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Background: Proteinuria is a major indicator of hypertensive disorder of pregnancy. The gold standard for diagnosis of significant proteinuria is based on a 24hour urine collection which is cumbersome, time-consuming, and inconvenient to patients. A need, therefore, exists for a rapid, valid, and accurate test to identify significant urinary proteinuria. Methods: We conducted an observational cross-sectional hospital-based study wherein a total of 150 pregnant women who met the criteria of preeclampsia were taken. Spot urine samples for calculating the urine P/C ratio were taken immediately before 24hr urine collection. Correlation between 24hour urine protein and spot PCR was then determined by Pearson’s correlation coefficient(r). Results: The correlation coefficient (r) between 24hr urine protein and spot PCR was found to be 0.734 (n=150) which was highly significant with p

Cyber Space, like outer space, is strategically a vital domain for state offence and defence. However, there has been a substantial rise in the sponsored cyber activities to inflict heavy losses to critical infrastructures due to the lack of rules or norms or any strict international regulations to govern the conflicts in cyberspace. This activity affects the national defence strategies when oppressed by the response crisis and hugely impacts the risk factors. In these circumstances, the dilemma is whether any operative or offensive choice in the event of a cyber threat or cyber-attack violates international law. War has always been a last resort when other forms of punishment have failed, but the power dynamic has fundamentally shifted since World War II. State Governments have been hoarding the arsenals that could destroy cities in a second; hence a need for unconventional resolution has led to the evolving nature of deterrence. States must reconsider alternate strategies to protect their sovereignty by implementing cross-domain deterrence that can cripple an adversary economy, swift surgical strike as retaliation, or curb the attack using counterintelligence. The threat landscape in Cyber Space is beyond frontiers, and the consequences cannot be contained at the perimeter by the regular armed forces. Require special forces and strategies to mitigate the risks. Cross-Domain deterrence to increase cyber resilience, it is crucial to identify existing strategy disparities to take necessary actions on the state misconduct and the misconduct of a policy for global cooperation during state-sponsored cyberattacks. This paper discusses the evolving framework by assessing the changing threat landscape and its associated risks.

The Brake system in automobiles plays a vital role in customer safety. Brake pads are crucial components that experience huge pressure while slowing down the vehicle’s movement. Designing a brake pad requires sound knowledge of structural design, manufacturing ability, and material properties. Further, an optimized model is chosen based on the size of the brake pad and the brake power requirement. Brake pad pressure distribution is one of the main studies in designing automobile brake pads. Numerical solvers are used to validating the experimental results, which is a repetitive process for every new design under the study. Computer-aided engineering tools are costly and time-consuming for design iterations. The present paper provides a new approach for estimating brake pad pressure distribution using machine learning techniques. The accuracy of the machine learning models for various designs shows promising outcomes.

The popularity of Artificial intelligence and machine learning have prompted researchers to use it in the recent researches. The proposed method uses K-Nearest Neighbor (KNN) algorithm for segmentation of medical images, extracting of image features for analysis by classifying the data based on the neural networks. Classification of the images in medical imaging is very important, KNN is one suitable algorithm which is simple, conceptual and computational, which provides very good accuracy in results. KNN algorithm is a unique user-friendly approach with wide range of applications in machine learning algorithms which are majorly used for the various image processing applications including classification, segmentation and regression issues of the image processing. The proposed system uses gray level co-occurrence matrix features. The trained neural network has been tested successfully on a group of echocardiographic images, errors were compared using regression plot. The results of the algorithm are tested using various quantitative as well as qualitative metrics and proven to exhibit better performance in terms of both quantitative and qualitative metrics in terms of current state-of-the-art methods in the related area. To compare the performance of trained neural network the regression analysis performed showed a good correlation., 10 figures 4 tables

Mucormycosis is an opportunistic fungal infection. India faced an unprecedented increase in patients with post coronavirus disease 2019 (COVID-19) associated rhino-orbito-cerebral mucormycosis (ROCM). This study proposes a grading system which correlates the extent of the disease with the management plan. An observational study was conducted January 2021-June 2021. We identified 65 patients. Eleven patients had mild disease, 27 patients had moderate, 16 patients were severe and 11 patients were graded as very severe. The management was planned based on this grading system. Early diagnosis, aggressive surgical debridement and antifungal drug therapy is the key to improve survival in ROCM. Procedures such as endoscopic orbital clearance, sublabial maxillectomy, and modified endoscopic Denkers (MED) approach facilitate access and surgical debridement. The new grading system proposed assists in planning the approach and extent of surgical debridement.

Aims and Objectives: To determine the prevalence and etiology of fractured anterior teeth due to trauma among 8–14 years old school going children of Hyderabad city. Materials and method: A cross-sectional study was carried out in 8-14 year old children studying in various schools of Hyderabad for the assessment of traumatic injuries of anterior teeth. Clinical examination was carried out and type of teeth affected, type of fracture, overjet and lip competence were noted. A closed end questionnaire was given to children with questions regarding etiology of trauma, place of injury, symptoms or outcomes after the injury, whether a dentist was consulted, type of treatment done by dentist and time elapsed between trauma and treatment. All the results were analyzed using “statistical package for social sciences” (SPSS) 20.0 software. Results: The prevalence of dental trauma was found to be 7.84%. 11-14year old children showed higher prevalence. Males were more affected than females. Maxillary central incisors were most affected. Fracture involving enamel and dentin were recorded the highest. Children having overjet of >3mm and incompetent lips were at a higher risk of dental trauma (p value = 0.001). The most common cause of injury was sports and home was the most common place of occurrence of injury. Most of the traumatic dental injuries (TDI) did not undergo any treatment. Conclusion: Increasing the awareness of the parents and teachers about the prevention of TDI and the importance of consulting the dentist after trauma should be instituted.

Tuberous sclerosis complex is a rare autosomal dominant neurocutaneous disorder characterized by the presence of multiple tumors influencing diverse body frameworks including the central nervous system, skin, eyes, heart, lungs, kidney, and bones. It is described by cutaneous changes, neurologic conditions, and the presence of hamartomas in numerous organs. The treatment of these patients requires a multidisciplinary approach. A port-wine stain is characterized as a telangiectatic macule that manifests during childbirth and stays all throughout life. They are associated with many syndromes. This article reports a rare case of co-occurrence of tuberous sclerosis with port-wine stain in a 2-year-old baby.

Background: PPH is most common cause of maternal mortality accounting for 25-30% incidence and third stage of labour plays most crucial role in preventing postpartum haemorrhage.Methods: A prospective randomized control study in which 100 low risk pregnant women, admitted to labour ward with term gestation were evaluated. They were divided into 2 groups- control group (controlled cord traction) and study group (placental cord blood drainage), 50 pregnant women in each group. Duration of third stage and Amount of blood loss in third stage were evaluated and compared between the 2 groups.Results: Mean duration of third stage of labour in study group was 3.96±1.36 minutes and in control group was 6.00±2.12 minutes. The mean amount of blood loss in third stage of labour in study group was 99.80±56.47 ml in control group was 171.760±96.94 ml. Drop in haemoglobin level after delivery in control group was almost double than study group.Conclusions: Placental cord blood drainage in the management of third stage is non-invasive, easy, safe method which can be used in active management of third stage of labour as it has minimal interference in natural mechanism of placental separation. Placental cord blood drainage should be encouraged for management of third stage of labour universally to all pregnant women specifically in low resource setting areas.

The amount of unstructured text present in all electronic media is increasing periodically day after day. In order to extract relevant and succinct information, extraction algorithms are limited to entity relationships. This paper is compendium of different bootstrapping approaches which have their own subtask of extracting dependencies like who did, what, whom, from natural language sentence. This can be extremely helpful in both feature design and error analysis in application of machine learning to natural language processing.

The study was conducted to determine the bacteriological quality of 112 infants’ feeding bottles. Samples were collected from the feeding bottles brought by the caregivers of infants in the OPD of Dept. of Pediatrics, Nalanda Medical College and Hospital, Patna from the period of August 2015 to October 2016. The study was selected because it has been observed that more number of babies were found to be sick that were bottle fed than breast fed infants presenting in the OPD, also bottle fed infants had multiple OPD visits compared to breast fed infants The coliform group of bacteria, like E.Coli,4 Enterobacter spp., Klebsiella spp., Citrobacter spp.; enteric pathogens such as enteropathogenic E.Coli, Salmonella, Shigela spp., S. aureus, and Bacillus cereus; fungus like Candida were isolated in the significant colony count of 104colonies/ml or more from inoculation of swab samples of feeding bottles or nipples in the appropriate culture media. Not only the milk, but the process of storage and milk preparation itself contributes to the growth of bacteria. Contamination due to improper cleaning, disinfection and handling of feeding bottles as well as repeatedly feeding of the milk kept in the feeding bottle over prolonged period of time has been observed to cause infections in bottle fed infants. In the results shown, high level of bacteriological contamination of milk is apparent which is caused due to the incorrect dilution, improper storage, inadequate cooking and poor hygiene. Nursing mothers should be taught on the proper handling of feeding utensils and emphasize on the superior quality of breast milk. To reduce the diarrheal diseases in infants, well controlled community based, longitudinal studies are recommended. Key​words:​ Feeding bottle, Bacterial contamination, Diarrheal illness, Recurrent illness.

Acute diffuse and total alopecia (ADTA) is a variant of alopecia areata which lacks the typical patchy hair loss seen in classical alopecia areata and presents with an acute onset of diffuse hair loss commonly reported in young females with the duration from disease onset to diffuse hair loss ranging from 2 to 20 weeks. Although the clinical features of ADTA resemble telogen effluvium, dermoscopy can prove to be a useful tool for differentiating these two conditions and avoiding unnecessary investigations as specific dermoscopic findings of alopecia areata are invariably present along the disease course. Herein, we report a case of ADTA in a 42-year-old Indian female who presented with sudden onset of diffuse hair loss of only 1-day duration.

INTRODUCTION: The temporo-mandibular joint (TMJ) is a complex anatomical structure that is concerned with mastication, deglutition, and speech. Ankylosis of the TMJ occurs when the condyle gets fused to glenoid fossa by bony or fibrous tissue. It is an incapacitating problem, commonly occurring in children and is usually associated with trauma or infection. MATERIALS AND METHODS: A total of ten patients with written informed consent having TMJ ankylosis (unilateral/bilateral) fulfilling the inclusion criteria were selected for the study and were operated under general anaesthesia with arthrectomy followed by reconstruction of ramal condylar unit with SCG (Group I) or CCG (Group II). Pre-operative and post-operative evaluation assessments were done at regular intervals for maximum mouth opening, range of mandibular movements, and height of ramus. RESULTS: Statistical analysis shows that the increase in maximum mouth opening was found 1.1% higher in Group II (75.9%) as compared to Group I (74.9%). The increase in lateral excursion at affected side was found 1.3% higher in Group I (84.6%) as compared to Group II (83.3%). The increase in lateral excursion at non-affected side was found 10.3% higher in Group I (76.9%) as compared to Group II (66.7%). The increase in protrusive movement was found 17.5% higher in Group II (88.9%) as compared to Group I (71.4%). Six months post-operative height of ramus was found 10.5% higher in Group II as compared to Group I. CONCLUSION: The present study concludes the superiority of costochondral graft over sternoclavicular graft in terms of growth and function. Continued deliberation between the two grafts with larger sample size and a longer follow-up with multicentric consensus will be required to draw definitive indications of the two grafts.

Background: The primary objective of the study was to evaluate the efficacy and safety of oral probiotics in the treatment of atopic dermatitis (AD) using the scoring atopic dermatitis (SCORAD) index, serum IgE levels and absolute eosinophil count (AEC). The secondary objective of the study was to determine the association of oral probiotic therapy and improvement in AD using global photographs, dermoscopic images (fotofinder) and individual patient satisfaction.Methods: This was a randomized, double-blind study conducted on 70 patients (20 adults and 50 children) with moderate to severe AD. The participants were randomized into control arm and treatment arm. The treatment arm received conventional and probiotic therapy and only conventional therapy was provided to the control arm. The research was carried out in five visits. For each visit, SCORAD was calculated and response compared using clinical and videodermoscopic images. Patient satisfaction was documented using a quality of life questionnaire during each visit.Results: Across the treatment arm, the mean serum IgE levels were greatly decreased in contrast to the control arm over the 12 weeks period. SCORAD score was significantly lowered in the treatment arm (55.20%) compared with 18.95% in the control arm. Dermoscopic assessment, global photographic assessment and patient satisfaction in the treatment arm showed statistically significant improvement in AD compared to the control arm.Conclusions: The decrease in SCORAD scores demonstrated strong associations with the use of probiotics in patients with AD as an adjunct to conventional therapy. Thus, in both adults and children suffering from moderate to severe AD, probiotic supplement can be administered effectively as an adjunct therapy.

Study Design. Cadaveric study. Objective. To define congenital hypoplasia of the atlas. Summary of Background Data. Little has been written about hypoplasia of the atlas and it is usually described in the setting of other skeletal dysplasias or syndromes. Methods. A total of 543 cervical spine specimens were randomly selected from the Hamann-Todd collection. Sagittal and coronal diameters of the atlas, axis, and C3 (when available), and the dens diameter were measured using digital calipers. Correction for modern size and radiographical magnification was performed. Hypoplasia of the atlas was defined as the lowest 2.5% of measurements. The correlation between inner sagittal diameters at C1 and C3 was calculated. Results. The mean C1 inner sagittal diameter was 30.8 ± 2.4 mm (range, 23.5–38.1 mm). We defined C1 hypoplasia as an inner sagittal diameter value representing the smallest 2.5% of subjects. Because the mean was 30.8 mm, hypoplasia was defined as a diameter of ≤26.1 mm or less. Correcting for size and magnification of radiographs, hypoplasia is defined as an inner sagittal diameter of the atlas of 28.9 mm. Approximately 10% of cases had a dens that occupied more than 40% of the spinal canal at C1, thus not following Steel's Rule of Thirds. There was only a moderate correlation between the spinal canal diameter at C1 and at C3 (r = 0.483, N = 345; P Conclusion. With an inner sagittal diameter of 26 mm or less, one may describe the atlas as hypoplastic. Ten percent of the specimens had an odontoid process that occupied more than 40% of the spinal canal at C1. There was little correlation between the inner sagittal diameter at C1 and the diameter at C3. Conclusion. Level of Evidence: N/A

Objectives: Natural killer (NK) cells are important effector lymphocytes. NK cells are considered to represent innate immune system. NK cells target and kill aberrant cells such as virally infected and tumorigenic cells. The purpose of this study was to assess the expression of CD57 in oral squamous cell carcinoma (OSCC) and to correlate the expression of CD57 with 3 years survival in patients with OSCC. Materials and Methods: About 100 histopathologically diagnosed cases of OSCC of various grades were divided into two groups, i.e., Group I (dead patients) and Group II (live patients) from the archives of Department of Oral Pathology and Microbiology. CD57 was detected in these tissues by immunohistochemistry. Result: The results were analyzed using Spearman's correlation coefficient and students unpaired t-test. The mean CD57 labeling index in Group II was significantly higher than that found in Group I (P = 0.000). There was a significant correlation (P = 0.00) in the mean CD57 levels between Groups I and II and prognosis of patient. Conclusion: CD57 could be a good prognostic marker for OSCC patients.

Most of the well known algorithms for watermarking of digital images involve transformation of the image data to Fourier or singular vector space. In this paper, we introduce watermarking in Hilbert transform domain for digital media. Hilbert transform provides an analytic representation of a signal in terms of a phase and amplitude function. In this work, we apply one-dimensional Hilbert transform on each of the vectors that define an image and embed the watermark in its phase. Based on this idea, we propose an algorithm for embedding and extracting watermark in a host image and analytically obtain a parameter related to this procedure. Using extensive simulations, we show that the algorithm performs well even if the host image is corrupted by various attacks.

Skeletal muscle atrophy in cancer cachexia is mediated by the interaction between muscle stem cells and various tumor factors. Although Notch signaling has been known as a key regulator of both cancer development and muscle stem cell activity, the potential involvement of Notch signaling in cancer cachexia and concomitant muscle atrophy has yet to be elucidated. The murine K7M2 osteosarcoma cell line was used to generate an orthotopic model of sarcoma-associated cachexia, and the role of Notch signaling was evaluated. Skeletal muscle atrophy was observed in the sarcoma-bearing mice, and Notch signaling was highly active in both tumor tissues and the atrophic skeletal muscles. Systemic inhibition of Notch signaling reduced muscle atrophy.In vitrococulture of osteosarcoma cells with muscle-derived stem cells (MDSCs) isolated from normal mice resulted in decreased myogenic potential of MDSCs, while the application of Notch inhibitor was able to rescue this repressed myogenic potential. We further observed that Notch-activating factors reside in the exosomes of osteosarcoma cells, which activate Notch signaling in MDSCs and subsequently repress myogenesis. Our results revealed that signaling between tumor and muscle via the Notch pathway may play an important role in mediating the skeletal muscle atrophy seen in cancer cachexia.

STUDY DESIGN Retrospective case series. OBJECTIVE The aim of this study was to determine the revision rates for all revision spinal deformity (SD) surgical procedures performed at a single center and to investigate the changes in measures of HRQL in these patients. SUMMARY OF BACKGROUND DATA Reported revision rates for primary adult spinal fusion surgical procedures have been in the range of 9% to 45%, but to our knowledge, the revision rate after revision SD surgery has not been reported. The reported improvements in health-related quality of life measures after revision SD surgery have also been quite modest. METHODS Four hundred fifty-five consecutive adult revision SD surgical procedures (1995-2008) were identified and the records were reviewed to determine the reason for and timing to any additional operation(s). Scoliosis Research Society (SRS) Outcome scores were recorded at the first visit and at planned follow-up visits. RESULTS Ninety-four of 455 patients underwent further surgical procedures for a revision rate of 21%. Two-year follow-up was available for 74 (78%) of these patients (mean follow-up, 6.0 yr; range, 2.4-12.6; sex: F = 61, M = 13; mean age, 53 yr; range, 21-78). The most common causes of revision surgery were pseudarthrosis (N = 23, 31%), implant prominence/pain (N = 15, 20%), adjacent segment disease (N = 14, 19%), and infection (N = 10, 14%). Twenty-five (27%) patients underwent more than one revision procedure. SRS outcome scores were available for 50 (68%) patients, at an average follow-up of 4.9 years (range, 2-11.4). The mean improvements in the SRS outcome measures were as follows: pain, 0.74 (P < 0.001); self-image, 0.8 (P < 0.001); function, 0.5 (P < 0.001); satisfaction, 1.2 (P < 0.001); and mental health, 0.3 (P = 0.012). CONCLUSION The rate of revision after revision SD surgery was 21%, most commonly due to pseudarthrosis, adjacent segment disease, infection, and implant prominence/pain. However, significant improvements in SRS outcome scores were still observed in those patients requiring additional revision procedures.

High performance liquid chromatographic (HPLC) method was developed for analysis of seven gibberellins, i.e., GA3, GA4, GA7, GA3 methyl ester, GA7 methyl ester 3,13 diacetate, GA7 methyl ester, and fusaric acid, using an isocratic system. Method was used for estimation of gibberellins from different Fusarium strains. Gibberellins were extracted from 28 strains of Fusarium, out of which six strains of Fusarium were isolated from soil of different parts of India and 22 strains were procured from the Indian Type Culture Collection, Indian Agricultural Research Institute, New Delhi. Extracts were analyzed for qualitative and quantitative estimation of gibberellins by thin layer chromatography and HPLC, respectively. On the basis of quantitative analysis of produced gibberellins by HPLC, they were categorized as low, moderate, and high gibberellin producing strain. For the first time, Fusarium solani was also reported as high GA3 producing strain.

25-Hydroxy vitamin D (25(OH)D) deficiency is linked with predisposition to autoimmune type 1 diabetes and multiple sclerosis. Our objective was to assess the relationship between serum 25(OH)D levels and thyroid autoimmunity. Subjects included students, teachers and staff aged 16–60 years (total 642, 244 males, 398 females). Serum free thyroxine, thyroid-stimulating hormone (TSH), and thyroid peroxidase autoantibodies (TPOAb), intact parathyroid hormone and 25(OH)D were measured by electrochemiluminescence and RIA, respectively. Thyroid dysfunction was defined if (1) serum TSH ≥ 5 μU/ml and TPOAb>34 IU/ml or (2) TSH ≥ 10 μU/ml but normal TPOAb. The mean serum 25(OH)D of the study subjects was 17·5 (sd 10·2) nmol/l with 87 % having values ≤ 25 nmol/l. TPOAb positivity was observed in 21 % of subjects. The relationship between 25(OH)D and TPOAb was assessed with and without controlling for age and showed significant inverse correlation (r − 0·08, P = 0·04) when adjusted for age. The prevalence of TPOAb and thyroid dysfunction were comparable between subjects stratified according to serum 25(OH)D into two groups either at cut-off of ≤ 25 or >25 nmol/l or first and second tertiles. Serum 25(OH)D values show only weak inverse correlation with TPOAb titres. The presence of such weak association and narrow range of serum 25(OH)D did not allow us to interpret the present results in terms of quantitative cut-off values of serum 25(OH)D. Further studies in vitamin D-sufficient populations with wider range of serum 25(OH)D levels are required to substantiate the findings of the current study.

To determine the efficacy of supplementation with oral vitamin D3 (cholecalciferol) on bone mineral biochemical parameters of school-going girls. Government school (government-aided) and Private school (fee paying) in Delhi. Randomized controlled trial. Cholecalciferol granules (60,000 IU) orally with water, either once in two months (two-monthly D3 group) or once a month (one-monthly D3 group) for one year. 290 healthy schoolgirls (6–17 y), 124 from lower socioeconomic strata (LSES) (attending government schools) and 166 from upper socioeconomic strata (USES) (attending private schools). Serum 25(OH)D, calcium, phosphorus, parathyroid hormone, and alkaline phosphatase levels at 6 and 12 months after start of supplementation. At baseline, 93.7% schoolgirls were vitamin D deficient [25(OH)D

Forty to fifty per cent of skeletal mass, accumulated during childhood and adolescence, is influenced by sunlight exposure, physical activity, lifestyle, endocrine status, nutrition and gender. In view of scarce data on association of nutrition and lifestyle with hypovitaminosis D in Indian children and adolescents, an in-depth study on 3127 apparently healthy Delhi schoolgirls (6–18 years) from the lower (LSES, n 1477) and upper socioeconomic strata (USES, n 1650) was carried out. These girls were subjected to anthropometry and clinical examination for hypovitaminosis D. Girls randomly selected from the two strata (LSES, n 193; USES, n 211) underwent detailed lifestyle, dietary, biochemical and hormonal assessment. Clinical vitamin D deficiency was noted in 11·5 % girls (12·4 % LSES, 10·7 % USES). USES girls had significantly higher BMI than LSES counterparts. Prevalence of biochemical hypovitaminosis D (serum 25-hydroxyvitamin D v. 64 %, P = 0·000). Significant correlation between serum 25-hydroxyvitamin D and estimated sun exposure (r 0·185, P = 0·001) and percentage body surface area exposed (r 0·146, P = 0·004) suggests that these lifestyle-related factors may contribute significantly to the vitamin D status of the apparently healthy schoolgirls. Hence, in the absence of vitamin D fortification of foods, diet alone appears to have an insignificant role.