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The interaction between gut microbes and gastrointestinal (GI) tract carcinogenesis has always attracted researchers' attention to identify therapeutic targets or potential prognostic biomarkers. Various studies have suggested that the microbiota do show inflammation and immune dysregulation, which led to carcinogenesis in GI tract. In this review, we have focused on the role of microbes present in the gut, intestine, or faeces in GI tract cancers, including esophageal cancer, gastric cancer, and colorectal cancer. Herein, we have discussed the importance of the microbes and their metabolites, which could serve as diagnostic biomarkers for cancer detection, especially in the early stage, and prognostic markers. To maximize the effect of the treatment strategies, an accurate evaluation of the prognosis is imperative for clinicians. There is a vast difference in the microbiota profiles within a population and across the populations depending upon age, diet, lifestyle, genetic makeup, use of antibiotics, and environmental factors. Therefore, the diagnostic efficiency of the microbial markers needs to be further validated. A deeper understanding of the GI cancer and the host microbiota is needed to acquire pivotal information about disease status.

“Digitalization of forest”, as this phrase itself suggests the sustainable implementation of cutting-edge technologies into forests for improving the current trends that are being used for forest environment monitoring, data acquisition, and analysis in the field of research and development. Technologies that can be used effectively for achieving these objectives include the Internet of Things, Wireless Sensor Networks, Internet of Trees, Deep Learning, etc. In this study, we will be exploring and assimilating the limitless possibilities for technological interventions in forests to drastically improve their ecosystem. Intelligent systems for sensing, monitoring, and methods for analysis to be used in applications such as forest fire incidents, illegal logging of trees, poaching, etc. have been discussed briefly. In addition to that, generalized architectures have been proposed which can be used directly in the future for advancements in research and development related to data collection and processing applications like flora analysis, forest fire predictions, etc. without the need for any changes in forest deployment systems. Various methods for enhancement of tribal livelihood, high yield marketing of minor forest produces, and wildlife monitoring is also discussed relating to the areas concentric on the forest environment. Effective connectivity, sustained deployment of real-time sensing systems, and energy harvesting are some of the vital recommendations included and addressed in this study for aiding the proper implementation of digital networks in the forest ecosystem.

Even in developing countries like Nepal, prevalence of ST-elevation myocardial infarction has been shown to be increased with rise in prevalence of conventional risk factors like diabetes, Hypertension, smoking, dyslipidemia and obesity. Our aim is to retrospectively analyze for various risk factors and angiographic patterns of coronary artery disease in patients with ST-elevation myocardial infarction undergoing Primary Percutaneous Intervention.During the period of 1 year (January 2019 to December 2019), 816 patients presented to our ER with acute STEMI, among them 437 (53.6%) patients underwent primary PCI strategy and among them 22 (5.3%) patients were died. Thirty-six (4.4%) patients received thrombolysis, among them 5 (13.9%) patients were died while remaining 343 (42.0%) patients were managed conservatively and among them 20 (5.8%) were died. The mean age of patient who underwent primary PCI was 58.5±12.7 years range from 25 years to 99 years. Among them 55-75 years old 217 (49.6%) were highest in number followed by55 years old 180 (41.2%). Males 318 (72.8%) were predominant. Among those who underwent primary PCI, hypertension 214 (49%) was the most common risk factor, followed by smoking 198 (45.3%), diabetes mellitus 123 (28.1%), dyslipidemia 53 (12.1%) and family history of premature coronary artery disease 18 (4.1%). Among those patients, 292 patients (66.8%) had single vessel disease, 99 patients (22.7%) had double vessel disease, 41 patients (9.3%) had triple vessel disease and 5 patients (1.1%) had non-significant coronary artery stenosis. Left anterior descending (53.3%) was the most frequently found culprit artery, followed by right coronary artery, left circumflex, ramus intermedius and left main artery.Fifty percent of patients presented with acute ST-elevation myocardial infarction and underwent primary PCI were between 55-75 years of age. Hypertension and smoking were the most common risk factors present in those patients. Single vessel disease was most prevalent with left anterior descending found to be the most commonly involved coronary artery followed by right coronary artery and left circumflex.

Opportunistic IoT networks operate in an intermittent, mobile communication topology, employing peer-to-peer transmission hops on a store-carry-forward basis. Such a network suffers from intermittent connectivity, lack of end-to-end route definition, resource constraints and uncertainties arising from a dynamic topology, given the mobility of participating nodes. Machine learning is an instrumental tool for learning and many histories-based machine learning paradigms like MLPROPH, KNNR and GMMR have been proposed for digital transformations in the field with varying degrees of success. This paper explores the dynamic topology with a plethora of characteristics guiding the node interactions, and consequently, the routing decisions. Further, the study ascertains the need for better representation of the versatility of node characteristics that guide their behavior. The proposed scheme Opportunistic Fuzzy Clustering Routing (OFCR) protocol employs a three-tiered intelligent fuzzy clustering-based paradigm that allows representation of multiple properties of a single entity and the degree of association of the entity with each property group that it is represented by. Such quantification of the extent of association allows OFCR a proper representation of multiple node characteristics, allowing a better judgement for message routing decisions based on these characteristics. OFCR performed 33.77%, 6.07%, 3.69%, 6.88% and 78.14% better than KNNR, GMMR, CAML, MLPRoPH and HBPR respectively across Message Delivery probability. OFCR, not only shows improved performance from the compared protocols but also shows relatively more consistency across the change in simulation time, message TTL and message generation interval across performance metrics.

Archimedes screw is one of the biggest innovations that the human mankind has ever experienced. From the day of its innovation AST has upgraded the lives of the people. Various studies have been done considering various parameters and the results shows that the maximum efficiency is recorded in between 20 and 25 degrees, but the accurate angle hasn’t been shown in any of the study. The experimentation study reveals that the maximum efficiency of 74.27% is recorded at 22 degrees with flow rate of 1 l/s and load of 0.9 kg. Maximum output power of 0.00577 kW was recorded at load 0.9 kg and Flow rate 4 l/s at 25-degree tilt angle. maximum speed of 141 RPM was recorded at load 0.5 kg at Tilt angle of 25 degree and at 4 l/s of flow rate. The results show the feasibility of AST to be installed at low head sites at low tilt angle and at heavy loads.

Evidence has emerged over the last 2 decades to ascertain the proof of concepts viz. mitochondrial dysfunction, inflammation-derived oxidative damage and cytokine-induced toxicity that play a significant role in Parkinson's disease (PD). The available pharmacotherapies for PD are mainly symptomatic and typically indicate L-DOPA to restrain dopamine deficiency and its consequences. In the 21st century, the role of antibiotics has emerged at the forefront of medicines in health and human illness. There are several experimental and pre-clinical evidences that support the potential use of antibiotics as a neuroprotective agent. The astonishing effects of antibiotics and their neuroprotective properties against neurodegeneration and neuro-inflammation would be phenomenal for the development of effective therapy against PD. Antibiotics are also testified as useful in not only preventing the formation of alpha-synuclein but also acting on mitochondrial dysfunction and neuro-inflammation. Thus, the possible therapy with antibiotics in PD would impact both pathways leading to neuronal cell death in substantia nigra and pars compacta in the midbrain. Moreover, the antibiotic-based pharmacotherapy will open a scientific research avenue to add more to the evidence-based and rational use of antibiotics for the treatment and management of PD and other neurodegenerative disorders.

SETTING: Biratnagar Eye Hospital, Biratnagar, Nepal, which offers ear surgery for chronic suppurative otitis media (CSOM).OBJECTIVE: In patients with CSOM awaiting surgery, to determine the 1) sociodemographic characteristics 2) bacterial isolates and their antibiotic resistance patterns and 3) characteristics of those refused surgery, including antibiotic resistance.DESIGN: A cohort study using hospital data, January 2018–January 2020.RESULTS: Of 117 patients with CSOM and awaiting surgery, 64% were in the 18–35 years age group, and 79% were cross-border from India. Of 118 bacterial isolates, 80% had Pseudomonas aeruginosa and 16% had Staphylococcus aureus. All isolates showed multidrug resistance to nine of the 12 antibiotics tested. The lowest antibiotic resistance in P. aeruginosa was for vancomycin (29%) and moxifloxacin (36%), and for S. aureus, this was vancomycin (9%) and amikacin (17%). Fourteen (12%) patients underwent surgery: myringoplasty (n = 7, 50%), cortical mastoidectomy with tympanostomy (n = 4, 29%) and modified radical mastoidectomy (n = 3, 21%). Those infected with P. aeruginosa and with resistance to over six antibiotics were significantly more likely to be refused for surgery.CONCLUSION: Patients awaiting ear surgery were predominantly infected with multidrug-resistant P. aeruginosa and were consequently refused surgery. This study can help inform efforts for improving surgical uptake and introducing cross-border antimicrobial resistance surveillance.

Background: Urinary tract infections are most common bacterial infection in routine clinical practice. It is also most common nosocomial infection in many hospitals. Antibiotics are usually given empirically before urine culture reports available and treatment failure rate used to be significantly high. Study of causative agents and their antimicrobial sensitivity pattern are important factors helping formulating antibiotic policy. Generally, most common uropathogene is Escherichia Coli. Tertiary care hospitals, catering of already partially treated or mal treated patients as major chunk, may have varying etiologies and different sensitivity patterns. Objective: To study the culture and sensitivity patterns of urinary tract infections in patients presenting with urinary symptoms in local hospitals. Study design: A cross sectional study Materials and methods: Study was conducted at Madanta Research Clinic Private Limited from 12th march 021 to 12th September 021. Urine from cases suspected to have symptoms suggestive of UTI were send for bacteriological culture and sensitivity. Demographic profiles of each participant along with pathogen isolated, culture sensitivity pattern was documented. Data analysis was done in IBM spss 25. Results: A total 200 samples were selected for bacteriological culture and sensitivity out of which 32% were male and 68% were female. Around 50% of participants were in age group 20-40. There was no growth in 64% sample. Among positive samples (36%), E. coli (most common) was detected in 91.66%, Klebsiella was detected in 6.94%. Gentamicin, Amikacin and Nitrofurantoin were most common antibiotics sensitive to organisms in culture and Cephalosporins group of antibiotics are commonly resistant. Conclusions: coli is the most common organism isolated in urine culture in our region Janakpur. Cephalosporins are resistant in majority of cases where as Aminoglycosides like Amikacin, Gentamicin and Nitrofurantoin are found to be highly sensitive in most of positive cases.

Solar energy is a one-of-a-kind renewable energy source that has many uses, and in the thermal applications, it is receiving more attention and is becoming more feasible. The present work presents numerical and experimental studies to investigate the performance of a parabolic trough solar concentrator (PTC) integrated with a thermal energy storage system. A new receiver design is built that stores thermal energy using phase change material (PCM). A concentric absorber tube with two different kinds of PCM - MgCl2·6H2O and erythritol (filling the annular-space of absorber tube) - were used to construct a PTC, and its thermal performance and thermal efficiency were investigated under two different HTF flow rates of 0.005 kg/s and 0.033 kg/s. Solar energy is transformed into heat, which is then used to store in the PCM before being discharged to cold water, which is the final heat transfer fluid in the receiver's inner pipe. The simultaneous studies of the PTC with and without PCM are investigated. A commercial Mat Lab's operating model through an imperialist competitive algorithm of the entire PTC system is presented, and the numerical results were compared to the experimental results, which were carried out with and without PCM in PTC. With the PCM in PTC (0.005 kg/s and 0.033kg/s), the HTF exhibited gain in peak temperatures of 11°C (erythritol) and 9°C (MgCl2·6H2O) at 0.05 kg/s, whereas the peak temperatures further increase to 14°C (erythritol) and 12°C (MgCl2·6H2O) respectively at 0.033 kg/s, as compared to HTF without PCM. Average thermal efficiency of PTC with HTF flow rate of 0.033 kg/s was highest with usage of erythritol (40.6%), among all the cases. The experimental and predicted thermal efficiency performance indices for different flow rates and PCM are found to be with a deviation of around ± 1.9%, demonstrating the accuracy of the developed numerical model.

The environmental pollution and growing energy demand necessitate the development of power generation using renewable energy systems, especially solar photovoltaic (PV) panels. Despite being an eco-friendly and durable power generation technology, PVs demerit for low conversion efficiency (15–20%). In other meaning, a very low amount of the incident irradiance is converted into electricity, whereas the major is absorbed as heat, uplifting the PVs' surface temperature and declining their efficiency and reliability. Therefore, it is crucial to find a proper cooling technique for upgrading PVs' performance. Recently, along with the nanotechnology development, nano-based PV cooling units have been proposed and investigated as the inclusion of nanoparticles enhances the thermal properties of base materials. Herein, in this paper, the conducted efforts to improve the PVs' performance using nano-based cooing systems were reviewed and discussed. The surveyed PVs' cooling methodologies were classified into separate and hybrid systems: nano-enhanced PCMs, nanofluid-based, and hybrid nano-based cooling units. All relevant equations of materials' properties and PV performance were presented. In addition, the research trend of this field was analyzed by conducting a comprehensive bibliometric analysis using VOSviewer software and based on the Scopus database in the period (2006–2020). Besides, comprehensive discussions of proposed and designed systems were conducted, and major findings were summarized. Based on the literature, using hybrid nano-based cooling systems, the surface temperature reduction can reach 16 °C with enhancement in electrical efficiency up to 50% compared to conventional uncooled PV panels. Furthermore, some future work suggestions were given.

Sarcoidosis causes granulomatous inflammation in multiple organ systems. Lungs are the most commonly affected organs. In 50% of the cases with lung involvement, other organs are also involved. The central nervous system is one of the rarer organ systems involved – comprising 5–15% of all the cases. Neurological involvement, when present, can affect virtually every part of the central and peripheral nervous system. We present an interesting case of a 30-year-old nonalcoholic, nonsmoker man who presented with a chronic headache of 6 years. He had a recent swaying of the body for 6 months and mild forgetfulness for 4 months. The patient had 2 episodes of facial nerve palsy in the past – which had responded to the treatment of Bell’s palsy; however, the patient had some residual findings on presentation. While CSF findings suggested meningeal tuberculosis, the radiological evidence and biopsy confirmed the diagnosis of neurosarcoidosis. On follow-up after 6 weeks of steroid therapy, the patient displayed a marked improvement in headache, cognitive function, and a good response on imaging studies. Our case emphasizes that neurosarcoidosis should be considered in the differential diagnosis of chronic headaches and recurrent facial nerve palsy despite being very rare.

Sameerpannag Ras (SPR) is a complex herbomineral formulation widely used in Ayurveda for stiffness in joints, cough, fever, headache, and respiratory symptoms like dyspnea. The metallic constituents of the formulation pose public health concerns; therefore, the current study was designed to evaluate the safety of the SPR in rats. In the present study, systematic preparation, characterization, and subacute oral toxicity of Sameerpannag Ras were performed. The formulation was prepared as per a standard protocol prescribed in the classical Ayurveda texts. The drug obtained was greenish-black with typical physicochemical properties. Energy-dispersive X-ray analysis (EDX) identified the sample with the presence of arsenic (As), sulphur (S), carbon (C), and mercury (Hg) predominantly. The subacute oral toxicity study of the formulation was conducted at different doses (6, 12, and 25 mg/kg BW) for 28 days on rats. No clinical signs and mortality were observed at any of the three doses in rats. The body weight, haematological, and biochemical parameters were comparable to the control animals. The histopathological examination revealed no significant pathological lesion in the vital organ except for mild changes in the intestinal villi of few rats at medium and higher doses. Overall, the study concluded that the formulation has no significant adverse effect and safe to use at the prescribed doses.

BACKGROUND Attenuation of vision may be due to underlying organic condition or due to functional visual disorder or malingering if secondary gain is associated. Causes of pathological vision loss include advanced primary open angle glaucoma, hereditary macular dystrophies and optic neuropathies. Problem in establishing diagnosis is faced where superimposition of organic and functional visual loss is there. Distinction between functional visual loss and pathological visual loss is made by thorough and careful examination of the patient by applying basic rules and tools of ophthalmology in which examining surgeon is well versed, but patient is unaware. During routine practice, every ophthalmologist encounters patients with nonorganic vision loss. The purpose of the article is to demonstrate how to distinguish between normal visual function without missing any organic visual loss. Examination of such patients requires number of tests including baseline visual acuity, pupillary reactions, slit lamp examination of anterior segment, fundus examination, visual field analysis, optical coherence tomography, visual evoked potential and electroretinography. By proving integrity and functioning of visual system, diagnosis of functional visual loss can be confirmed. Once the conclusive diagnosis is established, it is to be revealed with caution to the patient/patient’s attendant as it can lead to medico legal issues. Here, we present series of cases who presented to us in a tertiary care center of North India during a period of six months in the year of 2019 where case 1 and case 2 presented with decreased vision due to underlying pathological condition, case 3 presented with reduced vision due to functional visual disorder. Case 4, 5 and 6 provided decisive evidence of malingering. KEY WORDS Fogging, Hysterical Visual Loss, Malingering, Menace Reflex, Optokinetic Nystagmus.

Background: The patellar fractures treatment has changed by enhancements in both an improved understanding of patellar function and fracture fixation techniques. The goals of operative fixation include repair of extensor mechanism, restoration of articular congruity, secure fixation and early movements. In this Study Reconstruction patellar plate was introduced in the management of patellar fracture. Aim: To determine the Functional outcome of fixation method of patella fractures by Open Reduction and Internal Fixation with Reconstruction Patellar Plate. Methods: This Prospective study was performed at Department of Orthopaedic Surgery at Lahore General Hospital for a period of 12 months after the approval Research Board of University of health Sciences, Lahore. Non probability purposive sampling method was used to induct 30 patients (who met the inclusive Criteria) underwent reconstruction patellar plate for the treatment of patella fracture. The patients were followed in outpatient department at 4 weeks and 16 weeks. Variables mentioned in Modified Hospital for Special Surgery Knee Score were recorded and Knee score was calculated and graded at 16 weeks. Results: In this study, overall mean age was 25.26 ± 5.02 years. There were 19 (63%) male and 11 (37%) female subjects. The mean of Modified Hospital for Special Surgery Knee Score (MHSSKS) was 84.90±8.87. In this study, there were 12(40%) patients with excellent functional outcome, 14 (46.67%) patients with good functional outcome and 4(13.34%) patients with fair functional outcome. There was no patient with poor functional outcome. Conclusion: Reconstruction Patellar Plate fixation method of patella fractures by Open Reduction and Internal Fixation produced good Functional outcome, which can be familiarized as an alternate to tension band method for the treatment of transverse patellar fracture. Keywords: fracture, patellar, reconstruction patellar plate, tension Band wiring

Objectives: The aim of this study is to study the modulation of extracellular signal-regulated protein kinase (ERK) and tissue inhibitors of matrix metalloproteases 1 (TIMP 1) gene in patients with neuropathic pain (NP). Materials and Methods: In the present, cross-sectional, observational study, 2 ml of venous baseline sample was withdrawn from all the patients with neuropathic (NP) or non NP (NNP) soon after their diagnosis or on their first visit to the pain clinic. A real-time quantitative polymerase chain reaction experiment was conducted to measure the mRNA expression of TIMP1 and ERK genes in blood samples. The Delta Ct, Delta Ct, and fold change analysis of both the genes were conducted between patients with NP and NNP. Results: A total of 285 patients with chronic pain were assessed, out of which, 153 patients had NP and 132 had NNP. The average duration of chronic pain was 11 months for 285 patients. The mRNA expression of TIMP1 gene is significantly down regulated (2.65-fold) (P (-f. 01), and the mRNA expression level of ERK is significantly up regulated (2.03-fold) (P (-f. 01) in NP patients when compared with NNP. Conclusion: The mRNA expression of TIMP1 gene is significantly down regulated, and ERK is significantly up regulated in patients with NP. Further, multicentric trials with larger sample size are recommended to confirm this finding.

Background: Fatigue is generally a normal response to physical exertion or any stressful situation. Its prevalence rates have reached the level of 1.5-3% among the general population. Due to the unclear etiology, diagnostic ambiguity, and resultant heterogeneousness among the population, there is a lack of a solid treatment regimen for fatigue. As the absolute treatment option is vague, patients are moving towards complementary and alternative medicines. Hence it is mandatory to review the efficiency of complementary and alternative therapies along with herbal medicines. Objective: The purpose of this review is to carry out an evidence-based exploration of the potentiality of medicinal plants in the treatment and management of fatigue. Methods: This evidence-based review was performed by conducting a literature review of the available studies from the PubMed database. Results: The study was based on 23 pre-clinical and clinical studies. It showed that medicinal herbs including Andrographis paniculata, Angelina sinensis, Astralagus membranaceus, Cordyceps sinensis, Panax ginseng, Gymnostemma pentaphyllum, Holy Basil, Lepidium meyenii, Rhodiola rosea, and Withania somnifera that belong to various traditional medicinal systems such as Ayurveda and Chinese Traditional Medicines can be a promising strategy to manage the various forms of fatigue. Conclusion: On the basis of these studies, it was concluded that the medicinal herbs and the phytochemicals within have a possible role in improving the symptoms associated with fatigue which can be further validated to produce targeted therapy for fatigue.

The solar stills were developed to fulfil the freshwater need of the growing population. The paper presents the recent modifications made in still to improve their productivity like the application of phase change materials (PCM), connecting flat-plate collector (FPC), use of nanoparticles, stepped solar still, and attaching separate condenser in the still. Active solar stills are found more productive than passive ones and the thermal efficiency of active solar stills lie in the range of 50–70%, which is far better than passive still having 20–55% thermal efficiency. According to the literature studied in the paper, the maximum productivity of active solar still is 10 litres per day and in passive solar stills, it is 6 litres per day. The different approaches used to carry out the heat and mass transfer analysis of single and double slope active and passive solar stills are also discussed in the paper.

Percutaneous Coronary Intervention (PCI) is now the standard of care in patients with coronary artery disease. With advances in modern technology, the success of PCI has relatively increased, and so is its complication, specifically in complex coronary intervention. Coronary perforation is one of the most dreadful and life-threatening complications of PCI. The most vital step in the management of coronary perforation is its identification and quick action. Multiple methods for management are now recommended in the literature, but the mainstay of treatment is still prevention. This review discusses the incidence, risk factors, prevention, identification, and management of Coronary Artery Perforation (CAP).

Graphene field-effect transistors (GFETs) show high electron transfer rates, high charge-carrier mobility, low electrical noise levels and flexibility of surface functionalization, which are useful to realize the sensors for various applications. The key challenge is to develop the processes to fabricate a uniform array of GFETs devices. In this paper, single-layered graphene (SLG) was synthesized on copper (Cu) substrate using chemical vapor deposition (CVD) followed by its successful transfer over silicon (Si) substrate. To realize an array of graphene-based devices/ sensors, the process of oxygen plasma based clean etching of SLG was optimized. The Raman and Field Emission Scanning Electron Microscope (FESEM) characterizations ensure the complete etching of SLG in 240 s using 200 W, RF (13.56 MHz) power. Optimized SLG etching would help to fabricate an array of GFETs as a biochemical sensor platform.

In recent years, triple-negative breast cancer (TNBC) has emerged as the most aggressive subtype of breast cancer and is usually associated with increased mortality worldwide. The severity of TNBC is primarily observed in younger women, with cases ranging from approximately 12%-24% of all breast cancer cases. The existing hormonal therapies offer limited clinical solutions in completely circumventing the TNBC, with chemoresistance and tumor recurrences being the common hurdles in the path of TNBC treatment. Accumulating evidence has correlated the dysregulation of long noncoding RNAs (lncRNAs) with increased cell proliferation, invasion, migration, tumor growth, chemoresistance, and decreased apoptosis in TNBC. Various clinical studies have revealed that aberrant expression of lncRNAs in TNBC tissues is associated with poor prognosis, lower overall survival, and disease-free survival. Due to these specific characteristics, lncRNAs have emerged as novel diagnostic and prognostic biomarkers for TNBC treatment. However, the underlying mechanism through which lncRNAs perform their actions remains unclear, and extensive research is being carried out to reveal it. Therefore, understanding of mechanisms regulating the modulation of lncRNAs will be a substantial breakthrough in effective treatment therapies for TNBC. This review highlights the association of several lncRNAs in TNBC progression and treatment, along with their possible functions and mechanisms.

Background: Pericardial effusion (PE) is one of the common pericardial diseases in our population with its associated morbidity and mortality. Our study aims to evaluate the clinical characteristics of patients with PE from eastern region of Nepal. Materials and Methods: A descriptive cross-sectional study carried out in tertiary care center in eastern region of Nepal from March 2019 to February 2020. A total of 45 cases of PE were enrolled by convenient sampling method. Diagnosis was made based on clinical history, examination, and relevant laboratory investigations. Data was entered in Microsoft excel 2007 and converted into IBM SPSS data editor, version 20. Results: Forty five patients were included with mean age of 55.36 ± 16.38 years. Twenty seven patients (60%) were male and 18 (40%) were female. Hypertension was present in 12 (26.7%) and diabetes mellitus in 13 (28.9%). Mean serum hemoglobin was 10.85 ± 2.09 gm/dl. Chronic kidney disease (Uremia), tuberculosis and hypothyroidism were the common causes of PE. Common clinical symptoms were dyspnea, fever, and cough and chest pain. Moderate to large pericardial effusion was noted in 21 (46.7%) of patients. Cardiac tamponade was present in 6 (13.3%). Twenty seven patients (60%) patients underwent pericardiocentesis. Conclusion: Chronic kidney disease, tuberculosis and hypothyroidism were the common causes of PE with male predominance. Dyspnea was the most common presenting symptom. Cardiac tamponade was relatively less common.

Background: Low-income countries like Nepal experience a double disease burden infectious diseases risk as well as rising incidence of non-communicable diseases .The present cross sectional study assesses the prevalence of overweight and associated factors in ward no. 1 and 3 of Tankisinuwari VDC, Morang. Materials and Methods: A Community based cross sectional study was conducted in ward no. 1 and 3 of Tankisinuwari VDC, Morang. Total 152 (10%) households were selected by systematic random sampling technique and then 590 individuals (male 323 and female 267), with the age ranging from 10 to 70 years were included in the study. Measurement of weight and height was done by calibrated standard weighing scale and measuring tape. Results: The prevalence of overweight was 16.1% which was significantly more among male (11.5%) than in female ( 4.6%) while prevalence of obesity was 2.5% , which was significantly more among female (2.2%), than male (0.3)%, P

Indian mustard [Brassica juncea (L.) Czern.] is a major edible oil crop of India. The Indian Council of Agricultural Research—National Bureau of Plant Genetic Resources (ICAR-NBPGR) and ICAR—Directorate of Rapeseed Mustard Research (DRMR) together conserve one of the largest global collection of Indian mustard germplasm comprising 5950 accessions which includes indigenously collected landraces, exotic accessions, breeding lines, Improved/released cultivars, registered genetic stocks and other type of material of unknown origin. However, only a small fraction of this huge collection has been deployed in the breeding programme due to lack of information on majority of accessions. The objective of this study was to develop a core collection of Indian mustard to enhance utilization of conserved germplasm in crop improvement programme. For this purpose, the accessions were characterized at one ideal site (Bharatpur) using 14 agro-morphological traits and the resultant data was analysed using three state-of-the-art core collection construction tools—MSTRAT, Power Core and Core Hunter 3 (CH3), to obtain three core sets each with 595 accessions. The quality of these core sets was evaluated and compared using two genetic distance based metrices (E-NE & A-NE), several summary statistics, Shannon diversity index, phenotypic correlations etc. The core collection generated using CH3 which optimized simultaneously for both representativeness and diversity was found the best in capturing the genetic variation existed in the base collection for all the 14 traits. The diversity represented in the core collection will therefore, be a guideline to breeders for a wider use of the Indian mustard genetic resources available in the genebank for identification and introgression of new useful traits, as well as for delineation of their genetic basis particularly through marker-trait association.

Learning outcomes Discussion of the case will enable the students to: ● use “Strengths, Weaknesses, Opportunities, and Threats” analysis. ● Use “pros and cons” analysis. ● Explain what constitutes an effective strategy. ● Analyze the quality of the strategy for IndiGo Airlines (IA). ● Explain sustained competitive advantage through value, rareness, imitability and organization framework. Case overview/synopsis This case describes a situation in which InterGlobe Aviation Ltd. (IGAL) has been experiencing multiple engine snags because of the faulty Pratt and Whitney engines. In a span of two years between June 2018 and January 2020, IGAL faced around 22 snags. IGAL is known to be one of the safest airlines in the world, the engine issue has tainted its reputation. In October 2019, in just one week IA faced four-engine snags, forcing the Directorate General of Civil Aviation (DGCA) to come out with a guideline in November 2019. The faulty engines were to be replaced by January 31, 2020. If IA failed to complete the task by the given deadline then IA would have to ground around 70–80 aircraft. IA was way behind the deadline when on January 13, 2020, they received an email from DGCA mentioning an extension of the deadline to May 31, 2020. The purpose of this case is to provide an opportunity for the participants to take into consideration the data given for IA and make assumptions and resolve the dilemma through which Ronojoy Dutta (Dutta), the Chief executive officer if IA is going through. Complexity academic level The case engages the participants in deciding a suitable course of action for IA to develop a strategy and is ideal to teach elements of strategy. The case can be used in the following courses/programs: ● A strategy formulation module in strategic management program or post-graduate program in management. Supplementary materials Teaching Notes are available for educators only. Subject code CSS 11: Strategy. Supplementary materials Teaching Notes are available for educators only.

Background and objectives Quadripolar left ventricular (LV) leads in cardiac resynchronization therapy (CRT) offer multi-vector pacing with different pacing configurations and hence enabling LV pacing at most suitable site with better lead stability. We aim to compare the outcomes between quadripolar and bipolar LV lead in patients receiving CRT. Methods In this prospective, non-randomized, single-center observational study, we enrolled 93 patients receiving CRT with bipolar (BiP) (n = 31) and quadripolar (Quad) (n = 62) LV lead between August 2016 to August 2019. Patients were followed for six months, and outcomes were compared with respect to CRT response (defined as ≥5% absolute increase in left ventricle ejection fraction), electrocardiographic, echocardiographic parameters, NYHA functional class improvement, and incidence of LV lead-related complication. Results At the end of six months follow up, CRT with quadripolar lead was associated with better response rate as compared to bipolar pacing (85.48% vs 64.51%; p = 0.03), lesser heart failure (HF) hospitalization events (1.5 vs 2; p = 0.04) and better improvement in HF symptoms (patients with ≥1 NYHA improvement 87.09% vs 67.74%; p = 0.04). There were fewer deaths per 100 patient-year (6.45 vs 9.37; p = 0.04) and more narrowing of QRS duration (Δ12.56 ± 3.11 ms vs Δ7.29 ± 1.87 ms; p = 0.04) with quadripolar lead use. Lead related complications were significantly more with the use of bipolar lead (74.19% vs 41.94%; p = 0.02). Conclusions Our prospective, non-randomized, single-center observational study reveals that patients receiving CRT with quadripolar leads have a better response to therapy, lesser heart failure hospitalizations, lower all-cause mortality, and fewer lead-related complications, proving its superiority over the bipolar lead.

Background: Cardiovascular manifestations are an important cause of mortality and morbidity in COVID-19 infections. Conduction system abnormality in the form of symptomatic bradyarrhythmia is underreported in the literature. Aim: To evaluate epidemiological, demographic, laboratory, clinical management, and outcome data of symptomatic bradyarrhythmia in COVID-19 patients. Methods: This was a retrospective, observational study including all the adult patients (>18 years) who were diagnosed with COVID-19 infection and had complete heart block (CHB) or symptomatic high-grade Atrio-Ventricular (AV) block requiring a temporary pacemaker insertion (TPI). Epidemiological, demographic, laboratory, clinical management, and outcome data were extracted from all the enrolled patients and studied for the primary clinical composite endpoint of all-cause death. Results: The study population included 15 patients, including 14 patients with CHB and 1 patient with 2:1 AV block. Syncope was the most common presentation. The clinical endpoint in the form of death was seen in 5 patients (33.3%), 3 patients reverted to sinus rhythm, and 7 patients required permanent pacemaker implantation. The markers of inflammation were raised in all patients; however trend toward more inflammation was seen in patients reaching the primary clinical endpoint. 3 out of 7 patients with narrow QRS rhythm reverted to normal sinus rhythm, while all 8 patients with broad complex QRS either died or required a permanent pacemaker insertion. Conclusion: Symptomatic bradyarrhythmia is associated with a high inflammatory state, and high mortality in COVID-19 infection and a transient conduction block in patients with narrow QRS rhythm may suggest local subclinical myocardial inflammation. Resumen: Antecedentes: Las manifestaciones cardiovasculares son una causa importante de mortalidad y morbilidad en las infecciones por COVID-19. La anomalía del sistema de conducción en forma de bradiarritmia sintomática no se informa en la literatura. Objetivo: Evaluar datos epidemiológicos, demográficos, de laboratorio, de manejo clínico y de resultado de la bradiarritmia sintomática en pacientes con COVID-19. Métodos: Este fue un estudio observacional retrospectivo que incluyó a todos los pacientes adultos (> 18 años) que fueron diagnosticados con infección por COVID-19 y tenían bloqueo cardíaco completo (HBC) o bloqueo auriculoventricular (AV) de alto grado sintomático que requería una inserción de marcapasos (TPI). Los datos epidemiológicos, demográficos, de laboratorio, de manejo clínico y de resultado se extrajeron de todos los pacientes inscritos y se estudiaron para el criterio de valoración clínico primario compuesto de muerte por cualquier causa. Resultados: La población del estudio incluyó a 15 pacientes, 14 de los cuales tenían HBC y uno tenía bloqueo AV 2:1. El síncope fue la presentación más común. El criterio de valoración clínico en forma de muerte se observó en 5 pacientes (33,3%), 3 pacientes revirtieron al ritmo sinusal y 7 pacientes requirieron implantación de marcapasos permanente. Los marcadores de inflamación se elevaron en todos los pacientes; sin embargo, se observó una tendencia hacia una mayor inflamación en los pacientes que alcanzaron el criterio de valoración clínico primario. Tres de cada 7 pacientes con QRS estrecho revirtieron al ritmo sinusal normal, mientras que los 8 pacientes con QRS de complejo ancho murieron o requirieron la inserción de un marcapasos permanente. Conclusión: La bradiarritmia sintomática se asocia con un estado inflamatorio alto y una alta mortalidad en la infección por COVID-19, y un bloqueo transitorio de la conducción en pacientes con ritmo QRS estrecho puede sugerir una inflamación miocárdica subclínica local.

Background The long QT syndrome (LQTS) is a disorder of myocardial repolarization characterized by a prolonged QT interval on the electrocardiogram (ECG). This syndrome is associated with an increased risk of polymorphic ventricular tachycardia, a characteristic life-threatening cardiac arrhythmia also known as torsades de pointes. A rate related corrected QT interval (QTc) can be calculated as QT/√RR and normally is ≤0.44s. Some references given QTc upper normal limits as 0.43s in men and 0.45s in female. OP compound supposed to block K+ channel and Na+/Ca++ channel and hence causing prolongation of QT interval. As we know that prolongation of QT interval may precipitate polymorphic ventricular tachycardia and sudden cardiac death, so it become important in case of OP poisoning and related mortality. In this study, I calculated corrected QT interval in diagnosed cases of OP poisoning admitted at Bir Hospital and compared QTc among those with complications and without complication. I also tried to evaluate QTc as a predictor for duration of hospital stays, ICU admission, vasopressor and mechanical ventilation requirement, higher POP score and low GCS.

Background: Nasal Septal deviation is a frequently found entity in ENT OPD. The objective of the study was to describe the clinical presentations of deviated nasal septum, classify them according to the Mladina’s system and find out the relation of trauma with the type of septal deviation. Methods: One hundred fifty cases of septal deviation were classified ac­cording to Mladina’s classification, after thorough interview, nasal exami­nation and nasal endoscopy. Data were analyzed with SPSS version 21, after tabulation. Chi-square test was applied as the test of significance. Results: Out of 150 cases of septal deviation, Male 82 (54.6%) outnum­bered the female patients 68 (45.3%). Most of these patients were of sec­ond and third decade (20-40 years age group). The most common pre­senting complaint was that of nasal obstruction 121(80.6%), headache68 (45.3%) and nasal discharge52(34.6%). 78(52%) of patients revealed his­tory of trauma. Type II 32 (21.3%) and Type V 31 (20.6%) were the com­monest followed by Type III 24(16%). Conclusions: Nasal septal deviation is a common presentation in ENT OPD. Mladina’s classification found Type II and Type V to be quite common. Na­sal obstruction, headache and rhinorrhea are frequent associated com­plaints. Nasal endoscopy is very important for the diagnosis, especially of posterior deflections.

Type 2 Diabetes Mellitus (T2DM) is associated with a high risk of atherosclerotic cardiovascular disease (ASCVD). Intensive blood glucose reduction with antidiabetic drugs significantly reduce microvascular complications but there is no strong evidence of reduction in cardiovascular (CV) events. In 2008, the US Food and Drug Administration (FDA) issued guidance to demonstrate cardiovascular safety of newer antidiabetic drugs in addition to reduction in blood glucose level. After which a number of CVOTs were conducted involving newer antidiabetic drugs. The newer drugs (e.g. GLP-1 RAs, SGLT2 inhibitors and DPP 4 inhibitors) might have potential effects on body weight, lipid parameters and blood pressure, as well as endothelial dysfunctions, inflammatory markers and oxidative stress. The current review summarizes the results of the main trials focused on the cardiovascular outcomes of traditional as well as newer antidiabetic drugs.

Background: The incidence of stuck rotational atherectomy (RA) burr is extremely low, and its description has been sporadic in the literature about the systemic management of this complication. Aims and Objective: The current study was designed to present the experience of our center and propose an algorithm for the retrieval of stuck RA burr. Materials and Methods: We retrospectively evaluated cases of RA between August 2018 to August 2020 at our center. An entrapped RA burr was defined as an inability to move the burr backward without any additional maneuvers during or after the rotablation of a coronary lesion. Angiographic and procedural details were reviewed in the identified cases of entrapped rotablator burr, details of maneuvers used to retract the burr was documented. We further analyzed the literature using PubMed search using the keywords “entrapment of rotablator burr”, “stuck rotablator” and “rotablation complications”. All the articles with entrapped rotablation burr were identified and scrutinized for the techniques used for percutaneous retrieval. Results: Out of the total 5780 Percutaneous coronary intervention (PCI) procedures, RA was performed in 75 patients and RA burr entrapment was confirmed in two cases. Both the cases were seen in patients with angulated and heavily calcified lesions. The cases were managed percutaneously by endovascular maneuvers. A total of 8 techniques were identified by analysis of available literature for burr retrieval with surgery being the favored one. Using the experience of our center and available literature we propose a simplified working algorithm towards systematic management of this complication. Conclusion: RA burr entrapment is rare, but a life-threatening complication, and the operator should be prepared with strategies for successful retrieval of stuck burr. Percutaneous retraction maneuvers should be used as the first-line management for retrieval of stuck burr followed by surgical referral. Using the proposed algorithm this rare complication can be managed systematically and effectively.

Ischemic jejunal stricture due to mesenteric vein thrombosis (MVT) rarely occurs in patients with extrahepatic portal vein obstruction (EHPVO). This is because the thrombus often occludes only a short segment of superior mesenteric vein adjacent to splenoportal confluence, facilitating development of collateral veins that protect bowel from ischemia. However, ischemic strictures can develop when the thrombus involves jejunal veins, venous arcades or vasa recta. We report three patients with EHPVO, who developed jejunal strictures due to MVT. They presented with symptoms of proximal bowel obstruction. Two of these patients had evidence of recurrent deep vein thrombosis (DVT), suggesting possibility of an underlying prothrombotic state. One of them had completely occluded bilateral iliac veins and inferior vena cava following DVT, 10 years ago. At the same time, he was identified as having a portal cavernoma. Contrast-enhanced computed tomography showed portal cavernoma together with MVT in all the patients. The thrombus was identified in the jejunal veins in two patients and in the entire superior mesenteric vein up to splenic vein in one patient. All three patients were found to have a tight concentric stricture involving a long length of proximal jejunum. Two patients required urgent surgical intervention and one died.

Solar illumination is a promising source of primary energy to reduce global warming and to clean polluted waters, thus fostering research of the design of efficient photocatalysts for hydrogen production by water splitting and for contaminant degradation. In particular, photocatalysis by indium sulfide (In2S3) is drawing attention due to its suitable narrow bandgap of 2.0–2.3 eV for visible light harnessing, yet large-scale application of unmodified In2S3 is limited. Here we review the photocatalyst criteria for water splitting, the synthesis and morphological manipulations of In2S3, the synthesis of heterojunctions by coupling semiconductors to increase performance, and doping In2S3. In2S3-based heterojunctions, i.e., traditional type II, all-solid-state, and direct Z-scheme photocatalytic systems show benefits such as larger charge separation, broad solar spectrum absorption, and amended conduction band and valence band edge potentials for maximum pollutant removal and H2 production. The effect of dopant incorporation on electronic modulations of In2S3 is explained by the density functional theory.

Background The purpose of the present study was to determine the airway changes in skeletal class II division 1 malocclusion patients with mandibular retrognathism, treated with Twin-Block (TB) appliance. Methods Airway assessment was carried for twelve patients (mean age 11.7 ± 1.1 years) who underwent myofunctional therapy using TB appliance for correction of skeletal class II division 1 malocclusion with mandibular retrognathism. Acoustic pharyngometry (AP) was used to assess and quantify the comparative changes in the upper airway, pretreatment and posttreatment. Results Data acquired was subjected to appropriate statistical analysis. The paired ‘t’ test was used to compare pre-treatment (T0) and after the positive pterygoid response (T1). TB appliance increased mean minimum airway area by 0.28 ± 0.25 cm2 and mean airway by 0.47 ± 0.44 cm2 with 95% CI. Posttreatment minimum airway and mean area changes were found to be statistically significant (P-value Conclusion TB appliance therapy has a positive effect on upper airway and is beneficial for the treatment of sleep-related disorders associated with Class II division 1 malocclusion for achieving positive functional changes, esthetics, and healthier quality of life.

The limited availability of lithium is hindering the high demand of lithium-ion batteries (LIBs) resulting from rapid development in electric vehicle technology. Sodium-ion batteries (SIBs) are considered potential alternatives for LIBs owing to the large availability of sodium resources, low cost, and their similar electrochemical properties to LIBs. SIBs are also considered promising options for large-scale next-generation energy storage systems. In the last few decades, extensive research has been conducted to identify suitable anode materials for the high performance of SIBs. Among the carbonaceous materials, graphene exhibited excellent physical and chemical properties for utilization as the anode material, such as high specific surface area, energy storage density, and electric conductivity. The construction of composite anode materials through the incorporation of graphene with metal oxides and metal sulfides shows promising overall performance in SIBs. This paper critically reviews the recent advancements in graphene-based composite anode materials for SIBs, focusing on synthesis and energy storage techniques. The characteristics of various compositions and their energy storage behaviors are elaborately discussed and summarized. In addition, certain major challenges and advantages in graphene-based composite as a future anode materials for SIBs are discussed. This critical review illuminates a path to achieve economic, safe, and energy-efficient graphene composites as anode materials for SIBs.

Considering the current scenario of rising environmental and energy concerns, engineering of Z-scheme photocatalytic systems is in the spotlight. The prime reason for this includes efficient redox abilities and effective space separation along with the migration of photoinduced charge carriers over conventional heterojunction systems. Herein we foreground the stumbling blocks of traditional heterojunction systems and enlighten the generations of Z-scheme photocatalysis originating from liquid-phase to direct Z-scheme photocatalytic systems. We provide substantial criteria and selection aspects of choosing reductive type photocatalysts as a potential aspirant for the Z-scheme photocatalytic system. As Z-scheme photocatalytic systems render effective space separation of photogenerated carriers, active species generation, wide optical absorption and amended redox ability. We focus on comprehensive illustration of all solid-state and direct Z-scheme photocatalysts by coupling reductive type photocatalysts with other semiconductor material and explored their potential for efficacious conversion of solar energy into functional energy. Herein, we aim to provide in-depth and updated criteria for selecting Z-scheme photocatalysts for CO2 reduction, water splitting, and nitrogen fixation. Lastly, the article compiles with a conclusive note about future perspectives and challenges accompanying all solid-state and direct Z-scheme Z photocatalysts and their energy conversion applications.

Background: The present study focused on assessing the level of titanium in submucosal plaque in the peri-implant area with peri-implantitis in comparison to healthy implants. Methodology: Sixty patients with titanium dental implants were recruited. The degree of titanium in submucosal plaque around peri-implantitis and healthy implants was estimated using inductively coupled plasma mass spectrometry. Results: The mean ± standard deviation probing depth in Group I was 3.12 ± 1.1 and in Group II was 7.2 ± 2.5; gingival index was 0.64 ± 0.3 and 1.64 ± 0.8 in Group I and Group II, respectively. The plaque index was 0.82 ± 0.2 in Group I and 1.5 ± 0.6 in Group II. The mean plaque mass in Group I was 24.1 ± 3.8 ng/ul and 49.3 ± 6.4 ng/ul in Group II. The mean titanium level in Group I was 0.08 ± 0.02 μg and in Group II was 0.91 ± 0.04 μg. A highly significant difference between both groups was found (P < 0.05). Conclusion: There was a significantly higher titanium level in submucosal plaque around dental implants with signs of peri-implantitis as compared to healthy dental implants.

Inflammatory bowel disease (IBD) patients have an increased risk of developing colitis-associated colon cancer (CAC); however, the basis for inflammation-induced genetic damage requisite for neoplasia is unclear. Several studies have shown that IBD patients have signs of increased oxidative damage, which could be a result of genetic and environmental factors such as an excess in oxidant molecules released during chronic inflammation, mitochondrial dysfunction, a failure in antioxidant capacity, or oxidant promoting diets. It has been suggested that chronic oxidative environment in the intestine leads to the DNA lesions that precipitate colon carcinogenesis in IBD patients. Indeed, several preclinical and clinical studies show that different endogenous and exogenous antioxidant molecules are effective at reducing oxidation in the intestine. However, most clinical studies have focused on the short-term effects of antioxidants in IBD patients but not in CAC. This review article examines the role of oxidative DNA damage as a possible precipitating event in CAC in the context of chronic intestinal inflammation and the potential role of exogenous antioxidants to prevent these cancers.

Background: To determine the role of topical β- blocker in the management of residual hemangioma after propranolol therapy. Method: A retrospective study of all pediatric patients presenting with hemangioma from April 2014 to March 2019 was performed. Topical timolol gel was applied over the residual hemangioma which persisted even after one year of propranolol therapy. Result: Out of 68 patients included in this study 45 (70.3%), patients had complete resolution by one year using the treatment with propranolol. In 14 patients (21.8%) had residual lesion even after 1 year of treatment, upon which we applied topical timolol 0.5% gel for further 4 to 6 months. (Mean 5.35 months). At the end of the treatment, hemangioma was almost resolved. Conclusion: Timolol is a safer alternative to propranolol for residual hemangioma as a sequential treatment. It augments the regression of residual hemangioma with minimal side effects.

Aneurysmal bone cyst (ABC) of the talus is an extremely rare lesion. Less than 20 cases have been reported in PubMed till 2012 and none from Nepal. We report a rare case of primary ABC of talus in a 17 year old male that was managed by extended intra-lesional curettage and autologous cancellous iliac crest bone grafting. The patient had excellent functional outcome and there was no recurrence at 1 year of follow-up.

INTRODUCTION Corona virus disease (COVID-19) has been one of the cause for delay in diagnosing and management for all non COVID diseases since the pandemic started especially for head neck cancer where exposure of sites are considered high risk for disease spread. Head neck cancer need to be addressed early as per reporting various oncological guidelines in view of better prognosis if addressed early. We evaluated the non- COVID cause for primary delay by patients so that it can be addressed for better oncological care. MATERIAL AND METHODS We evaluated 35 cases of head neck cancer reported in outpatient of department of Otorhinolaryngology and head neck surgery. The inclusion criteria were the subsites( oral cavity, oropharynx, larynx and hypopharynx ) that need to be addressed promptly irrespective of COVID and the patients had given consent. Statistical Package for the Social Sciences (SPSS) version 16 used for statistical analysis and Mann Whitney U test applied for 2 independent variables. RESULTS Patients characteristic, tumor characteristics and symptoms were evaluated. Advanced age (>60 years) and male predominance were seen in 51.4% and 54.3% respectively. Median delay was noticed for 4 months . When variables were evaluated for delay, male sex and village resident showed significant primary delay in comparison to female sex and city residents with p value of 0.003 and 0.03 respectively. CONCLUSION Non COVID cause for primary delay was prevalent. The median delay noticed 4 months and need to be addressed for proper good oncological outcome and proper health care delivery because of when the pandemic will last is not clear.

Background: Visceral leishmaniasis is a major public health concern in Nepal. During the last few years, several Kala-azar outbreaks have been reported from Terai region including Morang district, Nepal. Objectives: The aim of this study is to determine the risk factors associated with Kala-azar at individual and household levels in selected highly endemic areas of Morang district of eastern Nepal. Methodology: A case control study was conducted in five endemic village development committees of Morang district with 62 cases already treated from B.P. Koirala Institute of Health Sciences and Koshi Zonal Hospital. Two hundred and forty eight controls were selected randomly from the same village at the ratio of 1:4. Data was collected between September and November 2013 using structured questionnaires. Bivariate and multivariate analysis were done and the final model was selected using the backward elimination strategy. Results: This study showed that the majority of cases (29.0%) were from the 13-25 years age group, males are more than females and indigenous caste (74.2%) were affected more than other caste. Living in thatched house (OR 4.57, 95% CI 1.91-10.93), ownership of animal (OR 3.95, 95% CI 1.87-8.37), sleeping on the ground floor (OR 3.90, 95% CI 1.83-8.31), history of migration to India and proximity to other Kala-azar cases within 50 metres distance of household were significant risk factors for visceral leishmaniasis. The association with socioeconomic status remained significant and there was a clear dose – response effect. Conclusion: Living in thatched house, ownership of animals, sleeping on the ground floor, history of migration to India, proximity to other Kala-azar cases within 50 metres distance and poverty are the main risk factors associated with visceral leishmaniasis transmission.

The removal of contaminants from sewage wastewater through constructed wetlands is becoming increasingly popular worldwide. Constructed wetland (CW) is a man-made structure for wastewater treatment that uses natural processes associated with wetland vegetation, soils, and their associated microbial combinations. This study investigated the performance of experimental vertical flow constructed wetland (VFCW) cells to remove heavy metals (HMs) from primary treated sewage. The primary treated sewage was collected from the sewage treatment plant (STP) in the campus of Indira Gandhi National Tribal University, Amarkantak, India. Sewage wastewater samples were collected from all cells of the experimental VFCW and analyzed for four heavy metals (Zn, Fe, Cu, and Cr). The plant species results show that the removal efficiency of the Canna indica L. for Zn, Fe, Cu, and Cr was 95%, 92%, 96%, and 93 % and Acorus calamus L.were 89 %, 80 %, 91 %, and 47 % respectively. These macrophytes with the substrate (gravel and sand) have presented a wide range of tolerance to all the selected metals and therefore can be used for field-scale constructed wetland removal of heavy metals from sewage wastewater.

A nineteen - year - old female presented with a history of binocular diplopia for one week. She had a history of headache, seizures, and memory loss. Magnetic Resonance Imaging (MRI) of brain revealed subependymal astrocytoma as the cause of her symptoms. Our pa tient was a probable case of tuberous sclerosis complex (TSC). Diplopia was the presenting sign in this case diagnosis.

Background: Inverted Papilloma arises from the lateral wall of nose and is common in maxillary sinus. It is locally invasive, can recur and has malignant potential. Endoscopic medial maxillectomy is the preferred choice. Materials and Methods: This prospective study was conducted in the department of Otolaryngology, Nobel Medical College and Teaching Hospital, Biratnagar from June 2015 to June 2018. A total of 26 patients were included in the study, after informed consent and ethical clearance. Staging was done by Krouse method after imaging studies and preoperative endoscopic biopsy was performed. These patients then underwent endoscopic medial maxillectomy. All the data were collected in excel spreadsheet and analyzed in SPSS software. Results: Out of a total of 26 patients, male: female ratio was 1.6:1, with 16 male and 10female. Average age was 40.5 years (25-72years). According to Krouse staging, 2 patients were in Stage I, 7 patients in Stage II and 17 patients in Stage III. IP mostly involved the lateral wall of nose. Unilateral nasal obstruction was the commonest presenting symptom. The commonest post-operative complication was nasal crusting. Most of the patients were treated with simple endoscopic medial maxillectomy. Conclusion: Inverted Papilloma is common in male in their 4th decade of life with lateral wall of the nose being mostly affected. Most patients were in stage III of Krouse’s staging system. Simple endoscopic medial maxillectomy was the commonest procedure.

The study intends to examine the value chain of liquid milk of informal sector based on procurement systems by dairy processing units, applying simulation model Vensim PLE x32 package. Mapping of product flow and core actors involved in value chains are based on primary data pertaining to year 2019. The total sample size was 27 of small and micro dairy processing units in Karnal district of Haryana state. The study concluded that cost of milk procurement was the least in collection centre (Model-I). The integrated production and processing system (Model-II) could attain higher profits (Rs. 9.56/L) compared to Model-I (Rs. 2.65/L) and Vendor system, i.e. Model-III (Rs. 1.78/L). The identified three key interventions, viz. training in milk handling, packing and processing; efficient transportation and processing technology and efficient design of procurement systems need to be applied for leveraging of milk value chain.

Background & Objective: SVD based audio watermarking schemes met the requirements of imperceptibility, having moderate payload and are robust to most common signal processing attacks. But, when the watermarked audios are compressed at higher compression i.e. compression at lower bit rate, the percentage retrieval of the watermark is reduced. Since the audios posted on the networked environment i.e. world wide web (www) are mostly Mp3 audios compressed at different compression rate, there is a need to develop a watermarking scheme which is inherently robust to compression attack at different bit rates. Methods: Scheme presented in this paper uses a two phase approach for embedding the watermark. The proposed scheme is having a high payload and is inherently robust to compression attack. In the proposed scheme, watermarked audios are made inherently robust to mp3 compression at different bit rates and common signal processing attacks through selection of embedding frames that resist the attacks fully. Results & Conclusion: A preliminary analysis of mp3 attack on the individual frames is done prior to finally embedding the watermark for ensuring robustness to mp3 compression and other attacks.

Benign fibrous histiocytoma (FH) is a benign soft-tissue tumor that can present as a fibrous tissue mass anywhere in the body. The involvement of the paranasal sinuses is extremely rare, and very few cases have been reported in literature till date. We here report a case of benign FH localized in the maxillary sinus. The clinical and histological features of the lesion are discussed with a brief literature review of this pathology in the paranasal sinuses.

International audience; In this letter, we propose a speckle removal denois-ing algorithm for synthetic aperture radar (SAR) images. The approach is based on the concept of extracting informative feature (based on the concept of multifractal decomposition of signals) from a speckle-induced SAR image and then estimating a noise-free image from the gradients restricted to those features. The experimental results show that the proposed technique not only improves the visual quality of the SAR images but also effectively preserves their texture. Comparison with the classical and state-of-the-art denoising techniques shows the advantages of the proposed scheme, both visually and quantitatively.

A new denoising technique is proposed in this study for synthetic aperture radar (SAR) images corrupted by speckle noise. The authors method extract informative features from a noisy speckled image, and then a denoised version of this image is estimated from the informative gradients, which are restricted to the features of this image. The technique of extracting features is designed on the framework of multifractal formalism followed by a reconstruction technique for the informative gradients based on the total variational (TV) regularisation framework. Experimental results demonstrate that the proposed approach is able to retain the finer details of the original image while removing noise. The superiority of the proposed approach is manifested qualitatively and quantitatively on comparing with state-of-the-art denoising techniques.