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Introduction The current literature suggests that the frequency and complexity of public health emergencies are rising and this trend will likely continue. From 2000 to 2023, seven events have been declared as a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO). Organisational models such as the Incident Management System, Incident Response System and Incident Command System or country-specific models are essential in managing PHEIC.The review aims to achieve four key objectives. First, identify and describe the organisational models used in the South-East Asia Region (SEAR) nations defined by WHO as Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, Timor-Leste and DPR Korea for managing PHEICs. Second, explore the indicators used to gauge the effectiveness of these models. Third, assess how these indicators impact the overall success of organisational models. Finally, the review will delve into the implementation aspects gaining a deeper understanding of how the organisational models are put into practice to manage PHEICs in the SEAR region.Methods and analysis Following Preferred Reporting Items for Systematic review and Meta-Analysis Protocols guidelines, a qualitative evidence synthesis will be conducted. A defined search strategy will be employed to conduct a comprehensive literature search of the following academic databases: PubMed (MEDLINE), Excerpta Medica Database, Cochrane CENTRAL, Cumulative Index to Nursing and Allied Health Literature, WHO Library Database, US Centers for Disease Control and Prevention (CDC), CDC’s Morbidity and Mortality Weekly Report and Web of Science; as well as non-academic databases including Google Scholar, Evidence Aid, Epistemonikos, Shodhganga and ResearchGate. This review will employ the SPIDER-D tool for searching qualitative studies. Two reviewers will check the quality of included studies and will be appraised using standard critical appraisal tools. In case of any difference between the two reviewers, a third reviewer will take the decision.Ethics and dissemination No ethical approval is required. Results will be published in a peer-reviewed journal and disseminated through a workshop for stakeholders and policymakers.PROSPERO registration number CRD42023394418.

Cardiovascular disease is a significant cause of death worldwide, emphasizing the crucial need for timely detection and diagnosis of heart abnormalities. This study presents a new approach that utilizes deep learning models to diagnose cardiac issues by analyzing raw phonocardiogram (PCG) signals. The proposed method introduces a novel technique called custom scalogram-based convolutional recurrent neural network (CS-CRNN). Diverging from conventional techniques, this model directly handles the raw PCG signals. These signals undergo a transformation into scalogram images within the initial layer of the CRNN architecture, without incorporating any learnable parameters. The results obtained from the CS-CRNN model are compared with traditional feature-based recurrent neural network (RNN) models. The comparison demonstrates comparable performance in both binary classification (normal and abnormal categories) and multiclass classification (5 categories). The CS-CRNN model directly handles raw PCG data and employs data augmentation to enhance performance on small datasets. It achieves an accuracy of 99.6% for binary classification and 98.6% and 99.7% before and after optimization for multiclass classification on the augmented dataset. The results show that the CS-CRNN model offers comparable performance to traditional methods, making it a promising tool for diagnosing cardiac abnormalities.

The execution of globally distributed information technology service projects (GDITP) by globally distributed teams, while inherently complex, offers the advantages of swift implementation and seamless service delivery to global clients. The numerous challenges including the intangibility of customer specifications, the iterative nature of information technology (IT) activities and coordination difficulties arising from diverse teams contribute to complexity in managing these projects. Moreover, the organizational complexity is compounded by competing power centres, turning project delivery into a politically contested process. In traditional projects such as construction or customized manufacturing, overcoming aforementioned challenges through strong top-down leadership is typical in many time-bound projects. However, in the realm of IT projects, which are inherently people-centric, enforcing a command-and-control environment is challenging. Communities-of-practice (CoP) offer an alternative structure that engages highly skilled employees in a collaborative community, navigating the challenges posed by IT projects. Our study explores this innovative approach, focusing on a product firm effectively leveraging CoPs to successfully execute global service projects. Delving into the functioning of CoPs, our research illustrates how they scale up using both formal and informal networks to meet diverse global customer requirements. Despite operating globally, CoPs exhibit emergent collective mindfulness, adapting tools, processes and products to the demands of the projects. The study also details how the organization manages complexity while adhering to product architecture and a uniform project framework.

Background: Asian patients with adenocarcinoma of lung have higher incidence of epidermal growth factor receptor mutations which predict increased response and survival in patients to oral tyrosine kinase inhibitors. This study was conducted to study the frequency of epidermal growth factor receptor mutation in patients in Nepal and compare the outcome in epidermal growth factor receptor mutated versus non-mutated patients receiving standard therapy. Methods: This is an observational study conducted among newly diagnosed patients with stage IV adenocarcinoma of lung in Bir Hospital from April 2017 to June 2018. Demographic and clinical data collection along with epidermal growth factor receptor mutation testing was done. Patients with epidermal growth factor receptor mutations received Gefitinib while non-mutated patients received systemic chemotherapy. Response evaluation, progression free survival at 1 year, objective response rate and quality of life were compared. Follow up period was for 1 year. Results: Eighty three (33%, n=253) patients were diagnosed with adenocarcinoma of the lung with mean age at diagnosis being 59.4 years. epidermal growth factor receptor mutations were found in 29% patients. Complete response was achieved in 9.1% vs 3.0 % (p=0.46), objective response rate was 27.3% versus 15.2% (p=0.23), progression free survival at 1 year was 39% vs 27%, (p = 0.29) and mean score of global health status was 68.1 versus 61.6 in epidermal growth factor receptor mutated versus non-mutated (p = 0.036). Conclusions: The frequency of epidermal growth factor receptor mutation in patients with adenocarcinoma of the lung was lower than in Eastern Asian studies, but higher than in western populations. epidermal growth factor receptor mutated patients had improved survival, better treatment response and quality of life in comparison with non-mutated. Keywords: Adenocarcinoma of lung; EGFR; quality of life

India has been a part of 5 major wars since its independence in 1947 and hosts over 212,413 refugees from Sri Lanka, Tibet and Bangladesh. So, a wide spectrum of trauma survivors, both civilian and military, live in this country and require mental healthcare. We discuss the psychological impact of armed conflict and how the country and culture tint it uniquely. We not only explore the current scene but the resources available and what can be done to make such vulnerable parts of the Indian population feel safer.

Abstract Introduction Cardiac resynchronization therapy (CRT) device insertion comprises of a transvenous pacing lead implanted in posterolateral branch of the coronary sinus (CS) for left ventricular (LV) pacing, in addition to leads in the right ventricle and right atrium. In patients undergoing CRT device implantation, failure of CS cannulation was earlier reported to be around 10% but has come down to about 4% in recent years. Although the use of electrophysiology (EP) catheter has been reported during CRT procedures but femoral approach to place decapolar catheter as fluoroscopic guide for CS ostium cannulation during LV lead implantation has not been evaluated. Materials and methods The aim of the study was to compare fluoroscopy time during CRT procedure between conventional technique and using decapolar EP catheter via femoral approach as fluoroscopic marker to cannulate CS. Results This study included 21 patients. Group 1 (using decapolar catheter) had 12 patients and group 2 (using the conventional technique) had 9 patients. CS cannulation was successful in all 21 cases. The mean fluoroscopy time for the CS cannulation and LV lead placement in group 1 was 10.7 (±1.03) min and in group 2 was 19.1 (±1.51) min. This difference in mean fluoroscopy time for the CS cannulation and LV lead placement was statistically significant with p

Strategic cost management is vital to the Australian university sector’s performance, and activity-based costing (ABC) is a widely accepted and used accounting technology assisting with this. We examine the status of ABC technology adoption in two categories—adopters and non-adopters of the technology—informed by Technology Diffusion Framework, Social Cognitive Theory and Dynamic Theory of Strategy. The study collected data by sending a pilot-tested survey questionnaire to senior executives for electronic completion. From the 39 universities that elected to participate, 24 usable responses were received, representing a 61% response rate. The data were analyzed using cognitive characteristics supported by Social Cognitive Theory, and organizational characteristics supported by the Dynamic Theory of Strategy of universities ABC technology adopter and non-adopter status. Cognitive characteristics provide a qualitative explanation, but selected determinants show no statistical significance. Organizational characteristics also provide a qualitative explanation and show organizational revenue is the most significant determinant; followed by universities located outside the cities, and in the southern part of Australia, have more propensity for ABC technology adoption.

Battery-powered EGC systems are improved with different IoT mechanisms in particular for the treatment of cardiovascular problems. To extend the battery capacity of IoT devices in the ECG monitoring system, an energy-saving technique was adopted using the VLSI design have been given in this study. The proposed power control computer automatically switches between two modes of transmission, i.e., greater style of power and reduced power, style, according to the battery intensity. A light approach stressing slope augmentation with a real-time segmentation algorithm was proposed for QRS complex assessment of pulse rate, guaranteeing optimum energy consumption during low battery capacity because on-node localized computation was a source of energy. Proper power transmission mode was chosen to efficiently achieve the objectives of the Wireless Body Area Network (WBAN) device, gathering sufficient ECG data from a specific patient and will increase in the charging level of the entire system with pulse rate consistency. The MIT-BIH arrhythmias dataset was used to assess the sensitivity. The design was suited for real-time ECG surveillance systems because it has been developed in a Spartan6 FPGA with a maximum frequency of 269 MHz and energy consumption of 0.7 MW.

Nasal bridge is a common site suffering personal protective equipment-induced skin damages over face among first-line health care workers in this coronavirus disease 2019 pandemic. We hereby report folliculitis as a complication following regular use of N95 respirator and goggles, unreported in literature till now.

Right ventricular outflow tract tachycardia is a type of monomorphic VT which originates from the outflow tract of the right ventricle or occasionally from the tricuspid annulus. It usually occurs in structurally normal heart but can also occur in patients with structural heart disease. A 45 year old male was referred to our hospital for EP study and RF ablation. Patient had multiple episodes of palpitations in the past 1 month and these were diagnosed as episode of ventricular tachycardia which were reverted each time with Direct Current Cardioversion in another hospital. Patient was diagnosed as case of RVOT VT, Double Chamber Right Ventricle, outlet VSD (restrictive) with RVOT aneurysm. He was managed conservatively and advised surgical repair.

Background: Day care spine surgery though practiced in many centers around the world, is still relatively an unchartered territory here in India, with very few centers performing spine surgeries in a day care setup. Our study was conducted to assess the feasibility of day care spine surgery in our setup. Materials and Methods: This is a prospective observational study in which patients who had undergone spinal surgery (lumbar discectomies, intradural-extramedullary lesions [IDEMs] and extradural space-occupying lesions [SOLs] extending up to one and a half vertebral levels, and one or two level anterior cervical discectomy and fusion [ACDF] in a day care setting) in our department from March 2018 to December 2018, were recruited. Of the 68 patients recruited, 33 were in the day care group and 35 were in the routine group. Data was collected on type of pathology, comorbidities, spinal segment involved, type of surgical procedure; visual analog scale (VAS) score in the preoperative period, immediately after surgery, 12h after the discharge, and at suture removal, length of hospital stay, cost, conversion of the day care to a routine admission, and disability/functional outcome. Results: We found comparable surgical results and postoperative pain profile in both the groups; median VAS in the immediate post-op period was found to be 5 in the day care and 4 in the routine group, at 12h after discharge, it was found to be 4 in both the groups, and at suture removal, it was found to be 2 in both the groups. There was statistically significant decrease in hospital stay and cost with a P value of 0.001 for both. Mean length of hospital stay was 1.15 ± 0.36 days in the day care and 9.66 ± 4.76 in the routine group. Mean cost was 2142.97 rupees in the day care, whereas it was 17971.94 rupees in the routine group. There were no new onset neurological deficits in the day care group. Five cases were converted from the day care group due to various reasons. Conclusion: One and two level lumbar prolapsed intervertebral discs (PIVDs)/canal stenosis, cervical PIVDs, especially single-level PIVD, IDEMs, and extradural SOLs can be performed in a day care setting.

Background: Postoperative pancreatic fistula (POPF) or leak from pancreaticojejunostomy (PJ) is one of the most common complications after pancreaticoduodenectomy (PD), with an incidence of 5%–30%. Various techniques have been advocated to bring down the incidence of POPF, but there is still none that can be called the “gold standard”. Peng's binding PJ (BPJ) was proposed as a good method of performing PJ with low fistula rates; we present our results with BPJ. Methods: The data of all patients who underwent PD with BPJ between January 2016 and March 2018 were retrospectively analyzed for demographics, clinical features, type of procedure performed, complications (especially POPF), hospital stay, morbidity, and mortality. Results: A total of 24 patients (18 males and 6 females) were identified. The mean age at the diagnosis was 65.5 ± 6.4 years. Majority of the patients had ampullary carcinoma (62.5%). The most common postoperative complication was delayed gastric emptying seen in 10 patients, whereas only 2 (8.33%) had POPF and there was one mortality. Conclusion: BPJ is safe and is associated with a low incidence of POPF.

Background: The emergence of oral dryness unrelated to salivary flow volume has always raised many questions over the hypothesis of oral dryness in postmenopausal women. The current research article tries to focus on qualitative changes in saliva in the postmenopausal women suffering from oral dryness. Aim and Objectives: To correlate the severity of oral dryness with qualitative changes in serum estrogen, serum parathyroid (PTH), serum calcium levels in postmenopausal women. Materials and Methodology: This case-control study was carried out on 60 postmenopausal women with 30 forming the case groups as having oral dryness and 30 forming control group without oral dryness. The severity of oral dryness was assessed through the Xerostomia Inventory Score (XI Score). Serum estrogen and serum parathyroid levels were assessed by the ELISA method and serum calcium levels were assessed by Arsenazo III reaction using a semi-autoanalyzer in all participants. Statistical analysis was done by student's t- test and Pearson correlation. Results: Significant differences were observed in the mean values of serum estrogen levels, serum parathyroid levels, and XI score between the case and control groups. (P < 0.001). Serum calcium levels did not show significant variation (P= 0.385) between the groups. The correlation proved that there was an inverse correlation between estrogen levels and XI scores (r-value -0.777). Conclusion: The severity of oral dryness was associated with decreased levels of estrogen and increased levels of parathyroid hormones in postmenopausal women. Fall in estrogen levels is associated with an increase in oral dryness.

The efficacy of SARS-CoV-2 vaccines reported in Phase 3 trials varies from ~45% to ~95%. This study tests the hypothesis that the observed variation in efficacy of SARS-CoV-2 vaccine candidates can be explained by the prevalence of the COVID-19 pandemic at trial sites. To test the proposed hypothesis, we conducted a systematic search following PRISMA guidelines. Our search resulted in 8 vaccine candidates that had reported efficacy data from a total of 20 Phase 3 trials, representing a total of 221,968 subjects, 453 infections across the vaccinated groups and 1,554 infections across the placebo groups. We use meta-regression models to analyse the potential associations between prevalence of COVID-19 pandemic at trial sites and efficacy of the reported SARS-CoV2 vaccines. The overall estimate of the risk-ratio is 0.24 (95% CI, 0.17-0.34, p ≤ 0.01), with a high degree of heterogeneity (τ2 = 0.50, I2 = 88.73%). Our meta-regression analysis with pandemic prevalence as the predictor explains almost half the variance in risk ratios across trials (R2 = 49.06%, p ≤ 0.01). This study finds that efficacy of SARS-CoV-2 vaccines reported in Phase 3 trial declines as pandemic prevalence at trial sites increases. Trials conducted in locations with low pandemic prevalence reported higher efficacies as compared to trials conducted in high pandemic prevalence locations.

We hereby present two patients with benign cardiac tumours presenting as ventricular tachycardia (VT). Most such tumours have a favorable prognosis, unless complicated by arrhythmias. Intracavitary tumours are easily diagnosed by echocardiography. Intramural tumours as in our patients may be missed at times by echocardiography. Multimodality imaging helped confirm the diagnosis and etiology, since biopsy was not safe. Surgical removal was not feasible due to extensive infiltration. The patients are so far doing well on medical therapy.

Immune checkpoint inhibitors (ICIs) are the standard of care for the treatment of several cancers. While these immunotherapies have improved patient outcomes in many clinical settings, they bring accompanying risks of toxicity, specifically immune-related adverse events (irAEs). There is a need for clear, effective guidelines for the management of irAEs during ICI treatment, motivating the Society for Immunotherapy of Cancer (SITC) to convene an expert panel to develop a clinical practice guideline. The panel discussed the recognition and management of single and combination ICI irAEs and ultimately developed evidence- and consensus-based recommendations to assist medical professionals in clinical decision-making and to improve outcomes for patients.

Introduction: Pulmonary vein isolation (PVI) is the most widely used procedure for ablation in patients with paroxysmal atrial fibrillation (AF). Not withstanding recent advancements in this field, including sophisticated three-dimensional (3D) based imaging and advanced ablation catheters with contact force technology, many patients and healthcare systems in developing countries will not afford such an expensive therapeutic procedure. There are no data from India analyzing the efficacy of PVI for PAF using conventional mapping and ablation. In this article, we have summarized the intermediate term outcome following PVI in patients with PAF using electrogram-based mapping and a 8 mm tip ablation catheter. Method: A total of 42 consecutive patients who underwent PVI for symptomatic PAF not controlled with at least one antiarrhythmic drug were studied in a tertiary care institute from March 2011 to June 2018. Patients with rheumatic AF were excluded. The pulmonary vein (PV) anatomy was assessed by pulmonary angiography during the ablation procedure. Using conventional electrophysiologic mapping, a variable curve Lasso catheter placed in the PVs was used to guide the earliest site of breakthrough. The segmental ostial PVI was performed using a 8 mm tip radiofrequency (RF) ablation catheter. Elimination of all PV ostial potentials and complete entrance block into the PV were considered indicative of complete electrical isolation. Follow-up visits were scheduled at one, three, and six months after the procedure, and every six months thereafter. History, symptom review, clinical examination, and 12-lead ECG were performed at each follow-up. Results: At pre-discharge, 34 patients (81%) were in sinus rhythm, while eight patients (19%) continued to have atrial fibrillation. The age of the study population was 51.5 ± 11.7 yrs. The mean follow-up duration was 44 ± 21 months (range 6–84 months). The number of PVs isolated included one (five patients, 11.9%), two (20 patients, 47.6%), three (12 patients, 28.6%), and four (five patients, 11.9%). In 42 patients, a total of 101 PVs were isolated. The right superior PV (RSPV) was isolated in 37 patients, the left superior PV (LSPV) was isolated in 39 patients, the left inferior PV (LIPV) was isolated in 14 patients, and the right inferior PV (RIPV) was isolated in six patients. The procedure duration was 125 ± 29 min and the fluoroscopy time was 47 ± 13 min. The number of patients who remained in sinus rhythm at 1, 6, 12, and 24 months were 34 (81%), 32 (76%), 30 (71%), and 26 (62%), respectively. Two patients of these underwent repeat PVI, which was successful, and they had freedom from AF episodes. Complications were rare. One patient had a minor pericardial effusion, and one patient had transient sinus pauses, which were conservatively managed. Conclusion: Conventional RF ablation using PV potential-based mapping and ablation with 8 mm tip catheters is safe for patients with PAF. The intermediate term outcome is satisfactory and cost-effective in our setting with limited resources. Keywords: Atrial fibrillation, Radiofrequency ablation, Pulmonary vein isolation

Background: Despite several decades of use of calcium channel blockers, the side effect of edema persists as a class effect, and its mechanism is unresolved. Amlodipine has effects on hemorheology (HR), and its hemodilutory property may partly contribute to its antihypertensive action. This aspect is not well studied, and the literature is sparse in this regard. Objective: This experiment was planned to determine effect of a single-dose administration of amlodipine on HR parameters in normal human volunteers. Methods and results: Amlodipine (5 mg) or S (-) amlodipine (2.5 mg) was administered to 27 normal human volunteers. Whole-blood viscosity (WBV) at different shear rates, plasma viscosity (PV), red cell rigidity (RCR), red cell aggregation (RCA), hematocrit (Hct), plasma hemoglobin, along with plasma drug concentration were determined at time intervals, t = 0, 4, 8, 12, and 24 h. Statistically significant reductions were observed at tmax = 4 h in WBV at shear rates of 0.512 s–1 (p

ABSTRACT: Objective: Iodine deficiency disorders (IDDs) remain a major public health concern in most parts of the world but are extremely rare in North America. We describe a case of goiter in a young male with dietary history and findings suggestive of IDD. Methods: Laboratory and imaging procedures including thyroid function tests, autoantibodies, urine iodine, thyroid ultrasound, and radioactive iodine (RAI) uptake scan were performed. Results: On initial presentation, thyroid-stimulating hormone (TSH) was 24.4 mIU/L (normal range is 0.4 to 5.0 mIU/L), free thyroxine was

Background & Objectives: The cardiovascular complications including morbidity and mortality remains alarmingly high in all stages of chronic kidney disease. Although patients with chronic kidney disease share many of the similar risk factors for cardiovascular disease as the general population, there are a number of uremia related risk factors, such as anemia and alterations in calcium/phosphorus metabolism that also play a role in promoting cardiovascular disease. The objective of the study was to study the cardiovascular complications in end stage renal disease patients on maintenance hemodialysis.Materials & Methods: It is a hospital based cross-sectional observational study conducted at College of Medical Science - teaching Hospital. Hundred patients (n=100) with a diagnosis of end stage renal disease (irrespective of the underlying cause), and those who were on hemodialysis support were studied over a period of one year.Results: One hundred end stage renal disease patients were analyzed. Cardiovascular disease was present in 74% (n=74). the mean age of the patient who had cardiovascular disease was 59.36+14.337 years. The three major causes of end stage renal disease in the study population were hypertension (35%) followed by diabetes(31%) and chronic glomerulonephritis (14%). On electrocardiogram, left ventricular hypertrophy was a major finding 64% (n=64) followed by arrhythmias 30% (n=30). On echocardiography, left ventricular hypertrophy was found in 49% (n=49) followed by left ventricular diastolic dysfunction 38% (n=38). On subgroup analysis, left ventricular hypertrophy was found statistically significant with calcium and phosphorus product > 55 mg2/dl2 (p=0.01). Similarly left ventricular systolic dysfunction, regional wall motion abnormalities and st-t changes was found statistically significant with anemia; p=0.006, p=0.0004 and p=0.02 respectively.Conclusion: Prevalence of cardiovascular complications were common in end stage renal disease patients receiving maintenance hemodialysis. Anemia, calcium and phosphorus product > 55 mg2/dl2 were their independent risk factors.

With the easy availability of computed tomography scanning, the majority of large extradural hematomas are identified and evacuated early. Hence, a large chronic extradural hematoma (CEDH) is rarely encountered in current clinical practice. The authors describe an interesting case of a large bifrontal CEDH associated with superior sagittal sinus injury in a 32-year-old man. We also present a review of 43 cases available in the literature, and discuss various concepts of classification of CEDHs and their management.

This clinical study assessed and compared the efficacy of tea tree oil (TTO), an alternative form of medicine, with clotrimazole (i.e., allopathy) and a conservative form of management in the treatment of oral fungal infection. In this interventional, observational, and comparative study, we enrolled 36 medically fit individuals of both sexes who were aged 20–60 years old. The participants were randomly assigned to three groups. Group I was given TTO (0.25% rinse) as medicament, Group II was given clotrimazole, and Group III was managed with conservative treatment. The results were analyzed from the clinical evaluation of lesions, changes in four most common clinical parameters of lesions, and subjective symptoms on periodic follow-up. Based on the results, the percentage efficiency of the two groups were taken and compared through a bar graph on the scale of 1. No toxicity to TTO was reported. Group I (TTO) was found to be more efficient than the other two groups, as changes in four parameter indices of lesions were noted, and results for all three groups were compared on a percentage basis. The study concluded that TTO, being a natural product, is a better nontoxic modality compared to clotrimazole, in the treatment of oral fungal infection and has a promising future for its potential application in oral health products.

Introduction: Obesity is a risk factor for many conditions including respiratory disorders. However, studies investigating pulmonary functions in obese adolescents from Malaysia are few in number. Aim: To investigate the effect of obesity on pulmonary function variables in the adolescent obese students of a private university in Malaysia. Materials and Methods: A Cross-sectional comparative study was conducted in a total of 100 (50 obese and 50 non obese control) adolescent students of both sexes aged 16- 19 years. Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1 ), FEV1 as a percentage of FVC (FEV1 / FVC%), maximum mid expiratory flow rate (FEF25-75%) and peak expiratory flow rate (PEFR) were measured using a computerized spirometer (Spirobank II MIR via Del Maggiolino125, 00155 Roma, Italy). Body weight, height, Waist Circumference (WC) and Hip Circumference (HC) were measured. Student’s t-test and Pearson’s product moment correlation (r) were used to interpret the data. The p-values less than 0.05 were considered as statistically significant. Results: There was no significant difference in mean pulmonary function parameters between obese and non-obese control group. However, five obese subjects had mild restriction, whereas no obstructive impairment was detected in any subject of the obese and control groups. In obese group, BMI, WC, HC and Waist Hip Ratio (WHR) had negative significant (p

The dynamics of brain area influenced by focal epilepsy can be studied using focal and non-focal electroencephalogram (EEG) signals. This paper presents a new method to detect focal and non-focal EEG signals based on an integrated index, termed the focal and non-focal index (FNFI), developed using discrete wavelet transform (DWT) and entropy features. The DWT decomposes the EEG signals up to six levels, and various entropy measures are computed from approximate and detail coefficients of sub-band signals. The computed entropy measures are average wavelet, permutation, fuzzy and phase entropies. The proposed FNFI developed using permutation, fuzzy and Shannon wavelet entropies is able to clearly discriminate focal and non-focal EEG signals using a single number. Furthermore, these entropy measures are ranked using different techniques, namely the Bhattacharyya space algorithm, Student’s t-test, the Wilcoxon test, the receiver operating characteristic (ROC) and entropy. These ranked features are fed to various classifiers, namely k-nearest neighbour (KNN), probabilistic neural network (PNN), fuzzy classifier and least squares support vector machine (LS-SVM), for automated classification of focal and non-focal EEG signals using the minimum number of features. The identification of the focal EEG signals can be helpful to locate the epileptogenic focus.

The brain is a complex structure made up of interconnected neurons, and its electrical activities can be evaluated using electroencephalogram (EEG) signals. The characteristics of the brain area affected by partial epilepsy can be studied using focal and non-focal EEG signals. In this work, a method for the classification of focal and non-focal EEG signals is presented using entropy measures. These entropy measures can be useful in assessing the nonlinear interrelation and complexity of focal and non-focal EEG signals. These EEG signals are first decomposed using the empirical mode decomposition (EMD) method to extract intrinsic mode functions (IMFs). The entropy features, namely, average Shannon entropy (ShEnAvg), average Renyi’s entropy (RenEnAvg ), average approximate entropy (ApEnAvg), average sample entropy (SpEnAvg) and average phase entropies (S1Avg and S2Avg), are computed from different IMFs of focal and non-focal EEG signals. These entropies are used as the input feature set for the least squares support vector machine (LS-SVM) classifier to classify into focal and non-focal EEG signals. Experimental results show that our proposed method is able to differentiate the focal and non-focal EEG signals with an average classification accuracy of 87% correct.

Background and Aims: Brachial plexus block is close to the ideal anesthetic technique for upper limb surgeries. Several clinical studies have shown that clonidine prolongs sensory motor blockade when used with bupivacaine but effect of clonidine on ropivacaine is not well defined. Present study was done to evaluate the effect of clonidine 2 μg/kg added to ropivacaine 0.5% in supraclavicular brachial plexus block. Methods: In this prospective, randomized, double blind study total 80 patients of American society of anesthesiologist, (ASA) grade I and II undergoing elective upper limb surgery under supraclavicular brachial plexus block were randomized into two groups. Patients in group 1 (n = 40) received 28 ml of 0.5% ropivacaine and in group 2 (n = 40) received 28 ml of 0.5% ropivacaine with clonidine (2 μg/kg body weight). Onset and recovery time of sensory and motor block, duration of analgesia and quality of block, hemodynamic variables, oxygen saturation and level of sedation were studied in both the groups. All the data were analyzed by using unpaired t test. P < 0.05 was considered significant. Result: Sensory and motor block onset times were similar in both the groups. The mean duration of analgesia was 1016.92 + 170.14 min and mean duration of motor block was 880.54 + 127.99 min in group 2. On comparing both the groups it was found statistically significant (P < 0.000). In group 2 four patients showed mild sedation. Group1 showed more severity of pain than group 2 and it was found to be statistically significant (P < 001). Conclusion: Clonidine 2 μg/kg body weight when added to 0.5% ropivacaine in supraclavicular brachial plexus block significantly prolonged sensory and motor block and provides better post-operative analgesia.

Mucoepidermoid carcinoma (MEC) is the most common malignant neoplasm of the major salivary glands, accounting for 15.5% of all cases, benign and malignant. The aim of this article is to report a case of MEC in a 73-years-old male patient who presented with a painless firm fluctuant swelling in left preauricular area. The lesion was thoroughly examined preoperatively, and investigations were carried out. Fine-needle aspiration cytology was done for the lesion and report suggested tumor of the parotid gland. Superficial parotidectomy procedure was done, taking care not to injure the lower division of the facial nerve. Post recovery was uneventful with no defect of facial nerve functions. The histologic picture confirmed that the tumor was MEC of parotid gland. Through the literature reviews of MEC the discussions on prevalence, origin, diagnosis, histological finding, investigation and the modes of treatment are made.

Regional odontodysplasia is a rare developmental dental anomaly affecting both primary and permanent dentition in any of the jaws with uncertain etiology. Clinically, affected tooth are impacted and if erupted are hypoplastic or hypocalcified. Radiographically, the affected teeth show a typical "ghost-like" appearance. In this article, two such case reports are presented by the authors associated with supernumerary teeth in the same region.

Field experiments were conducted to study the effect of weather variability on mustard crop at Research Farm of Agromet Research Centre, SKUAST-J, Chatha, Jammu during rabi seasons of 2010- 11 to 2012-13. Treatments were comprised of three sowing dates (9th October, 24th October and 8th November) and two cultivars of mustard (RL-1359 and RSPR-01). The results revealed that days taken to physiological maturity and yield reduced significantly with delayed sowing. Mustard crop sown on 9th October utilised more thermal, and heat units as compared to 24th October and 8th November sown crops. The shortening of the duration of the crop sown late was due to forced maturity because of higher temperature during reproductive phase of the crop. Heat use efficiency (HUE) was found to be higher for earlier sown crop and it decreased with delay in sowing. Correlation studies indicated that lower night temperature during vegetative phase is favourable and higher day temperature during reproductive phase is not favourable for mustard yield.

Styloid process has a close proximity to many vital neurovascular structures in the neck, making it clinically significant. It is said to be elongated if its length is more than 3 cm. Only 4% of the general population has been found to have elongated styloid process, most of which are asymptomatic. An unusual case of a calcified styloid process measuring, 8 cm on the right side and 6.75 cm on the left side, viewed on a digital orthopantomograph as well as on a computed tomographic scan is reported in this article.

Background and purpose: Vision has been considered as the dominant modality in the human multi-sensory perception of the surroundings. The congenitally blind individuals use cortical areas that are normally reserved for vision during Braille reading. Use-dependent reorganization and neural plasticity changes occur as a consequence of many events, including the normal development and maturation of the organism, the acquisition of new skills. The research was designed to study the effect of blindness on SEPs in the dominant hand (Braille reading hand) compared to the non dominant (non Braille reading hand) in the congenitally blind. Material and methods: SEPs were recorded in 15 Braille reading congenitally blind females and compared with 15 age matched normal sighted females following right and left index finger stimulation. Latency and amplitudes of SEP waveforms (N9, N13, and N20) were measured. Results: The SEP-N20 amplitude was significantly increased in the congenitally blind (p < 0.0001 for right index finger and p < 0.005 for left index finger). There is a very large effect of blindness (3.11) on right index finger. Conclusions: The congenitally blind individuals have larger N20 amplitude, which is suggestive of greater somatosensory cortical activity. Effect of blindness and Braille reading skills is greater on SEPs recorded from the dominant and preferred hand. A varied contribution from Basic mechanisms in plasticity like neurogenesis, activity-dependent synaptic and neuronal plasticity may be involved.

Background: Scrotal ultrasound, though reliable in distinguishing between intratesticular and extratesticular lesions and characterizing them as cystic and solid, cannot distinguish benign from malignant pathology. Although fine needle aspiration cytology (FNAC) has proved to be of great diagnostic importance in testicular lesions, its scope in extratesticular lesions is largely unexplored. Aim: To evaluate extratesticular scrotal lesions cytologically and compare it with their clinical, radiological, and histological findings. Materials and Methods: Sixty five patients with extratesticular scrotal lesions were assessed clinically, radiologically, and cytologically. Histopathology was done in 45 cases where surgical exploration was undertaken. All the data were then analyzed and correlated. Results : Extratesticular lesions accounted for 72.2% of the scrotal swellings. Of these, the epididymis is most commonly involved (61.5% cases) with the commonest type of lesion being cystic (49.3% cases). Ultrasonography preferably with color doppler is highly useful for the evaluation of the scrotum. Apart from distinguishing extratesticular from testicular and cystic from solid lesions, it has an important role in identifying individual lesions, thus reducing the list of differential diagnosis. Fine needle aspiration cytology contributed to a definitive diagnosis in 47.7% cases. It helps classify cystic masses on the basis of their contents and defines the etiology of chronic inflammatory lesions, apart from corroborating with the clinico-radiological diagnosis. Histological evaluation was possible only in cases where surgery was performed and helps further define the diagnosis. Conclusion : Fine needle aspiration cytology is essentially non-traumatic and easy to carry out and should be a technique of choice for the study of scrotal pathology, main advantage being avoidance of delays in diagnosis.

Port site hernia after laparoscopic surgery is a rare complication. Here we present a case of a 55-year-old female, diagnosed with an anterior abdominal wall hernia through the 10mm umbilical port, just two days after her laparoscopic cholecystectomy. The uniqueness of this case is its extremely early presentation. Patient presented with features of acute intestinal obstruction and due to prompt diagnosis and timely intervention, she underwent a successful reduction of hernia and an anatomical repair of the fascial and peritoneal defect through the midline laparotomy incision.

Introduction: There is important preclinical evidence that substance abuse may produce neurophysiological disturbances particularly in relation to altered neural synchronization in Visual Evoked Potentials (VEP). Aim : The purpose of current study was to compare the latencies and amplitudes of different waveforms of VEP among different drug abusers and controls and also to identify early neurological damage so that proper counseling and timely intervention can be undertaken. Materials and Methods: VEP was assessed by Data Acquisition and Analysis system in a sample of 58 drug abusers, all males, within age group of 15-45 years as well as in age matched 30 healthy controls. The peak latencies and peak to peak amplitudes of different waveforms were measured by applying one-way Anova test and unpaired t-test using SPSS version 16. Results: In between drug abusers and controls, the difference in the duration of N75 and P100 waveform of VEP was found to be statistically highly significant (p

Introduction: Usage of tobacco is prevalent worldwide in some or other form in all age groups. Smoking and tobacco use is a major public health issue in developing countries. As Rajasthan is a place with different cultural and traditional variations when compared with other parts of the world. To extract if the same diversity exists in the usage of tobacco in Jaipur district Rajasthan, this study was conducted as no similar studies have been done previously Materials and methods: A total of 552 patients who visited Outpatient Department of Jaipur Dental College, Jaipur, were studied. Complete information regarding presence of smoking and other forms of tobacco was recorded in case history proforma and any of tobacco-related oral lesions among these patients were examined. Results: In age group of 0.05) in 12.84% subjects, oral cancer was reported in 33 patients (p-value = 0.001) whereas smoker′s palate in 25 patients and OSMF being the most common. Awareness level about ill effects of tobacco was 51.10 %. Conclusion: High incidence of tobacco usage in smokeless form is seen in Jaipur population especially in adolescents. There were no significant findings found between males and females. Of all lesion examined, OSMF was found to be more prevalent. Therefore, it is important to take immediate steps to curb the habit.

Subgaleal hematoma is a potentially life-threatening extracranial bleed that occurs most commonly in neonates after difficult instrumental deliveries. Its occurrence beyond the neonatal period is rare and is often associated with head trauma involving tangential or radial forces applied to the scalp causing emissary veins traversing the subgaleal space to be ruptured. Large progressive subgaleal hematoma due to trivial head trauma in a 5-years-old child of hypofibrinogenemia with no reported literature is interesting to describe.

Giant cerebral cavernous malformations (GCCMs) are very rare malformations in adults, and they rarely present with raised intracranial pressure due to obstructive hydrocephalus. Around 20 cases of GCCMs have been reported in available literature. We report such a case, discuss and review the available literature regarding this eminently treatable group of vascular malformations.

Background: Medical students today are subject to a variety of stress; academic, social, emotional or stress in the form of affliction of health during their stay at medical school. The physiological response to these depends on various factors including their inherent coping abilities. This study was designed to examine the coping ability of medical and nursing students at the time of admission to medical school. Materials and Methods: 42 medical and 34 nursing students volunteered for the study. They were administered the BAI questionnaire and classified as good and poor adjusters based on their score. Results: The study revealed an unsatisfactory overall coping ability to be prevalent among medical and nursing students. Conclusion: This study showed that there is a need for orientation and counselling of medical and nursing students at the start of college.