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Photovoltaic technology, a rising renewable energy source, relies heavily on irradiation and temperature for performance. Defects like shading, hot spots, and soiling can disrupt the current–voltage curve, challenging inverters to operate at maximum power point (MPP). Indirect measurement and real-time loss detection methods are essential due to the inaccessibility of PV cell circuits. The conventional methods of performance measurement consider the performance based on standard test conditions. The main focus of the present work is to develop a novel performance ratio, which captures real-time efficiency involved in Solar farm operations using data-driven methodologies. The major contributions of this work are: Monitoring health and performance of solar farms by collecting 8 months of SCADA data using IEC standard 61724; Developing a data-driven model to predict ideal I-V curve and MPP at each transient state in the absence of panel-level data; Developing a new performance ratio which provides insights into the transient operational state of the inverter and the deviation of real-time data from the MPP. The results reveal the interplay of different inverters and the evolving overall performance of solar farm over time. This underscores necessity for maintenance and highlights the potential for enhancing solar farm’s output.

Vibrio fluvialis (V. fluvialis) is commonly found in coastal environments and is an emerging pathogen encountered in diarrhoeal outbreaks and sporadic extraintestinal cases. V. fluvialis infections usually manifest as watery bloody diarrhoea, nausea, vomiting, gastroenteritis and peritonitis. In this case report, an unusual presentation of Multidrug Resistant (MDR) V. fluvialis along with Klebsiella pneumoniae co-infection from a case of Walled Off Necrosis (WON)- A complication of Acute Necrotising Pancreatitis (ANP) is discussed. The patient presented with the acute abdomen and had peripancreatic collection for which Ultrasound (USG) guided 12F pigtail drain placed over the right lower quadrant of the abdomen and conservatively managed. Routine cultures were done and the growth on Sheep Blood Agar (SBA) plate and MacConkey (MAC) agar plates were subjected for automated phenotypic identification by Matrix Assisted Laser Desorption Ionisation Time of Flight-Mass Spectrometry (MALDITOF-MS) and Vitek-2 systems and was identified as V. fluvialis. Also, molecular tests like 16S rRNA Polymerase Chain Reaction (PCR) followed by Sanger’s sequencing was done and the identification was further confirmed. Phenotypic RESIST-5 TRURAPID O.K.N.V.I. commercial lateral flow immunochromatographic assay for detection of clinically relevant and common carbapenemase genes like NDM, OXA-48, VIM, IMP and KPC was done which revealed this V. fluvialis isolate as New Delhi Metallo betalactamase (NDM) type of Carbapenemase producer. Patient was managed with levofloxacin and doxycycline and patient condition improved and was discharged.

Background: Hereditary hemorrhagic telangiectasia (HHT) is a rare genetic disorder usually known to manifest with epistaxis, mucocutaneous telangiectasia, and visceral arteriovenous malformations (AVMs). Clinical Description: A 12-year-old girl presented with altered sensorium on hand ventilation, referred as a case of an acute cerebrovascular event due to cerebral AVM. She was afebrile with labored breathing and profound hypoxia. General and systemic examinations were unremarkable, except for clubbing in all digits. Management and Outcome: Investigations were largely normal, except for elevated hematocrit. Chest-X-ray showed mild infiltrates, while echocardiography was unremarkable. After stabilization and improvement of the sensorium, the child continued to have refractory hypoxemia, even with high ventilatory settings. The presence of digital clubbing and elevated hematocrit, in the background of cerebral AVM, led to suspicion of pulmonary AVM, the latter being detected by bubble contrast echocardiography and digital subtraction angiography (DSA). Genetic analysis confirmed a likely pathogenic variant in the ENG gene. Coil embolization of the pulmonary AVMs was done in stages, following which saturations improved and the child became asymptomatic. Conclusion: Persistent hypoxemia, in a child with cerebral AVMs, should raise suspicion of pulmonary AVMs, as a part of the disorder of HHT. Appropriate investigations can identify the AVMs and prompt intravascular intervention can be successful. Genetic analysis confirms the underlying HHT.

Transfusion therapy in an alloimmunized liver transplantation (LT) recipient still remains a major challenge due to the unpredictable blood unit requirements and difficulty in finding compatible antigen-negative units. We present the case report of a 30-year-old male patient with multiple red blood cell alloantibodies admitted for LT. Immunohematological tests by column agglutination method (gel) were employed for testing for antibodies. The antibodies were confirmed to be anti-E, anti-S, and anti-Fyb, and over a period of 10 days, nearly ninety units were crossmatched and phenotyped matched units were reserved for surgery. During the intraoperative phase, the patient could be supported with all three antigen-negative blood units. However, in the postoperative period, transfusions were switched over to two antigen-negative compatible units (E-Fyb−) under close monitoring. Direct antiglobulin test remained negative with no evidence of hemolysis throughout the perioperative period. This case delineates the approach to a case with multiple red blood cell antibodies and accentuates the role of well-equipped immunohematology laboratory for timely detection of alloantibodies and transfusion support for patients. An effective strategy for such patients needs to be devised well ahead to prevent the possible risk of any hemolytic reactions during the perioperative course. This case also re-emphasizes on the need of adequate inventory, advance assays like monocyte monolayer assay, and the active national rare donor registry to aid in the management of patients with single/multiple antibodies.

Aim: The aim of this study was to determine the fall risk amongst the elderly and to assess the effect of preventive rehabilitation. Study Design: This was a prospective pre–post study. Materials and Methods: Sixty patients attending the outpatient department were selected according to the inclusion and exclusion criteria. Timed up and go (TUG) test and functional reach test (FRT) and modified FRT were done to identify the risk groups. Appropriate preventive rehabilitation measures such as strengthening and balance exercises, footwear modifications and assistive aids along with treatment of the disease for which they approached the clinic were done. The study population was assessed after 2 weeks for fall risk using the same TUG and FRT. Results: A statistically significant reduction in fall risk was seen after appropriate rehabilitative strategies. Fall risk can be detected early by simple clinical tools such as TUG test and FRT. Conclusion: Simple clinical tools such as TUG test and FRT can be used for the early identification of fall risk amongst the elderly. This study establishes that a comprehensive preventive rehabilitation to the geriatric community with risk of fall can reduce the “fall risk” in the future and can also improve their functioning.

Background: The disruption of autonomic function following a spinal cord injury (SCI) is common and can negatively affect quality of life. As social engagement and relationships are critical for well-being and quality of life, it is important to gain a detailed understandings about how bladder and bowel dysfunction impact on social participation. People living with SCI can experience diminished opportunities to socialise and develop relationships because of problems such as a lack of financial and transportation resources, poor environmental accessibility, the negative attitudes of others and depression. Aim: The aim of this study was to determine social issues faced by SCI patients with bladder and bowel dysfunction. Study Design: This was a cross-sectional study. Fifty-five SCI patients with bladder and bowel dysfunction were recruited for this study. Materials and Methods: International SCI survey questionnaires were used and telephonic call interviews were done. Results: Quadriplegic patients faced issues for bowel and bladder management, architectural barriers and psychosocial issues than paraplegic persons. Conclusion: This study emphasize on the importance of health education and psychological counselling to the SCI patients as well as to their family. This study also throws light on the areas where we as a society needs to improve to provide a better environment for the disabled so as to make their lives less troublesome.

Background Hemoglobin (Hb), a red pigment of red blood cells (RBCs), carries oxygen from the lungs to different organs of the body and transports carbon dioxide back to the lungs. Any fault present in the Hb structure leads to undesirable functional effects of the RBCs, such as sickle cell anemia (SCA), thalassemia, etc. Hemoglobinopathies affect around 7% of people in both developed and developing countries globally. The aim of the present study was to determine the prevalence and carrier frequencies of hemoglobinopathies including SCA, thalassemia, and other abnormal Hb variants among Malayali tribes in the Jawadhu hills of Tiruvannamalai district, Tamil Nadu, India.Methods A community-based cross-sectional study was carried out among 443 Malayali tribes inhabiting the Jawadhu hills of Tiruvannamalai district from July 2022 to September 2022. The RBC indices were analyzed using an automated 5-part hematology analyzer (Mindray, BC-5150) and hemoglobin fractions were done using the HPLC system (Bio-Rad, D-10) following standard protocols.Findings A total of 443 participants were screened, out of whom 14.67% had an abnormal Hb fraction, 83.30% were identified as normal, and 2.03% were borderline. Notably, the study revealed a prevalence of 0.68% for the α-thalassemia trait and 13.99% for the β-thalassemia trait.Interpretation Haemoglobinopathies, specifically the β-thalassemia trait, were most prevalent among the Malayali tribal population of Tamil Nadu residing in the Jawadhu hills of Tiruvannamalai district. Hence, we need special attention for creating awareness, increasing hemoglobinopathies screening programs, and improving the importance of tribal health conditions by the government and non-governmental organizations (NGOs) for the betterment of the ethnic tribes.