prevalence of infectious diseases is rising annually, making it an important risk factor for human health that should not be neglected. Consequently, infection control and prevention have become even more important. The key to determining and designing the most effective anti-infectious medication depends upon the immediate and accurate identification of the causative agent. The standard techniques used for routine infection screening and surveillance tests are shifting toward biosensors. Furthermore, biosensors are projected to be employed for microbiological detection to satisfy the higher accuracy required for clinical diagnosis. This is because of their compact size, real-time monitoring and ability to analyze large sample numbers with less sophistication and manpower requirement, which have allowed them to develop quickly with extensive uses. Biosensors have multiple applications in food safety, environmental surveillance, drug sensing and national security because they offer several advantages such as quick response, outstanding sensitivity, remarkable selectivity, high degree of accuracy and precision, ease of use and affordable price. This review highlights the performance aspects of recently developed biosensors for the detection of infectious bacteria and viruses in biological and environmental samples and emphasizes the significance of nanotechnology in signal amplification for enhanced biosensor performance and dependability.

The study focused on the adsorption of tetracycline (TC) using Thysanolaena maximaactivated carbon (TMAC) in a batch experiment. TMAC was formed via a chemical activation process involving potassium hydroxide mixed in a 2:1 ratio with carbonized char. Various analytical techniques such as Fourier transform infrared spectroscopy (FT-IR), scanning electron microscopy–energy dispersive X-ray spectroscopy (SEM–EDX), X-ray diffraction (XRD) spectroscopy, and Brunauer–Emmett–Teller (BET) surface area analysis was performed to characterize the produced carbon. The TMAC possessed specific surface area, total pore volume, and average pore diameter values of 1065.011 m2/g, 0.4443 cm3/g, and 3.036 nm, respectively. The effect of various adsorbent dosage (0.15 g/L), initial TC concentration (20 mg/L), contact time (110 min), temperature (328 K), and pH (2) on TC adsorption was investigated, and the TMAC exhibited a high adsorption efficiency of 97%. Thermodynamic analysis revealed that the spontaneous adsorption process was endothermic. The Langmuir (Qm= 21.317 mg/g) and the pseudo-second-order model (R2= 0.9980) provided the best fit for the adsorption isotherm and kinetic study. The fifth regeneration cycle of the adsorbent was successful, proving its ability to be reused multiple times. Density functional theory (DFT) simulations revealed that the carboxyl group appeared to have a greater impact on the adsorption process than the hydroxyl and carbonyl groups, with an Eadsorpvalue of − 47.99 kJ/mol. The results indicate that the produced TMAC effectively eliminated TC from aqueous solutions.

In the current study, the effect of the inclusion of waste plastic in different quantities (0–10%) on the compressive strength of fly ash reinforced concrete is explored. Compressive strength decreases with increasing plastic waste due to its inert, hydrophobic nature and poor bonding within the concrete matrix, while 10% fly ash improves strength slightly through pozzolanic reactions that densify the matrix and reduce voids. Support vector machine (SVM) was explored as a potential machine learning technique for accurately predicting and modeling the compressive strength of concrete. Predictive models were developed using SVM-radial basis function (RBF), SVM-linear, SVM-power and linear regression. The models were analyzed using performance metrics such as mean absolute error (MAE), mean squared error (MSE), root mean squared error (RMSE), mean squared logarithmic error (MSLE), root mean squared logarithmic error (RMSLE), coefficient of determination (R2), mean absolute percentage error (MAPE), Willmott's index of agreement, Mielke and Berry index, and Legates and McCabe's index. Taylors diagram was also used to analyze the models. SVM-RBF model outperformed all other models with an R2value of 0.969 and 0.771 in training and testing respectively. Sensitivity analysis revealed that % plastic waste is the most influential parameter in predicting the compressive strength of concrete with a score of 59.04%.

Wireless connections with high capacity, security, and affordability are becoming increasingly crucial for the growth of interactive multimedia and broadband services. A promising approach to meet this need is the use of radio frequency (RF) and optical fiber technology to distribute millimeter-wave signals. This article provides a summary of current research on the radio over fiber (RoF) technology and future uses for it in next-generation networks. Firstly, we introduce the basics of RoF technology, including its various components and architectures. We provided a comparative analysis between External Modulation Based and Direct Modulation based RoF link. On the basis of simulation analysis, the measured Q-Factor is 303.064 and 5.50 while using External and Direct modulation schemes respectively, for 1 dB/km optical fiber impairments. We also discuss the benefits and challenges of employing RoF technology in wireless access networks, highlighting the key issues that require attention for RoF technology to fully realize its potential. Afterward, we provide an extensive review of recent research on RoF technology. We examine the performance and limitations of used RoF link and identify the key research challenges in the associated field. Finally, we discuss the future directions and opportunities for research in RoF technology, our article aims to provide easy to understand of RoF technology and its impact on the next- generation networks.

We examine a higher-order nonlinear Schrödinger equation featuring competing effects of group velocity dispersion (GVD), third-order dispersion (TOD), fourth-order dispersion, fifth-order dispersion, cubic nonlinear effects, as well as linear and nonlinear absorption and amplification. This model elucidates dynamics of ultrashort optical pulses, operating at femtosecond durations, within highly nonlinear optical fibre medium. A new method is applied to extract the nonlinear chirp related to the propagation of femtosecond solitary waves. This paper provides a detailed derivation of precise solutions for chirped bright and dark soliton-like profiles within the context of the generalized NLS equation. The equation incorporates variable coefficients to account for dispersion management or soliton control, encompassing both nonlinear and linear loss or gain effects.

The impact of financial accessibility on the success of SMEs in Wa Township, Ghana, was investigated in this study employing determiners such as guarantee requirements, zero-interest levies, tax exemptions, and start-up incentives. A fixed-format questionnaire was used to select 411 SMEs randomly for the survey. SPSS was leveraged to analyse the results via descriptive and confirmatory statistical means. Correlation and regression techniques aided in determining whether accessibility to funding significantly drives SMEs' success. The correlation analysis shows that each of the determinants significantly impacted SMEs' thrives. The regression analysis also reveals funding accessibility as a critical determinant influencing SMEs' success (R2= 0.074, Prob > F = 0.000). Collateral requirement explained the largest portion (12.5%) of the difference in SMEs' success (F = 4.954, p = 0.004). Hence, support for SMEs in the municipality to enhance financial access should not require collateral.

Thyroid hormones (triiodothyronine and thyroxine) are pivotal for metabolic balance in the liver and entire body. Dysregulation of the hypothalamus–pituitary–thyroid axis can contribute to hepatic metabolic disturbances, affecting lipid metabolism, glucose regulation and protein synthesis. In addition, reductions in circulating and intrahepatic thyroid hormone concentrations increase the risk of metabolic dysfunction-associated steatotic liver disease by inducing lipotoxicity, inflammation and fibrosis. Amelioration of hepatic metabolic disease by thyroid hormones in preclinical and clinical studies has spurred the development of thyromimetics that target THRB (the predominant thyroid hormone receptor isoform in the liver) and/or the liver itself to provide more selective activation of hepatic thyroid hormone-regulated metabolic pathways while reducing thyrotoxic side effects in tissues that predominantly express THRA such as the heart and bone. Resmetirom, a liver and THRB-selective thyromimetic, recently became the first FDA-approved drug for metabolic dysfunction-associated steatohepatitis (MASH). Thus, a better understanding of the metabolic actions of thyroid hormones and thyromimetics in the liver is timely and clinically relevant. Here, we describe the roles of thyroid hormones in normal liver function and pathogenesis of MASH, as well as some potential clinical issues that might arise when treating patients with MASH with thyroid hormone supplementation or thyromimetics.