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BACKGROUND Progressive multifocal leukoencephalopathy, (PML) a demyelinating disease of the brain, caused by the John Cunningham (JC Virus) is usually seen in patients who are immunocompromised. Here, we describe a case of an immunocompetent patient diagnosed with PML and a comprehensive literature review. CASE DESCRIPTION A 64-year-old Caucasian male presented with acute worsening of progressive neurological decline with difficulty in vision and reading. Based on history, examination, CSF markers, histopathology, and MRI Brain at the time of presentation diagnosed the patient with PML in a setting of no immunosuppression disorder. Patient was started on Pelfilgrastim with significant systematic improvement. RESULT In our literature review, it was seen that the average age of symptom presentation was 57.5 with predominance in males. Most of the patients presented with progressive neurological deficits with symptomology ranging from mild confusion, aphasia, anxiety to sensory disturbances with numbness, hemiparesis and hemianopsia. Out of the 21 cases, patients responded to mirtazapine and intravenous pulse methylprednisolone (IVMP). The mortality rate was close to 50% with 11 fatal cases and 10 non-fatal cases. CONCLUSION Our case and literature review demonstrate the possibility that PML may very rarely occur in patients that our immunocompetent. Furthermore, our review showed that patients responded well to mirtazapine and IVMP. We also want to highlight that mortality rate was lower in this review and was only compared to morality in PML associated with immunocompromised status. This article is protected by copyright. All rights reserved.

Tin chalcogenides (SnX, X = S, Se)-based heterostructures (HSs) are promising materials for the construction of low-cost optoelectronic devices. Here, we report the synthesis of a SnSe/CdSe HS using the controlled cation exchange reaction. The (400) plane of SnSe and the (111) plane of CdSe confirm the formation of an interface between SnSe and CdSe. The Type I band alignment is estimated for the SnSe/CdSe HS with a small conduction band offset (CBO) of 0.72 eV through cyclic voltammetry measurements. Transient absorption (TA) studies demonstrate a drastic enhancement of the CdSe biexciton signal that points toward the hot carrier transfer from SnSe to CdSe in a short time scale. The fast growth and recovery of CdSe bleach in the presence of SnSe indicate charge transfer back to SnSe. The observed delocalization of carriers in these two systems is crucial for an optoelectronic device. Our findings provide new insights into the fabrication of cost-effective photovoltaic devices based on SnSe-based heterostructures.

Background: In the present study, we aimed to determine the expression of PDL1 and its correlation with TIL in Triple Negative (ER, PR and Her 2neu negative) cases of breast carcinoma (immune-histochemical study) Methods: Expression of PD-L1 was seen on 40 proven triple negative cases of breast carcinomas (TNBC) and to correlate it with other parameters affecting prognosis of the disease. All the cases were infiltrating ductal carcinoma NOS (not otherwise specified) Result: Maximum cases were Grade III (67.5%) followed by Grade II (32.5%). PD-L1 positivity was seen in 32.5% cases whereas TIL was positive for PD-L1 in 27.5 %. 5 cases were positive for both epithelial cell and TIL. Out of 13 PD-L1 positive tumors, 38.5% cases showed TIL positivity whereas out of 27 PD-L1 negative tumors, only 22.2% were TIL positive. PD-L1 expression in TIL was seen in 38.5% of cases however there was no statistically significant correlation between PD-L1 positivity and TIL positivity. PDL-1 positivity was more in Grade III (33.3%) as compared to Grade II (23%) lesions. Thus, it was observed that PD-L1 positivity increased from grade II to grade III lesions. Conclusion: Intra-tumoral expression of PD-L1 is directly proportional to histological grade, aggressive subtypes in TNBC cases however there was no statistically significant correlation between PD-L1 positivity in tumor cells and TIL positivity. We thus postulate that measurement of PD-L1 expression in TNBC cases could enhance the accuracy of predicting patient prognosis and allow for optimal treatment selection.

Raj Yoga is one of the tested spiritual, holistic healing approaches nowadays used for every field for promoting self-esteem in healthy and unwell patients at mental and psychological levels. Cancer is one of the end-stage diseases that give not only physical pain but also causes psychological threats to the patient. The patient may experience grief, fear of death, loneliness, low self-esteem and other emotional changes resulting in depression and anxiety disorders. During this stage, some spiritual or holistic healing approaches are must for the enhanced wellbeing status of cancer patients, so the current study is focused on evaluating the effectiveness of Raj Yoga Meditation in cancer patients in selected hospital of Punjab In this study, the Raj Yoga Meditation programme was introduced for 15-20 minutes per day for six consecutive days to the experimental group. Although the study period was concise, however, the results showed that there was a significant difference between pre-test (141.64±18.9624) and post-test (167.400±23.0922) wellbeing scores at the 0.05 level of significance.

It is undeniable that oil and gas explorations are going on at a frantic pace due to excessive fossil fuel usage across the world. This has compelled us to explore isolated or even uninhabited places to meet the surging demand for oil and gas. There is no doubt that scientists and researchers worldwide are exploring more renewable energy sources to produce value-added products. In the last few years, biogas' usage as a reactant gas in the catalytic reforming process has emanated as an energy carrier to produce energy-efficient products, i.e., syngas and methanol. This review aimed to analyze the research works focusing on the biogas DR reactions and methanol production from biogas. The findings of some experimental studies have been presented in the form of graphs for important selective parameters as case studies. The overall impression from the review suggests that the performance of the reforming catalysts deteriorates regarding different operating conditions. Still, the improvement in syngas production has been reported by neglecting the effect of H2S impurity. Furthermore, various parameters have been discussed paragraphically to evaluate the catalytic performance in biogas dry reforming reactions and a check on catalyst synthesis methods. After that, a few scattered studies have been discussed on methanol synthesis using biogas as a feedstock.

Background: This study was conducted to evaluate the expression of Cyclin D1 in colorectal carcinoma, and to correlate Cyclin D1 positivity with the grade of the tumor along with other parameters such as age, tumor location, lymph node metastasis, and vessel invasion.Materials and Methods: The present cross-sectional study was conducted on 40 proven cases of colorectal carcinoma from October 2015 to October 2017. The tissues were fixed, processed, and stained with hematoxylin and eosin followed by immunohistochemical staining with Cyclin D1 using monoclonal antibodies.Results: 75% of the cases were conventional adenocarcinoma while the rest were mucinous adenocarcinoma. Of the total colorectal carcinomas,12.5% were Grade I, 50% were Grade II and 37.5% cases were Grade III. Cyclin D1 positivity was seen in 60% of cases with the most positivity in grade II tumors. A statistically significant correlation of Cyclin D1 was seen with age group (5th- 6th decade) and histological type of tumor. No significant correlation was seen of Cyclin D1 with lymph node involvement, depth of invasion, vascular invasion, or perineural invasion. A significant statistical correlation was seen with Crohn’s-like reaction and peritumoral lymphocytic response.Conclusions: Thus, it was concluded that a highly statistically significant correlation was seen with age group (5th- 6th decade) and histological type of tumor. No significant correlation was seen with Cyclin D1 expression with lymph node involvement, depth of invasion, vascular invasion, or perineural invasion.

Chalcogenide-based type II heterojunctions are considered to be a promising candidate for optoelectronic device fabrication such as in solar cells, photodetectors, and light-emitting diodes. Type I...

Background Religious and sociocultural beliefs influence the nature of treatment and care received by people with epilepsy. Objective This study aimed to study knowledge, attitude, and practice (KAP) among epilepsy patients in north India. Materials and Methods In this study, 201 patients attending the outpatient and inpatient services of the neurology department of Sir Sunderlal Hospital, Banaras Hindu University, were asked to fill a questionnaire comprising 25 questions assessing the KAPs in English or Hindi, whichever the patient was proficient with. The same questionnaire was also given to 200 patients without epilepsy for the control group. Responses were recorded as yes/no/do not know. Results Approximately, 67% of the patients consisted of a young population, of which 64.7% were males and 35.3% were females. Around 25.9% of patients had studied up to 10th class, 96.5% of patients had heard of epilepsy, and 89.05% thought it was treatable by modern drugs. Out of all patients, 80.1% of patients believed that epilepsy was not contagious, 87.6% believed that they can work, 93.5% believed that they can marry, 66.5% did not feel discriminated by batchmates, and 78.5% did not feel discriminated by teachers. Of all patients, 41.8% said that they would disclose the epileptic condition of their daughters before marriage and 96.01% knew epilepsy patients should be taken to hospital. Conclusion Poor knowledge, negative attitude, and malpractices regarding epilepsy are still prevalent in North India. Epilepsy patients have better knowledge than normal people about this disease. There is still a need to educate people about epilepsy.

The angulated C-MAC D-Blade videolaryngoscope (VL) is designed for difficult intubation and may not be compatible with standard PVC endotracheal tubes.Present study was planned to compare efficacy of C-MAC, D-blade VL using endotracheal tube with three different stylets versus No stylet in patients undergoing tracheal intubation with simulated difficult airway.After obtaining written consent and IEC approval, total 144 adult patients were allocated to four groups of 36 each using no stylet or different types of stylets. The four groups were Group NS: No stylet; Group CS: C-MAC stylet; Group DS: D-blade type stylet; Group HS: hockey-stick shaped stylet. A rigid appropriate sized Philadelphia cervical collar was placed around the neck to simulate difficult airway and C-MAC D-Blade VL was used for intubation. The duration of each intubation stage and attempts were evaluated. Statistical analysis was performed using SPSS 22.0 for Windows and appropriate tests for different variables were applied. Appropriately, Student's t test, Chi-square test, Mann-Whitney U test and one-way ANOVA test were applied.Similar Cormack Lehane grade glottic view was observed in all groups. The number of attempts and duration of intubation was significantly greater using NS than for other groups. Additional laryngeal manipulation, was required in all cases in Group NS, compared to one, zero and two cases in group CS, DS and HS respectively (p0.001).Use of Hockey stick shaped, D blade shaped stylet and C Mac stylet decreased the total intubation duration in patients with simulated difficult airway.

Dental profession is at a very critical conjecture owing to novel coronavirus sickness, COVID-19. Dentistry is a profession where healthcare professionals are extremely susceptible of being infected as well as retain a high susceptibility to cross infect and transmit the contagious viral sickness among general public attending dental clinics. The grounded reality for an average dental practitioner is that walking back to operative clinical work in dentistry post-pandemic is quite tedious. Most of the safeguards and practices recommended in the current COVID-19 pandemic phase need significant alterations in the ways to practice clinical dentistry in terms of prevention and transmission of cross infection. 3D printing or additive manufacturing is the most upcoming surge of technology in the field of health care. Many novel research-driven and technology-based interventions from 3D printing technologies must be exploited and adapted to find ways and means to fight out the outburst of the pandemic. Many such 3D printed mass produced and cost-effective tools, equipments, and barrier materials instilled in clinical dental practice shall prevent or minimize COVID-19 cross contamination and transmission by ensuring safe clinical practices.

Fine needle aspiration cytology has long been an accepted diagnostic modality in combination with physical examination and mammography to investigate breast lesions. In the present era, more proficient methods such as stereotactic mammographically guided breast biopsy is the preferred choice, however, in low resource setting, FNAC still remains the most cost effective and sampling modality to diagnose breast cancer. With the intention to evaluate the efficacy and limitations of FNAC in evaluation of breast lesions in low resource setting, we employed the Masood's cytological staging system to stratify the breast lesions and correlate them with histopathology wherever possible. All breast lesions aspirates were analyzed and classified according to the Masood's cytological scoring system and correlated with histopathological findings wherever adequate material was available. A total of 776 patients were studied of which 23 aspirates were unsatisfactory, 120 aspirates were categorized as inflammatory breast disease. Six hundred and thirty-three cases were classified according to Masood's cytological system. Nonproliferative breast diseases (Group I) encompassed maximum cases with 55% followed by carcinoma in situ and invasive cancers (Group IV) with 39% and proliferative breast disease without atypia (Group II) and with atypia (Group III) which had equal number of cases constituting 2.4% each. Cyto-histopathological correlation done in 102 cases revealed 100% concordance in group IV and 75% concordance in group III while it could not be performed in Group I and II as no histopathological specimen was available in those patients. Masood Cytological grading for breast aspirates is a reliable and an easily reproducible system which can be used to formulate appropriate treatment protocols in cases presenting with breast lesions.

Diabetes is probably the deadliest disease on the planet. It is not only a sickness but also a contributor to umpteenth types of illnesses like visual impairment, kidney failure, and coronary episode. The most challenging task for a doctor is the early prediction of diabetes in a patient whether the patient is diabetic or not. Moreover, anticipating the ailment early prompts treating the patients before it progresses and gets serious. The objective of this paper was to propose an expert system which can foresee whether the patient has diabetes or not with high accuracy. Data mining can separate concealed information from the humongous sea of diabetes-related information available on account of which, it provides a huge help in diabetes examination. The point of this venture was to build up a framework which can anticipate the diabetic hazard level of a patient with higher precision utilizing strategic relapse. The model developed using artificial neural network consists of total of six dense layers. Each of these layers is responsible for the efficient working of the model. The model makes the prediction with an accuracy of 77%, which is fairly good and reliable.

Yue (Computers & Industrial Engineering 102 (2016) 233–245) proposed a geometric approach for solving IVIFMAGDM (interval-valued intuitionistic fuzzy multiattribute group decision making) problems and used it to solve a real-life supplier selection problem. In future, the other researchers may use the same approach to solve other real-life IVIFMAGDM problems. However, after a deep study, it is observed that this approach fails to rank the alternatives. Therefore, the aim of this note is to make the researchers aware that it is scientifically incorrect to use this approach for solving real-life IVIFMAGDM problems.

Background The microscopic examination of fired cartridge cases and fired bullets helps the expert to determine if a suspect firearm/firearms were, or were not, discharged in a shooting incident. This is achieved by using a combination of class and individual characteristics. But in case of malfunctioning of firearm, experts have to adopt different methods to link fired cartridge cases and fired bullets with the suspected firearm. Case presentation In this paper, a new method for the reproduction of the firing pin and breech face impression on two different surfaces are reported. Two chosen surfaces are plasticine and lead metal. Conclusions The surface of the lead being soft and brittle reproduced the impression with maximum detail. Five match points were seen on the lead surface with clear demarcation whereas only three points of individual characteristics marks were observed on plasticine surface.

The calcifying cystic odontogenic tumour (CCOT) is an uncommon benign neoplasm of odontogenic origin, which was first described by Gorlin. It has been shown to have extensive diversity in its clinical and histopathological features and its biological behaviour. Most of these cases present with cystic characteristics, but a few are of the solid type. Cystic variant of CCOT associated with odontoma is considered as rare variant. A case of calcifying cystic odontogenic tumour associated with odontoma is reported in an 11-year-old female patient. In this report, the lesion was very large extending from the midline up to the right tuberosity region and impeded the eruption of five permanent teeth. Through this article, the radiographic and histopathological features of this entity are discussed and the literature is reviewed.

Author(s): Shreve, Lauren; Kaur, Arshdeep; Vo, Christopher; Wu, Jennifer; Cassidy, Jessica M; Nguyen, Andrew; Zhou, Robert J; Tran, Thuong B; Yang, Derek Z; Medizade, Ariana I; Chakravarthy, Bharath; Hoonpongsimanont, Wirachin; Barton, Erik; Yu, Wengui; Srinivasan, Ramesh; Cramer, Steven C | Abstract: BackgroundEarly diagnosis of stroke optimizes reperfusion therapies, but behavioral measures have incomplete accuracy. Electroencephalogram (EEG) has high sensitivity for immediately detecting brain ischemia. This pilot study aimed to evaluate feasibility and utility of EEG for identifying patients with a large acute ischemic stroke during Emergency Department (ED) evaluation, as these data might be useful in the prehospital setting.MethodsA 3-minute resting EEG was recorded using a dense-array (256-lead) system in patients with suspected acute stroke arriving at the ED of a US Comprehensive Stroke Center.ResultsAn EEG was recorded in 24 subjects, 14 with acute cerebral ischemia (including 5 with large acute ischemic stroke) and 10 without acute cerebral ischemia. Median time from stroke onset to EEG was 6.6 hours; and from ED arrival to EEG, 1.9 hours. Delta band power (P = .004) and the alpha/delta frequency band ratio (P = .0006) each significantly distinguished patients with large acute ischemic stroke (n = 5) from all other patients with suspected stroke (n = 19), with the best diagnostic utility coming from contralesional hemisphere signals. Larger infarct volume correlated with higher EEG power in the alpha/delta frequency band ratio within both the ipsilesional (r = -0.64, P = .013) and the contralesional (r = -0.78, P = .001) hemispheres.ConclusionsWithin hours of stroke onset, EEG measures (1) identify patients with large acute ischemic stroke and (2) correlate with infarct volume. These results suggest that EEG measures of brain function may be useful to improve diagnosis of large acute ischemic stroke in the ED, findings that might be useful to pre-hospital applications.

Background: Use of face mask and hand hygiene may break the chain of transmission of severe acute respiratory syndrome coronavirus-2 by reducing the infectiousness of the subclinical virus shedders while also offering some protection to the susceptible population. Aim and Objective: This study aims to assess the knowledge and practices of community wide use of face mask and hand hygiene for prevention and control of coronavirus disease. Materials and Methods: The cross-sectional, observational study carried out in Punjab, using an online questionnaire developed using Google Forms. General population excluding the health-care professionals were included in the study. The participants were selected using convenience snowball sampling. The study period was May 26–June 26 (30 days period). All responses fulfilling inclusion criteria and received within 15 days period after sharing the link will be included in the study. Statistical analysis was done using EPI INFO VERSION 7.0. Results: Maximum participants were between 20 and 39 years of age. About 97.70% knew the importance of hand hygiene in prevention of coronavirus infection. The usage of face mask was less at private settings like home or at work. The cleaning practices of cloth masks were improper. Further, the study population was aware of the importance of hand washing but the duration of hand washing with soap and water was not appropriate. Conclusion: Community of Punjab needs little more awareness regarding hand hygiene and face mask to prevent the transmission of coronavirus infection effectively.

Background: Hypertension is a long-term medical condition in which the blood pressure in the arteries is persistently elevated.[1] Hypertension is one of the diseases of the 21st century, with a social dimension and is major public health problem in urban and nowadays in rural areas as well. Aims and Objectives: This study aims to assess the modifiable and non-modifiable risk factors for hypertension among rural population of district Amritsar. Materials and Methods: A cross-sectional study was conducted among 500 rural participants between the age group of 18 and 69 years, which were selected by systematic random sampling method from five villages in district Amritsar. Out of total, 250 males and 250 females were selected. Data was analyzed statistically using Epi Info 7. The association of the categorical variables with outcomes was seen by the Chi-Square test. P < 0.05 was taken as statistically significant. Results: This study shows that 168 (33.60%) participants were hypertensive out of total 500 in rural areas. Among non-modifiable risk factors, hypertension was directly proportional to age and maximum hypertensives were above 60 years, that is, 53.06%. Conclusion: It becomes essential to strengthen health systems in rural areas and public policies required to be formulated to reduce the exposure of rural population to risk factors such as an unhealthy diet, physical inactivity, and harmful use of alcohol and tobacco with a special focus on children, adolescents, and youth.

Background: Acne vulgaris is a self-limited disease primarily seen in teenagers and young adults. The permissible factor for the expression of the disease in adolescence is the increase in sebum production by sebaceous glands after puberty. The bacterial activity in the blocked follicular orifice leads to release of free fatty acids from sebum which results in inflammation with in the cyst leading to its rupture. This leads to formation of open comedones, closed comedones, pimples, and possible scarring and sometimes psychological disturbances such as loss of confidence, depression anxiety can also occur. Various systemic drugs are given to treat acne which may lead to alterations in thyroid stimulating hormone (TSH) levels. Aims and Objectives: The aim of the study was (1) to compare the severity of acne vulgaris with TSH levels according to age and (2) to correlate TSH levels with treatment. Materials and Methods: The study group included 100 female patients of acne vulgaris who came to outpatient department of the department of skin and venereology and dermatology Tertiary Hospital, Ludhiana in a study period of 1 year. Patients were graded on a scale of I-IV according to Pillsbury Classification. Out of these 93 female patients came for follow-up and data of 93 patients were finally included in the study. Only female patients aged 15–40 years with Grades III and IV acne were included in this study. Results: No significant change in TSH levels in acne vulgaris patients after treatment. Conclusions: It can be concluded that alteration in hormone levels can be responsible for the pathogenesis of acne. Systemic therapy can causes alterations in TSH levels.

Coronavirus disease 2019 caused by severe acute respiratory syndrome-CoV-2 is an emerging infectious disease first identified in Wuhan City, Hubei Province, China, which subsequently spread as a global pandemic posing a global threat. As per World Health Organisation worldwide around 38 lac people have been infected and 2.6 lac people have died from the disease and in India 59,662 people are infected with 1981 deaths by May 9, 2020. It is feasible that potentially infectious specimens may be submitted in our laboratory those are the impending source of infection to the laboratory personnel. Using imaging equipment on coronavirus confirmed/suspected patient/carriers is a serious hazard for healthcare providers because there is a risk that the virus could remain on the surface of the computed tomography scan machines or ultrasound (US) probes/patient bed/couch. Here, we have enlisted the rigorous biosafety measures which if executed appropriately can significantly drop the chances of spread of infection to health care workers in these diagnostic sections.

A total of 104 laboratory model tests on a square footing subjected to eccentrically inclined loads supported by sand reinforced with randomly distributed polypropylene fibers were conducted in order to compare the results with those obtained from unreinforced sand and with each other. For conducting the model tests, uniform sand was compacted in a test box at one particular relative density of compaction. The effect of percentage of reinforcement used, thickness of the reinforced layer, angle of inclination of load to vertical and eccentricity of load applied on various prominent factors such as ultimate load, vertical settlement, horizontal deformation and tilt were investigated. An improvement in ultimate load, vertical settlement, horizontal deformation and tilt of foundation was observed with an increase in the percentage of fibers used and thickness of reinforced sand layer under different inclinations and eccentricities of load. A statistical model using non-linear regression analysis based on present experimental data for predicting the vertical settlement (sp), horizontal deformation (hdp) and tilt (tp) of square footing on reinforced sand at any load applied was done where the dependent variable was predicted settlement (sp), horizontal deformation (hdp) and tilt (tp) respectively.

Primary leiomyosarcoma of the uterine cervix is an exceedingly rare tumor. It is malignant mesenchymal tumour of smooth muscle origin. We report a case of 15-year-old adolescent girl who presented with complain of excessive bleeding per vaginum off and on since 3-4 months and was diagnosed as leiomyosarcoma of cervix. Patient was advised further management but father refused as according to them when bleeding has stopped completely then what is the need of further treatment. In this article we want to highlight the points: what is prognosis and survival of such patient whose mass was removed completely and patient is not willing for further treatment inspite of knowing the aggressive nature of tumor and if hysterectomy is the answer what about the reproductive outcome in such young girls and what is the prospect of uterine transplant surgery.

Background: Introduction-carcinoma of cervix is the commonest cancer in Indian women. It constitutes 14%of the total population above age of 50 years. Atrophic changes in the genital tract causes problems in Pap smear as well as in the colposcopy.Methods: This is prospective observational study conducted in the department of obstetrics and gynecology of SGRDIMSR, Sri Amritsar, which comprised 30 cases of postmenopausal women referred for colposcopy. Inclusion criteria were complaints of post-menopausal bleeding, abnormal vaginal discharge, post coital bleeding, an abnormal PAP smear, an unhealthy-looking cervix. Women with history of any surgery on the cervix in the past three months or with obvious cervical cancer were excluded.Results: Patient with age group of 44-70 years were included, and maximum number of patients had complaint of post-menopausal bleeding (50%). 9 (30%) patients were positive for malignancy on histopathology, while with 9 (30%) false positive patients on colposcopy. Problems encountered while performing colposcopy includes cervix flushed with vagina, atrophy of introitus, bleeding from the cervix and relaxed vaginal walls. Use of various corrective measures were helpful to overcome the problems of colposcopy.Conclusions: It is an essential part of cervical screening programme, but it has some limitations and pitfalls which can lead to error in the diagnosis.

Background: Many studies have been conducted on prevention and treatment of substance abuse but focus on recovery phase is still little. Recovery from addiction is a process of reconnecting and taking oneself back; finding their voice. Spirituality, social support, family support, and hobbies have played major role in self-help recovery programs and the treatment of substance use disorders (addictions) for a long time. The previous studies focused on problems associated to the life of substance abusers raised the question on whether these factors could influence their recovery. Set against this background, this study explains the role of non-pharmacological modalities in the recovery of substance abusers. Aim and Objective: This study aims to study the role of non-pharmacological modalities in recovery of relapse cases of substance abuse. Materials and Methods: A cross-sectional study was carried out at drug deaddiction center attached to Government Medical College, Amritsar, between January 1, 2015, and December 31, 2015, involving 400 male relapse cases. The subject who visited drug deaddiction center was visited which was included in the study based on inclusion and exclusion criteria. The collected data were entered into Microsoft Excel sheets and analyzed in EPI INFO VERSION 7. Prior approval from the Institutional Ethical Committee was obtained. Results: Significant association of hobbies and fitness measures with state of mind and degree of satisfaction with life was seen. Conclusion: The study highlights need of peer recovery support system and family support.

This paper presents a novel review of various clustering algorithms used in the vehicular ad hoc networks (VANET). VANET is an emerging technology sharing a plethora of applications providing safety and contentment to the vehicle users. It is a vital part of Intelligent Transport Systems (ITS) which provides coherent and well organized communication between the vehicles like sending warning messages to avoid the accidents and fatal conditions. Peculiar traffic conditions and the dynamic topology of the network can be challenging for the timely delivery of the messages. Though VANETs presents a unique range of challenges for routing, on the other hand it equally presents solutions via clustering algorithms. Clustering can be useful in maintaining the stability and reliability of an ad- hoc network that results in performance enhancement. Clustering is basically a key technology in VANET that outperform the MANET clustering algorithms like 0lowest ID algorithm, maximum degree algorithm etc. that does not perform well on the pitch of VANET. Adding to the merit of vehicular ad- hoc networks, they have a good hand in accident avoidance, congestion detection, information dissemination etc. This paper is a reviewed comparative study of various clustering algorithms researched in recent years hence making it an easy task to examine the best algorithm for clustering in a particular situation.

Histoplasma capsulatum is no longer confined to certain geographic areas and should always be considered in the differential diagnosis of lymphadenopathy and organomegaly in HIV-positive patients. We present an unusual case of a 20-year-old immunocompromised male of African origin presenting with fever, jaundice, hepatosplenomegaly, and retroperitoneal and cervical lymphadenopathy. Fine needle aspiration (FNA) smears from the cervical lymph node revealed numerous yeast forms of histoplasma in macrophages. The patient succumbed to the fulminant infection. Postmortem liver biopsy also revealed infiltration by histoplasma, confirming the diagnosis of disseminated histoplasmosis. This case highlights the variable nature of the clinical presentation of disseminated histoplasmosis which can mimic tuberculosis, leishmaniasis, or lymphoma. FNA cytology is a rapid, cost-effective, and reliable diagnostic tool for early detection and prompt management of histoplasmosis.

School is an institution where talents are nurtured. Therefore it becomes very important to continuously revise and introduce such measures and schemes which will impact the mind, character and physical ability of the learner. Indian education is moving from summative to a continuous evaluation system. This study is an attempt to find out the challenges faced by secondary school teachers in carrying out CCE. The sample consisted of 100 government and private school teachers and random sampling technique was used for the collection of data. The results of the study revealed regarding the challenges. The teachers are not adequately prepared for the effective execution of CCE in schools. Further the study revealed that the major challenges faced by the school teachers in the execution of CCE were increased volume of work, disturbance in classes, difficult in implementation, time consuming, financial difficulties, lack of adequate infrastructure and teaching materials.

Introduction: Endovascular therapy (EVT) improves outcomes in the setting of acute ischemic stroke (AIS) in a time-dependent manner, highlighting the need for improved methods to rapidly identify eligible patients, particularly in the pre-hospital setting. Current pre-hospital assessments are imprecise for this goal. Pre-hospital measurement of brain injury via EEG might provide additional useful diagnostic information regarding EVT eligibility. As a first step, the current study examined (1) feasibility of obtaining EEG early during ER assessment of patients with suspected AIS, and (2) EEG metrics predicting infarct volume. Methods: In subjects transported to the UC Irvine Medical Center for suspected AIS, a 3 min dense-array resting EEG was obtained during ED assessment. Results: EEG was acquired in 25 subjects (mean age 65 yr), 12 of whom were discharged with a diagnosis of radiologically confirmed AIS and 13 of whom were discharged with a non-stroke diagnosis. Median time from ED arrival to EEG = 114 min (and as early as 32 min after arrival), and time from last known well to EEG = 333 min. EEG was acquired in 24 subjects, with data lost due to human error in 1 subject. Among patients with AIS, median NIHSS score = 4 (range 0-19) and median infarct volume = 12 cc (range 0.3- 83). Infarct volume was found to correlate inversely with power in the low beta (13-19Hz) frequency range, bilaterally: larger infarcts were associated with reduced beta power in the leads over motor cortex (C3, C4) on the ipsilesional side (rho = -0.57, p=0.03) and on the contralesional side (rho = -0.60, p=0.02). Conclusions: The current findings support the potential of rapid EEG methods to identify patients with large infarcts who may be ideal candidates for EVT. Future studies will examine how well current findings extend to the pre-hospital setting, and how specific these EEG findings are for patients eligible for EVT.

Central nervous system infection continues to be an important cause of mortality and morbidity worldwide. Our incomplete knowledge on the pathogenesis of how meningitis-causing pathogens cause CNS infection and emergence of antimicrobial resistance has contributed to the mortality and morbidity. An early empiric antibiotic treatment is critical for the management of patients with bacterial meningitis, but early recognition of bacterial meningitis continues to be a challenge.This review gives an overview on current therapeutic strategies for CNS infection with a focus on recent literature since 2010 on bacterial meningitis. Bacterial meningitis is a medical emergency, requiring early recognition and treatment. The selection of appropriate empiric antimicrobial regimen, after incorporating the epidemiology of bacterial meningitis, impact of vaccination, emergence of antimicrobial-resistant bacteria, role of adjunctive therapy and the current knowledge on the pathogenesis of meningitis and associated neuronal injury are covered.Prompt treatment of bacterial meningitis with an appropriate antibiotic is essential. Optimal antimicrobial treatment of bacterial meningitis requires bactericidal agents able to penetrate the blood-brain barrier, with efficacy in cerebrospinal fluid. Emergence of CNS-infecting pathogens with resistance to conventional antibiotics has been increasingly recognized, but development of new antibiotics has been limited. More complete understanding of the microbial and host factors that are involved in the pathogenesis of bacterial meningitis and associated neurologic sequelae is likely to help in developing new strategies for the prevention and therapy of bacterial meningitis.

Salivary duct carcinoma (SDC) is a rare, highly aggressive neoplasm representing about 1%–3% of all malignant salivary gland tumors. Approximately, 85% of the cases occur in the parotid gland followed by the submandibular gland and minor salivary gland. Pathomorphologically, these tumors showed great similarities to ductal carcinoma of the female breast, which is why they described this tumor as “SDC.” This article highlights a case of rapidly growing swelling in the left mandibular region in a 60-year-old female. As this entity is rare and highly aggressive, an early detection followed by appropriate treatment is very important to improve the survival rate of the patient.

This paper presents the method proposed to calculate the bearing capacity of a square footing under oblique and eccentric oblique loading condition (satisfying both shear failure and settlement criteria) resting on fiber reinforced sand layer underlain by sand with geosynthetic/fabric sheet at the interface. Large direct shear tests were carried out to investigate the shear strength parameters of sand and randomly distributed fiber reinforced sand (RDFS) and soil-plastic fabric sheet bond. The ultimate bearing capacity of RDFS was determined using direct shear results. Non-dimensional charts proposed by Kumar (Behaviour of eccentrically–obliquely loaded footing on reinforced earth slab. Ph.D. thesis, University of Roorkee, Roorkee, India, 2002) were used to consider the contribution of plastic fabric sheet in increasing the bearing capacity. Also, for calculating the settlement, horizontal deformation and tilt at a given pressure the regression analysis of plate load test data have been carried out. The predicted values of ultimate bearing capacity, settlement, horizontal deformation and tilt are compared with the experimental values which are in good agreement with each other. There appeared to be an increase in the residual shear strength and angle of internal friction of RDFS.

Objectives: In this study, crops were irrigated with sewage and groundwater. The soil was tested for various characteristics during the growth time of the crop. Methods/Statistical Analysis: To investigate the beneficial impacts of domestic waste water on soil properties, groundwater and domestic wastewater samples are discharged into the soil separately. After 10 days, 15 days, 20 days of application of wastewater soil parameters N, P, K & pH of two soil sample containing sewage and groundwater was determined. Findings: The use of the sewage improves the physicochemical properties of the soil as compared to the application of groundwater. Sewage leads to increase of crop yield with an improved fertility status of the soil. There is a significant change in the properties of the soils irrigated with sewage and groundwater. Thus, use of sewage for irrigation is a considerable method for the management of wastewater. Applications: Farming with wastewater is a potential method to decrease the rise of freshwater demand.

Wireless Sensor Network is a network consisting thousands of small nodes which provides conviction communication for sensor(data), have ability to activate device that have only control conditions like switches and others and it is monitoring the physical and environmental condition of the networks. Basically wireless sensor network is part of Ad-hoc network. It is very laborious to recharge or change the batteries, like very difficult to monitor the application underwater because communication or signal made through only sound wave. So, without the proper countermeasures, under sensor networking is a mission unsound. In this paper we detect and handling the black hole attack by using Received packet and time delay concept in the wireless sensor network. The study of various Black hole detection schemes for sensor networks presents a classification for various approaches followed. Simulation of time synchronization technique is conceded over two different scenario with same source node and destination node.

Psoriasis vulgaris is a hyper proliferative, autoimmune skin disorder affecting 1-3% of the world's population. The prescribed synthetic drugs for the treatment of psoriasis are associated with severe side effects, thus, researchers around the globe are searching for new, effective, and safer drugs from natural resources.The present review has been prepared with an objective to compile exhaustive literature on pharmacological reports on antipsoriatic plants, plant products, and formulations. An attempt has been made to incorporate chemical constituents (with structures) isolated from different plants responsible for antipsoriatic activity and their possible mechanism of actions in this review.The review has been compiled using references from major databases like Chemical Abstracts, Medicinal and Aromatic Plants Abstracts, PubMed, Scirus, Google scholar, Open J Gate, Scopus, Science Direct and Online Journals, and includes 127 references.A survey of literature revealed that extracts/fractions/isolates from 18 plants, 23 chemical constituents of plant origin and 40 plant-based formulations from various systems of medicine have been reported to possess antipsoriatic activity, and 37 antipsoriatic formulations containing plants have been patented.Preliminary antipsoriatic activity studies have been carried out on crude extracts of traditionally used and medicinally promising plants. Such plants need to be explored properly with a view to isolate antipsoriatic constituents, and to evaluate their possible mode of actions so that these plant drugs could be exploited properly as potential antipsoriatic drugs.

This paper presents different distance based verification techniques for online signature verification system. For the purpose of extracting the features of the signature, histogram feature extraction technique is used. Each signature is symbolized as a feature vector. In case of verification of the online signature three different distance calculation methods: Manhattan, Chebyshev and Euclidean are applied separately and compared. The experiments were performed on the internationally recognized SVC2004 database. Experimental results obtained using the three different distance calculation based verification techniques confirms that out of these three Euclidean distance calculation based verification technique provide more accurate results. Manhattan and Chebyshev distance calculation method yields equal error rate (EER) 8.5% while Euclidean distance calculation method yields EER 6.5% on skilled forgeries.

The paper presents a numerical Analysis of deep water Steel Catenary Riser (SCR) under random sea loads. A finite element method is implemented in the time domain using Newmark's-Beta method. The response analysis is based on a simulation technique which duly considers the various non-linear effects such as relative velocity squared drag force, variable added mass due to variable submergence and nonlinearity due to large excursions. It also accounts for variable tension in riser due to variable submergence, variable buoyancy and wave forces. Results are presented which illustrates the effects of nonlinearities, long term drift oscillations and current velocity on the bending stress in the marine risers. The bending stress response time histories are obtained and presented in terms of bending stress envelopes and spectra showing contribution of various harmonics which is significant because of a non-linear system.

Background: Substance abuse is a multidimensional problem, which threatens the quality of life of not only substance abusers but also the family members who live with them. Most of the time a member of the family assumes the role of caregiver and he or she is most burdened from this process. Considering that the involvement of family members is recommended for the recovery process of chemical dependents, it is necessary to appropriately provide the training to caregivers and evaluate their needs for caregiving.Methods: This cross sectional study was conducted at Swami Vivekananda Drug De-addiction Centre attached to the Government Medical College, Amritsar from January 2016 to December 2016. A total of 349 caregivers of substance abusers were interviewed by using pretested and semi structured questionnaire.Results: 44.69% caregivers were wives. Mean age of the caregiver was 33.45 years. 25.21% were high pass. 67.6% were housewives. None was trained in caregiving professionally. 37.53% provided family care while emotional support to the patients was provided by only 10% women and 2% men, no gender specific association with emotional support was statistically significant. 54.15% developed stress while caregiving, 12.60% had social and financial problems.Conclusions: Findings confirmed that quality of life is compromised and stress is high among caregivers, highlighting the need for providing emotional support.

Background: Engagement of head is the most important event in labor which decides obstetric outcome. Floating head in primigravida at term is considered an important obstetric risk factor. Cephalopelvic disproportion, occipito-posterior position and deflexed head should be suspected in most cases of floating head. Present study was conducted to determine the outcome of labor in primigravida with floating head at term. The primary objectives of the study was to analyse the progress of labor, need of medical and surgical interventions and fetomaternal outcome. The secondary objective was to find out the rate of caesarean section for floating head in all situations whether elective or emergency in labor.Methods: This study was conducted in department of Obstetrics and Gynaecology SGRDIMS and R, Sri Amritsar on 100 primigravida subjects with floating head at term admitted through OPD admissions for induction of labor /spontaneous labor or referred from outside directly in early labor.Results: In present study the mean age was 24.95±3.01 years. The youngest case was 19 years old and eldest being 32 yrs old. The mean height was 151±3.41. At the time of admission 21% of cases had floating head, 55% cases were at -3 station, 17% of cases had -2 station, with only 7% of cases had -1 station. 56% of women delivered by caesarean section, 8% by forceps assisted vaginal delivery and 36% by normal vaginal delivery. The mean duration of labor was more in free floating and -3 stations in comparison to -2, or -1 stations. The need for augmentation was more in higher head stations. Mean birth weight was 2.84±0.31, it was more in higher fetal stations in comparison to lower fetal stations. No significant maternal and fetal morbidity was seen. There was no significant difference in the Mean APGAR score of higher head stations in comparison to lower fetal stations.Conclusions: Primigravida with floating head at term and during labor should be managed cautiously. By proper monitoring and maintenance of partogram most of these cases deliver vaginally and without any maternal and fetal morbidity. The attitude of watchful expectancy and timely intervention will be used in all cases, especially in those appearing to be taking a protracted course.

Spellchecker is a software tool that identifies and corrects any spelling mistakes in a text document. Designing a spell checker for Punjabi language is a challenging task. Punjabi language can be written in two scripts, Gurmukhi script (a Left to Right script based on Devanagari) and Perso-Arabic Script (a Right to Left script) which is also referred as Shahmukhi. Gurmukhi script follow ‘one sound - one symbol’ principle where as Shahmukhi follows ‘one sound - multiple symbol’ principle. Thus making Shahmukhi text even more challenging which complicates the design of spell checker for Shahmukhi text. The text written in Shahmukhi normally does not have short vowels and diacritic marks. So missing some of diacritic marks should not be considered as a mistake. But for Holy books like Quran, missing diacritic marks are considered as a mistake. So spell checker is designed in such a way that it can spell check with and without diacritic marks compulsion, which depends on user’s selection to spell check. In addition to this, Shahmukhi text has complex grammatical rules and phonetic properties. Thus it needs different algorithms and techniques for expected efficiency. This paper presents the complete design and implementation of a spell checker for Shahmukhi text.

A novel compact multiband fractal printed patch antenna has been proposed with simulated and experimental results. F-shape fractal patch has been employed to achieve size reduction and enhance the number of operating bands. Various iterations of this fractal antenna are compared, and an optimized design is presented. There are three various iterations have been applied one by one on square patch which results in fractal patch antenna which resonates at 3.1 GHz, 6.3 GHz, 9.9 GHz respectively with bandwidth of 270 MHz, 180 MHz, 1700MHz at corresponding frequencies. This antenna finds applications for defense and secure communication, C band (4 GHz to 8 GHz)and X band (8 GHz to 12 GHz) applications where antenna can be used for satellite communication and RADAR application. Exploitation of E-shape fractal notion in antenna design makes the patch antenna flexible in terms of generating resonances and bandwidth as an iteration order of the fractal is increased. Several properties of the antenna such as impedance bandwidth, radiation patterns, radiation efficiency, electric current distributions on the patch, and gain have been demonstrated numerically and empirically in detail. Experimental results have authorized the design procedure and confirm the gratification of the requirements for multistandard mobile terminal applications. Proposed antenna is designed using IE3D Simulator.

Substance abuse has been defined as the use of chemical substances for non medical purposes in order to achieve alterations in psychological functioning. The substances commonly abused in India include nicotine, alcohol, cannabis and opioids. However, the use of solvents and propellants is also on the rise as these are inexpensive, legally available household, industrial, office and automobile products; which are more commonly available to children and adolescents. We hereby describe a 16-year-old boy with combined volatile and alcohol abuse; who presented with increasing ataxia, visual and hearing disturbances.

doi: 10.1111/j.1741-2358.2010.00415.x Palatal schwannoma in an elderly woman Schwannoma also known as neurilemmoma is a benign tumour derived from schwann cells and is relatively rare in occurrence. Only 1% of the schwannomas in the head and neck region occur at intra-oral sites. Schwannomas usually occur during the third or fourth decades of life and the tongue is the most common intra-oral site. A case of intra-oral schwannoma in a 70-year-old female in the region of hard palate is described which is extremely rare.