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The proposed approach is designed to boost the IEEE 802.15.4 / ZigBee-based WSN streaming efficiency by introducing multipurpose routing. We investigate how those networks can be designed in order to achieve optimum throughput using computational models to explain intra-track and inter-track interference in multipath routing networks. One mode of action in particular – Spatial-TDMA (S-TDMA), Zig Bee dependent WSNs, will greatly reduce the amount of interference, both in one- and multi-track environments. It is also seen that two-way networks can be stronger than their one-way counterparts by means of deliberately selected implementation parameters. Finally, a greater degree of spatial isolation between the routes used indicates improved average efficiency in multi-path scenarios. The simulation is one of our results.

Enhancement of reliability is critical in designing and planning of distribution systems that operate efficiently and with minimal interruption to customer loads, because they use various types of resources and technologies to meet energy demand such as distributed generation (DG). DG is expected to play an enhanced role in emerging power systems. One of the major issues in the planning stage for future distribution systems is the optimal design of multiple micro-grids (MMGs) in distribution systems. This paper describes a novel method for clustering a traditional passive distribution system into a cluster of Multiple Micro Grids (MMGs). Clustering a traditional distribution system into MMGs provides numerous merits for costumers and distribution system operators, including a local control strategy to minimise interaction between various MGs, local reactive power compensation to prevent fault propagation, minimise power losses, and ultimately improving system reliability. In each MG area, DGs and reactive power resources are deployed to reach the acceptable level of reliability. The proposed clustering procedure is based on a weighted graph partitioning approach, with the weights representing the apparent power of the lines. Various reliability tests were performed in order to determine the best location for DG penetration in the distribution system. The passive distribution system becomes an active system after DG penetration. As a result, planners must investigate the influence of DG on distribution system reliability. The aim of this paper is to investigate the impact of DG on distribution system reliability. The results on the test distribution system demonstrate the proposed method’s performance and effectiveness.

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.

The data collected on distribution of improved chicken varieties over the past 25 years (1992–2017) from the ICAR-Directorate of Poultry Research, Hyderabad (ICAR-DPR), poultry seed project centres (PSP) and other Government agencies who had taken parent stock from ICAR-DPR, were analysed to estimate the impact of the backyard poultry. A total of 7.56 million improved chicken germplasm (27%) to 20.37 thousand stakeholders from ICAR-DPR, Hyderabad and 1.7 million (6.09 %) to 28.38 thousand stakeholders from PSP were distributed during 1992–2017. Other agencies distributed 18.67 million (66.85%) germplasm to 311.17 thousand stakeholders. The majority of the beneficiaries were from southern region (35%) followed by central (23.4%) and eastern (20.8%) region of the country. Of the total varieties, Vanaraja constituted about 52% of the total germplasm followed by Gramapriya (38%). The share of improved chicken germplasm increased from 0.01 (1992) to 0.41% (2012) in the poultry population of India i.e., from 100 to 9433 indices as compared to 100 to 244 of the country. Contribution of improved germplasm to the Indian economy increased from 1.9 (8th plan) to 62. 5 (12th Plan) million USD. The total contribution during the 25 years was estimated to be about 168.7 million USD to Indian economy. Higher productivity of birds increased the income leading to socio-economic development of farmers. The study concluded that backyard poultry significantly contributed to the national economy and improved the livelihoods of the rural and tribal people, which needs to be further strengthened across the different geographical regions of the country.

Graphical abstract, Highlights • COVID-19 reveals radiological signatures that can be detected using chest X-rays. • The evaluation of radiological signatures is a time-consuming and error-prone task. • Therefore, there is a need to automate the analysis of chest X-rays. • An automatic analysis of chest X-rays is achieved using deep learning models., The most widely used novel coronavirus (COVID-19) detection technique is a real-time polymerase chain reaction (RT-PCR). However, RT-PCR kits are costly and take 6-9 hours to confirm infection in the patient. Due to less sensitivity of RT-PCR, it provides high false-negative results. To resolve this problem, radiological imaging techniques such as chest X-rays and computed tomography (CT) are used to detect and diagnose COVID-19. In this paper, chest X-rays is preferred over CT scan. The reason behind this is that X-rays machines are available in most of the hospitals. X-rays machines are cheaper than the CT scan machine. Besides this, X-rays has low ionizing radiations than CT scan. COVID-19 reveals some radiological signatures that can be easily detected through chest X-rays. For this, radiologists are required to analyze these signatures. However, it is a time-consuming and error-prone task. Hence, there is a need to automate the analysis of chest X-rays. The automatic analysis of chest X-rays can be done through deep learning-based approaches, which may accelerate the analysis time. These approaches can train the weights of networks on large datasets as well as fine-tuning the weights of pre-trained networks on small datasets. However, these approaches applied to chest X-rays are very limited. Hence, the main objective of this paper is to develop an automated deep transfer learning-based approach for detection of COVID-19 infection in chest X-rays by using the extreme version of the Inception (Xception) model. Extensive comparative analyses show that the proposed model performs significantly better as compared to the existing models.

Insensate flaps are used in several reconstructions. A search of the literature showed that most studies are limited to particular flaps in specific body areas. There is a lack of uniform scientific data on the pattern of sensory recovery in various body parts for different kinds of flaps. We conducted a prospective observational study for over one year to study the pattern of sensory return in 74 flaps and studied the disparity in the return of sensation of touch, pain, warmth and cold. After that, we analyzed the relationship between sensory return in flaps and the region of the body (head and neck/upper limb/lower limb), type of flap (cutaneous/fasciocutaneous/musculocutaneous), age of patient and type of wound bed (surgically created defect/raw area such as post trauma, post debridement). Touch sensations were assessed by Semmes-Weinstein (SW) monofilament of 5.01 number, pain was assessed using a sterile 26 G needle, cold sensation was assessed using water at 4 °C and warm sensation was assessed using water at 44 °C. The sensations were evaluated at one-fourth and one-half of distance from the periphery to the center, at eight equidistant points along the circumference and at the center of the flap. Sensations were observed to return in the periphery of the flap earlier and in the center later. Touch sensation was recovered the earliest (three months onwards), followed by sensations of pain, warmth and cold (around the sixth month). Flaps performed in the head and neck showed the best recovery of sensation. Best recovery of sensation was observed in cutaneous flaps. Flaps performed on surgically created defects showed better recovery of sensation compared with flaps performed to cover raw areas; however, the differences were statistically nonsignificant. Children showed better recovery of sensations; however, this was not statistically significant. Sensory nerve coaptation is recommended in flaps folded on themselves and in fasciocutaneous flaps of the lower limb.

Tin oxide is an impressive metal oxide for optoelectronic applications and its properties can be easily augmented with doping. In current research work, undoped and zinc-doped SnO2 nanoparticles annealed at 500 °C were prepared by a solid-state reaction method. The rutile tetragonal structure for undoped and zinc-doped SnO2 nanoparticles was proved by the analysis of their x-ray diffraction (XRD) patterns. Scanning electron microscope (SEM) images confirm the spherical, smooth, and dense morphology. The presence of Sn, O, and Zn ions are supported by energy dispersive x-ray study (EDX). The transmission spectrum obtained by UV–Visible spectroscopy shows a blue shift and the energy band gap (Eg) for undoped and zinc-doped SnO2 nanoparticles changes from 3.03 to 3.18 eV. Photoluminiscence (PL) spectra of synthesized samples shows one emission peak at 430 nm whose intensity increases with zinc-doping. The electrical resistivity was studied by Hall-effect measurement and it revealed that the resistivity decreases with zinc doping.

This retrospective study analyzed the 12-month pulp sensibility (cold and electric) test response after mineral trioxide aggregate (MTA) full pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis.The records of 120 subjects from 3 completed and 1 ongoing clinical study on MTA full pulpotomy were retrieved. Ninety-six first and second mandibular molar teeth with a diagnosis of symptomatic irreversible pulpitis that underwent a single-visit MTA full pulpotomy and had completed a 12-month clinical, radiographic, and pulp sensibility (cold and electric) test follow-up were included. The data were analyzed using the Fisher exact test, the Pearson chi-square test, and the McNemar test. The significance level was predetermined at P .05.A higher percentage of teeth (94.7%) responded to the electric pulp test in comparison with the cold test (13.5%) (P .05). Sex-based responses to the electric pulp test (P .05) and the cold test were similar (P .05). The age-based response was similar for the electric pulp test (P .05) but was significant for the cold test (P .05). The tooth quadrant (left and right), the tooth (mandibular first and second molar), and the location of restoration (proximal or occlusal) did not influence the response of either the electric pulp test (P .05) or the cold test (P .05). At the 1-year follow-up, all the teeth that were classified as clinically and radiographically successful responded to the electric pulp test; however, only 13 teeth responded to the cold test (P = .00).The majority (94.7%) of the teeth that underwent MTA full pulpotomy responded to the electric pulp test at a 1-year time interval.

Maffucci syndrome is a rare congenital, non-hereditary condition characterised by presence of multiple enchondromas and haemangiomas. Enchondromatous lesions affecting epiphysial growth plates can lead to angular deformities and leg-length discrepancy in the lower limb. We describe a 12-year-old girl with monomelic Maffucci syndrome affecting her left lower limb. She presented with progressive genu valgus deformity of her left knee. This caused her to limp during her gait and was a cosmetic dissatisfaction. The deformity affected her quality of life. She underwent a supracondylar distal femoral corrective osteotomy with a successful clinical outcome and restoration of her gait and cosmetic deformity.

Obesity is characterized by low-grade, chronic inflammation, which promotes insulin resistance and diabetes. Obesity can lead to the development and progression of many autoimmune diseases, including inflammatory bowel disease (IBD), psoriasis, psoriatic arthritis (pSA), rheumatoid arthritis (RA), thyroid autoimmunity, and type 1 diabetes mellitus (T1DM). These diseases result from an alteration of self-tolerance by promoting pro-inflammatory immune response by lowering numbers of regulatory T cells (T(regs)), increasing Th1 and Th17 immune responses, and inflammatory cytokine production. Therefore, understanding the immunological changes that lead to this low-grade inflammatory milieu becomes crucial for the development of therapies that suppress the risk of autoimmune diseases and other immunological conditions. Cells generate extracellular vesicles (EVs) to eliminate cellular waste as well as communicating the adjacent and distant cells through exchanging the components (genetic material (DNA or RNA), lipids, and proteins) between them. Immune and adipocyte from individuals with obesity and a high basal metabolic index (BMI) produce also release exosomes (EXOs) and microvesicles (MVs), which are collectively called EVs. These EVs play a crucial role in the development of autoimmune diseases. The current review discusses the immunological dysregulation that leads to inflammation, inflammatory diseases associated with obesity, and the role played by EXOs and MVs in the induction and progression of this devastating condition.

Sepsis is a clinical syndrome resulting from infection followed by inflammation and is one of the significant causes of mortality worldwide. The underlying reason is the host's uncontrolled inflammatory response due to an infection led to multiple organ dysfunction/failure. Neutrophils, an innate immune cell, are forerunners to reach the site of infection/inflammation for clearing the infection and resolute the inflammation during sepsis. A relatively new neutrophil effector function, neutrophil extracellular traps (NETs), have been demonstrated to kill the pathogens by releasing DNA decorated with histone and granular proteins. A growing number of pieces of shreds of evidence suggest that unregulated incidence of NETs have a significant influence on the pathogenesis of sepsis-induced multiple organ damage, including arterial hypotension, hypoxemia, coagulopathy, renal, neurological, and hepatic dysfunction. Thus, excessive production and improper resolution of NETs are of significant therapeutic value in combating sepsis-induced multiple organ failure. The purpose of this review is intended to highlight the role of NETs in sepsis-induced organ failure. Furthermore, the current status of therapeutic strategies to intersect the harmful effects of NETs to restore organ functions is discussed.

As a consequence of expanded science and technical research, the market perception of consumers has shifted from standard traditional to valuable foods, which are furthermore nutritional as well as healthier in today’s world. This food concept, precisely referred to as functional, focuses on including probiotics, which enhance immune system activity, cognitive response, and overall health. This review primarily focuses on functional foods as functional additives in beverages and other food items that can regulate the human immune system and avert any possibility of contracting the infection. Many safety concerns must be resolved during their administration. Functional foods must have an adequate amount of specific probiotic strain(s) during their use and storage, as good viability is needed for optimum functionality of the probiotic. Thus, when developing novel functional food-based formulations, choosing a strain with strong technological properties is crucial. The present review focused on probiotics as an active ingredient in different beverage formulations and the exerting mechanism of action and fate of probiotics in the human body. Moreover, a comprehensive overview of the regulative and safety issues of probiotics-based foods and beverages formulations., Graphical abstract

Background: Scaling of the dimensions of semiconductor device plays a very important role in the advancement of Very Large-Scale Integration (VLSI) technology. There are many advantages of scaling in VLSI technology such as increment in the speed of the device and less area requirement of the device. Aggressive device scaling causes some limitations in the form of short channel effects which produce large leakage current. Large leakage current harms the characteristics of the device and affects the reliability of the device. Objective: The most important and popular reliability issue in Deep Sub Micron (DSM) regime is Negative- Bias Temperature Instability (NBTI). NBTI effect increases the threshold voltage of p-channel Metal Oxide Semiconductor (PMOS) device over the time and affects the different characteristics of the device. As a result, circuit delay exceeds the design specification and there may be timing violations or logic failure. Different performance parameters are observed under NBTI effect for different logic gates. Methods: This paper presents an impact of NBTI at 22nm Berkeley short-channel IGFET model4 (BSIM4) Predictive Technology Model (PTM) for Complementary Metal Oxide Semiconductor (CMOS) logic gates. Reliability simulations are utilized to evaluate the amount of gradual damage in PMOS device due to NBTI effect. Results : The impact of NBTI degradation is checked for various CMOS logic gates using Mentor Graphics’s Eldo circuit simulator. Output voltage and drain current are reducing over the time under NBTI effect. Conclusion: NBTI degradation increases the threshold voltage of PMOS device over time and affects the different characteristics of the device.

COVID-19 has shaken all the countries across the globe and researchers are trying to find promising antiviral to cure the patients suffering from infection and can decrease the death. Even, different nations are using repurposing drugs to cure the symptoms and these repurposing drugs are hydroxychloroquine, remdesivir, and lopinavir, and recently, India has recently given the approval for the 2-deoxy-d-glucose for emergency purpose to cure the patients suffering from the COVID-19. Plitidepsin is a popular molecule and can be used in treatment of myeloma. Plitidepsin was explored by scientists experimentally against the COVID-19 and was given to the patient. It is found to be more a promising repurposing drug against the COVID-19 than the remdesivir. Therefore, there is a need to understand the interaction of plitidepsin with the main protease of SARS-CoV-2. Molecular docking of the plitidepsin against Mpro of SARS-CoV-2 was performed and the binding energy was found to be − 137.992 kcal/mol. Furthermore, authors have performed the molecular dynamics simulations of the main protease of SARS-CoV-2 in presence of plitidepsin at 300 and 325 K. It was found that the plitidepsin binds effectively with the main protease of SARS-CoV-2 at 300 K.

The new generation of information technology is exchanging a huge data and these data should be process for analytical and visualization purposes. In most of our daily activities we are exchanging the data such as our mobile devices maintains call records, visited location records, exchanging messages etc., and these data are growing drastically and becomes a challenging task to maintain these data. From the starting of human civilization until 2000, humankind produces five Exabyte data but we are producing five Exabyte data every day. These data become useless if some query operation is not performed on it. Data analysis canon these data results any business more responsive and stronger and overcome business challenges. Thus, query-processing system takes place and it plays very decisive part in big data. This paper differentiates betwixt disparate query optimization processes and their algorithms utilized in big data for avoiding issues in query optimization. Utilizing different query processing techniques, the researchers are assisted by this review to find a disparate way for processing the data and how to enhance the query processing as well as optimization in various applications.

Plant cell and tissue culture makes provision of a sustainable and nature-friendly strategy for the production of secondary metabolites, and modern progress in gene editing and genome engineering provides novel possibilities to improve both the qualitative and quantitative aspects of such phytochemicals. The ever-expanding quest for plant-based medicine to treat diabetes facilitates large-scale cultivation of Stevia rebaudiana to enhance the yield of its much-coveted low-calorie sweetener glycosides. The potential to process stevia as a "natural" product should enhance the acceptance of steviosides as a natural calorie-free sweetener especially suitable for use in diabetic and weight control drinks and foods. Besides sweetener agents, S. rebaudiana is a potent source of many antioxidant compounds and is used to cure immunodeficiencies, neurologic disorders, inflammation, diabetes mellitus, Parkinson's disease, and Alzheimer's disease. This comprehensive review presents the research outcomes of the many biotechnological interventions implicated to upscale the yield of steviol glycosides and its derivatives in in vitro cell, callus, tissue, and organ cultures with notes on the use of bioreactor and genetic engineering in relation to the production of these valuable compounds in S. rebaudiana. KEY POINTS: • Critical and updated assessment on sustainable production of steviol glycosides from Stevia rebaudiana. • In vitro propagation of S. rebaudiana and elicitation of steviol glycosides production. • Genetic fidelity and diversity assessment of S. rebaudiana using molecular markers.

Development of safety features to prevent accident on the roads is one of the major challenges in the automobile industry. Driving with no prior information about the upcoming road can be dangerous. Not knowing about what’s coming down the road can disbalance the vehicle and lead to accident. Driving when tired or drunk can lead to major life risking accidents. The road accidents can be prevented by collecting the data of road’s characteristics and providing an alert to the driver if any distraction comes in the way. This paper introduces a concept of real-time monitoring of the driver and generating an alert when the driver gets sleepy or unconscious. Road analysis was also done to classify spots with high possibility of accidents and alerts generated for the same. The system thus covers two major reasons which cause heavy accidents on the road and provides solution to overcome them.

A simple and compact circularly polarized broadband circular slot antenna is proposed for WLAN/WiMAX/DBS applications. The main objective of this work is to design a microstrip line fed broadband circularly polarized antenna that is achieved by introducing an asymmetric perturbation over the circular slot onto the ground plane. A broad axial ratio bandwidth is achieved by using a small circular segment cut into the circular slotted ground and by adding a short stub on the feedline. To achieve a broad impedance bandwidth, a horizontal strip onto the slotted ground is placed just above the feed line on the opposite side. The proposed antenna is fabricated with an overall dimension of 20 × 20 × 1.6 mm3 (0.34λ o × 0.34λ o × 0.03λ o, where λ o represents the free-space wavelength at the center operating frequency). It is found that the impedance bandwidth of 75.82% ranges from 3.21 to 7.13 GHz and the 3 dB axial ratio (AR) bandwidth reaches 54.27% from 3.8 to 6.6 GHz. Throughout this paper, the improvement and validation process of the proposed antenna outcomes to accomplish desired characteristics are discussed.

This article on ‘Micro-machining: An Overview (Part II)’ is in continuation to ‘Micro-machining: An Overview (Part I)’ published in this journal ( Journal of Micromanufacturing). It consists of four parts, namely, electrochemical micro-texturing, electrochemical spark micro-machining, molecular dynamics simulation and sustainability issues of micro-machining processes. Electrochemical micro-texturing (ECMTex) deals with various techniques developed for micro-texturing on different types of workpiece-surfaces, namely, flat, curved and free-form surfaces. Here, basically two categories of techniques have been reviewed, namely, with mask and without mask. It also deals with ‘single point tool micro-texturing’ which turns out to be a single-step technique requiring minimum time, but the accuracy and repeatability obtained after micro-texturing need to be critically analysed. For mass production, one needs to go for sinking kind of ECMTex processes. Electrochemical spark micro-machining (ECSMM) is an interesting hybrid (ECM+EDM) process which can be applied for electrically conducting as well as electrically non-conducting materials. However, the work reported in this article deals only with the electrically non-conducting materials for which this process was initially developed. This process has a lot of potential for theoretical work to be done. In this article, two theories of sparking/discharging have been briefly mentioned: single bubble discharging/sparking and single surface discharging. It also dicusses its applications for different types of electrically non-conducting materials. Molecular dynamics simulation (MDS) of micro-/nano-machining processes is very important, but it is very cumbersome to understand at atomic/molecular scale. In these processes, the material behaviour at micro-/nano-level machining is completely different as compared to bulk-machining (macro-machining) processes. Hence, some fundamentals of MDS have been discussed. It just gives the idea of available techniques, softwares and models for different types of processes. However, there is the need of further research work to be done for clearly understanding the MDS of micro-/nano-machining. In the end, the sustainability of micro-machining issues have been discussed, mainly based on the energy consumption per unit mass of production. It is concluded that the advanced micro-manufacturing processes are highly energy-intensive processes, and they need further studies to be done for making them more suitable from sustainability point of view. At the end of each section, some potential areas of research for enhancing the accuracy and repeatability, and minimising the production time of each process have been discussed.

Introduction Cytogenetic abnormalities are integral to the risk stratification of acute lymphoblastic leukemia (ALL). Objectives The present study aimed to highlight a rare, yet nonrandom cytogenetic abnormality notably dicentric (9;12), which was observed in ALL patients who presented to our institute. The study analyzed the frequency, clinicohematological features, and treatment response of these patients. Materials and Methods A single-group observational study was conducted from April 2014 to April 2020. Cytogenetic analysis was done on bone marrow aspirate samples of the patients referred to the cytogenetics laboratory with clinical diagnosis of acute leukemia. Cytogenetic, clinical, and hematological data were collected from respective departmental records, case files, and patients. Results Dic(9;12) was identified in 1.2% of ALL (19 out of 1,544 patients). They showed striking preponderance in teen and young adult males with characteristic precursor B cell immunophenotype. Majority of these patients displayed favorable risk profiles such as low total count, mild lymphadenopathy and splenomegaly, mild-to-moderate elevation of lactate dehydrogenase, and good response to first induction chemotherapy. Rare coexistence of dic(9;12) with well-established cytogenetic markers such as t(9;22) and t(1;19) was observed. Conclusion Dic(9;12) is one of the most specific cytogenetic markers of precursor B cell (pre-B) ALL. It defines a subgroup with favorable clinical and biological profile. We suggest inclusion of dic(9;12) in cytogenetic risk stratification of precursor B cell ALL. Long-term follow-up studies are recommended to establish the prognostic significance of this cytogenetic subgroup, which may benefit from less intensive chemotherapy.

This paper addresses the problem of determining the optimal promotional policy for a diffusion model in a segment-specific market under the assumption that the additional demand of the new product ...

The need of performance enhancement at the RF and millimeter wave is highly desirable to eliminate the heating effects and power dissipation. Silicon substarte found to be a suitable candidate which reduces about 70% channel temperature than sapphire. To achieve high performance, a GaN on the Silicon substrate high electron mobility transistor is designed and its various performance paramters are analyzed by varying the design specifications. Moreover, the problem of blocking voltage improvement is resolved by epitaxial design approach. Since, threshold voltage, doping-level, work-function of gate material and channel length are considered as some of the important parameters while device modeling. Therefore, the impact of these parameters is examined and analyzed to enehace the performance and reliability of the device for RF applications. The performance parameters like trans-conductance, drain current curves are plotted at different state of device physical and electrical parameters. Results exhibits maximum value of transconductance gm=13 milli-mho, minimum gate capacitance Cg=0.5pf, wheras Vth is varied between − 0.25 volts to 0.25 volts.

Diverse ethnic genetic populations display variability in the risk regarding anti-seizure medicine (ASM)-induced severe cutaneous adverse reactions (SCARs). However, clinical and epidemiological data on ASM-induced SCARs in Asians is limited.We conducted a retrospective, post-market study until April 30, 2020 using VigiBase® for demographic characteristics, causative ASMs, complications and mortality. The study included adverse events as classified by Standardized Medical Dictionary for Regulatory Activities (MedDRA) queries of SCARs, mainly Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug rash with eosinophilia and systemic symptoms (DRESS), and SJS/TEN overlap reported for ASMs.A total of 694,811 adverse events were reported across the world while using ASMs. Of this, skin and subcutaneous tissue adverse events were 122,885 (17.6%). Among ASM-induced skin and subcutaneous tissue adverse events, SJS, TEN, DRESS and SJS/TEN overlap represented 11,181 (9.1%), 3,645 (3.0%), 5,106 (4.1%) and 6 (0.004%) cases, respectively. Female SJS/TEN/DRESS patients were 54.1%, and 75% of them were adults (18Y). Nearly 64% of the ASM-induced SCARs were serious and culminated in death (3.5%), life-threatening conditions (11.5%), and hospitalization/prolonged hospitalization (43.5%) of patients on ASM therapy. Carbamazepine (31.6%), phenytoin (29.6%), lamotrigine (24.3%), valproic acid (6.4%) and phenobarbital (5.7%) are the most commonly used ASMs linked with SCARs. ASMs associated with significantly higher risk of SCARs in Asians were carbamazepine [n = 3265, ROR 3.55 (95% CI 3.38-3.72, P 0.0001)], lamotrigine [n = 1253, ROR 3.90 (95% CI 3.63-4.18, P 0.0001)], gabapentin [n = 85, ROR 3.58 (95% CI 2.79-4.60, P 0.0001)], pregabalin [n = 68, ROR 3.16 (95% CI 2.40-4.16, P 0.0001)], clonazepam [n = 53, ROR 3.19 (95% CI 2.31-4.41, P 0.0001)], lorazepam [n = 31, ROR 3.07 (95% CI 2.06-4.59, P 0.0001)] and acetazolamide [n = 28, ROR 3.90 (95% CI 2.45-6.21, P 0.0001)].Based on our study, carbamazepine, lamotrigine, gabapentin, pregabalin, clonazepam, lorazepam, and acetazolamide are the most common causative ASMs for SCARs in the Asian population.

BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).

Purpose: Similar to fresh- and brackish water aquaculture ponds, commercial shrimp farming in degraded saline areas holds the potential to bury carbon (C) in the sediments. However, studies on the mechanisms of sediment C dynamics and C-flux in response to inland saline aquaculture management practices are still scarce. Therefore, the objectives of the present study are to quantify the C burial rate in inland saline aquaculture ponds and assess the impact of inland saline aquaculture on sensitive C fractions in the bottom sediment of the ponds. Materials and methods: The sediment samples (n = 12 from each pond) were collected from six shrimp farming ponds (1000 m2 area of each pond) of different ages. The sediment depth, sediment accumulation rate and the levels of total carbon (TC), total organic carbon (TOC) and sediment oxidizable organic carbon (SOC) and its different fractions were determined using standard procedures. The data were analysed by one-way analysis of variance (ANOVA), followed by the Duncan's multiple range test for comparing the means, and the Pearson correlation test was used to assess the relationship between the different pond sediment parameters and SOC content. Results and discussion: The results revealed that the annual C accumulation rates varied from 902 to 1346 kg C ha−1 year−1 in 7-year-old earthen ponds (EPs) and bottom cemented ponds (BCPs), respectively. The sediment C fractions, including TC, TOC, SOC and its fractions (very labile, VLc; labile, Lc; less labile, LLc), and non-labile carbon (NLc)) were progressively increased over the pond age. The inland saline aquaculture practices over the years increased both active (AC) and passive carbon (PC) pools in the pond sediments, helped in the restoration and improvement of sediment quality and enhanced C sequestration potential of the sediments. Furthermore, a significant increase in the level of particulate organic carbon (POC) in BCPs justified that the non-ploughing practices at BCPs facilitated the formation of macro- and micro-aggregates, thereby increasing the C retention and stability of the pond sediments. Conclusion: This study suggested that the shrimp farming ponds in semi-arid saline soils represented considerable C burial hotspots, enhanced the stable passive C pools and improved the sediment quality. Refereed/Peer-reviewed

To highlight causal relationship between stress fracture in the presence of tarsal coalition and hindfoot pain in adolescents on magnetic resonance imaging (MRI). A retrospective review was performed of the clinical and MRI imaging findings of 6 adolescents referred for MRI to evaluate symptoms of hindfoot pain with possible tarsal coalition. MRI studies were systematically assessed for cause of hindfoot pain, types of tarsal coalition, patterns of stress fractures, bone marrow oedema and any other associated features. All the 6 patients (4 male: 2 female) aged between 12 and 19 years developed insidious onset of hindfoot or midfoot pain over a period of weeks to months. On MRI, all 6 cases had features of fibrous tarsal coalition predominantly in the calcaneonavicular articulation (5 out of 6 patients). Associated stress fractures/response were in the posterior facet/body of the calcaneus (3), talar head (2), cuboid (1) and third metatarsal bone in one patient. Stress fractures/response adjacent to tarsal coalition could be because of altered biomechanics and can be an unusual cause of hindfoot pain in adolescents. A high index of suspicion and complementary MRI findings is crucial to interpret this condition to direct appropriate patient management.

Purpose of Study: To study the radiological and imaging services in terms of Quality Assurance in relation to accreditation norms. Methods: We performed cross sectional evaluation of the data obtained from the participants in the study Semi structured both open and closed ended questionnaire were administered among the participants who were agreed to participate in the study. The questionnaire was formulated to evaluate different parameters of Quality Assurance Programme (QAP). The parameters were divided into structure, process and outcome measures and were derived from literature [National Accreditation Board for Hospitals and Health care Providers during accreditation of healthcare institutions]. Results: The radiology and imaging services of Vydehi Medical College Hospital was established in the year 2002, and was approved by AERB (Atomic Energy Regulatory Board) in the year 2007. The department was renewed by AERB in the year 2012. Checklist was formulated which includes several parameters in terms of structure, process and outcome measures. Conclusion: Quality assurance programme is to provide good patient timely care and the policies adopted by the department of radiology and imaging service in terms of quality are on par with standard guidelines in our study. Safe and sustainable quality care is the need of the hour and it can be practically achieved by regular monitoring of the quality assurance programme. Key words: Quality assurance; Imaging services; Utilisation; Guidelines; Healthcare

Optical vortex beams have attracted significant research interest owing to their potential for application in optical communication and imaging. In this study, we demonstrated devices with electric...

Background: SARS-coronavirus-2 is a new virus infecting people and causing COVID-19 disease. The disease is causing a worldwide pandemic. Although some people never develop any signs or symptoms of disease when they are infected, other people are at very high risk for severe disease and death. Objective: If we’re able to intervene to prevent even some transmission, we can dramatically reduce the number of cases. And this is the public health goal for controlling COVID-19. Methods: This article initializes an approach for comparatively accurate values prediction of new cases and deaths for a particular day in order to be considered for preventive measures. The three statistical analysis methods considered for forecasting are Fbprophet, Moving average and the Autoregressive Integrated Moving Average algorithm. Results: The results obtained are in-line with the past and present trend of COVID-19 data collected from WHO website. Conclusion: The output is satisfactory for further consideration. Bangladesh Journal of Medical Science Vol.20(5) 2021 p.85-96

Background There is a paucity of literature on the anesthetic management of pediatric esophageal substitution using the stomach. We did a retrospective analysis of all such cases done at our institution. We analyzed the patient’s demography, indication, and type of surgery, co-morbid conditions, anesthesia techniques, duration of postoperative ventilation, hospital stay, complications, and mortality. The use of beta-blockers and their effect on the incidence of intraoperative and postoperative tachycardia in gastric pull-up patients was also analyzed. Results Thirty-four cases of gastric substitution of the esophagus in children were done over 19-year period; gastric pull-up was done in 28 patients and a gastric tube was made in 6 patients. General anesthesia was given to all; a thoracic epidural for pain was sited in 25 patients. Twenty-eight patients were ventilated postoperatively; the mean duration of ventilation is 54 h. Significant intraoperative tachycardia was observed in 85.7% of patients without beta-blocker as compared to 23.8% patients with beta-blocker (p = 0.004). Postoperatively, tachycardia was absent in patients receiving beta-blocker and present in 71.4% of patients not receiving beta-blockers (p < 0.001). Overall mortality was 8.8% but mortality due to cardiac arrhythmia was 42.9% in the patients not receiving beta-blockers (p = 0.001). Conclusions A thorough preoperative preparation, control of tachyarrhythmias, postoperative ventilation, and pain management is recommended for a favorable outcome. In addition, our paper supports the preoperative use of beta-blockers in reducing the incidence of fatal tachyarrhythmias associated with gastric pull-up surgery without any serious adverse effects. Level of evidence Level III

Now a day’s defence applications associated to novel, army and military war fields are required wall imaging discrimination. As of now many wall-imaging techniques are designed but cannot discriminate the target and clutter with accurate working. Therefore, a novel advance wall image tracking method is required for differentiate the clutter and human target. In this research work single value decomposition technique is used to estimate the range bin behind the wall target. In order to track the target and clutter single-value-decomposition (SVD) is not sufficient, so that along this SVD, threshold skewness (TS) method has been presented. Combination of SVD-TS giving the accurate long range-bin sensing and directed the human’s targets. SVD-TS method is a statistical scheme, which can realise the amplitude ranges through large number of range-bin scans. This technique improves the accuracy by 98.6%, skewness by 8%, and normalised power by 98.9%. These SVD-TS method is more efficient and compete with existed techniques.

In light of the devastation caused by COVID-19, the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and vaccine research and development (R&D) have been occupying a prominent position in the field of global health diplomacy (GHD). Most countries, international organizations, and charitable organizations have been engaged in the R&D of COVID-19 vaccines to ensure timely affordability and accessibility to all countries. Concomitantly, the World Trade Organization (WTO) provides some provisions and enforcements regarding copyrights, patents, trademarks, geographical indications, and industrial designs. Given these safeguards, it is considered that intellectual property rights (IPRs) have become major barriers to the affordability and accessibility of vaccines/medicines/technology, particularly to the developing/least developed countries. Realizing the gravity of the pandemic impact, as well as its huge population and size, India has elevated this issue in its global health diplomacy by submitting a joint proposal with South Africa to the World Trade Organization (WTO) for a temporary waiver of IPRs to ensure timely affordability and accessibility of COVID-19 medical products to all countries. However, the issue of the temporary waive off had become a geopolitical issue. Countries that used to claim per se as strong advocates of human rights, egalitarianism, and healthy democracy have opposed this proposal. In this contrasting milieu, this paper is aimed at examining how the TRIPS has become a barrier for developing countries’ development and distribution of vaccines/technology; secondly, how India strategizes its role in the WTO in pursuant of its global health diplomacy? We conclude that the IPRs regime should not become a barrier to the accessibility/affordability of essential drugs and vaccines. To ensure access, India needs to get more engaged in GHD with all the involved global stakeholders to get strong support for their joint proposal. The developed countries that rejected/resisted the proposal can rethink their full support.

This study aims to identify neuropsychiatric manifestations in neurological Wilson disease (NWD), and their correlation with MRI changes and glutamate excitotoxicity. Forty-three consecutive patients with NWD from a tertiary care teaching hospital were evaluated prospectively who fulfilled the inclusion criteria. The neuropsychiatric evaluation was done using Neuropsychiatric Inventory (NPI) battery that assesses 12 domains including delusion, hallucination, agitation/aggression, dysphoria/depression, anxiety, euphoria, apathy, disinhibition, irritability, aberrant motor activity, appetite change, and abnormal nighttime behavior. Cranial MRI was done using a 3 T machine, and locations of signal changes were noted including the total number of MRI lesions. Serum glutamate level was measured by a fluorescence microplate reader. Abnormal NPI in various domains and total NPI scores were correlated with MRI lesions, serum and urinary copper, and glutamate level. The median age of the patients was 16 years. Forty-one (48.8%) patients had cognitive impairment and 37 (86%) had movement disorder. Neurobehavioral abnormality was detected in all-commonest being agitation (90.7%) followed by appetite change (81.4%), elation (74.4%), irritability (69.8%), anxiety (67.4%), depression (65.1%), apathy (44.2%), night time abnormal behavior (32.6%), aberrant motor behavior (20.9%), delusions (16.3%), and hallucination (18.6%). The thalamic lesion was associated with depression, globus pallidus with depression and anxiety, caudate with anxiety and agitation, brainstem with irritability, and frontal cortex with apathy. Serum glutamate level was higher in NWD. NPI sum score correlated with MRI load and glutamate level. Varying severity of neurobehavioral abnormalities are common in the patients with NWD and correlate with the location of MRI lesion and glutamate level.

In this paper we present a direct semi-dense stereo Visual-Inertial Odometry (VIO) algorithm enabling autonomous flight for quadrotor systems with Size, Weight, and Power (SWaP) constraints. The proposed approach is validated through experiments on a 250 g, 22 cm diameter quadrotor equipped with a stereo camera and an IMU. Semi-dense methods have superior performance in low texture areas, which are often encountered in robotic tasks such as infrastructure inspection. However, due to the measurement size and iterative nonlinear optimization, these methods are computationally more expensive. As the scale of the platform shrinks down, the available computation of the on-board CPU becomes limited, making autonomous navigation using optimization-based semi-dense tracking a hard problem. We show that our direct semi-dense VIO performs comparably to other state-of-the-art methods, while taking less CPU than other optimization-based approaches, making it suitable for computationally-constrained small platforms. Our method takes less amount of CPU than the state-of-the-art semi-dense method, VI-Stereo-DSO, due to a simpler framework in the algorithm and a multi-threaded code structure allowing us to run real-time state estimation on an ARM board. With a low texture dataset obtained with our quadrotor platform, we show that this method performs significantly better than sparse methods in low texture conditions encountered in indoor navigation. Finally, we demonstrate autonomous flight on a small platform using our direct semi-dense Visual-Inertial Odometry. Supplementary code, low texture datasets and videos can be found on our github repo: https://github.com/KumarRobotics/sdd_vio .

The battery-driven portable systems are the lifeline of the modern era. Very large-scale integration (VLSI) designers are continuously working to enhance the performance of the portable systems. Th...

Recently, the Wormhole Attack (WA) affects the Wireless Sensor Networks (WSN). So far, there are ‘2’ solutions to trounce WA, that is, utilizing specialized hardware or capturing a specific pattern extra overhead over the network. Some prevailing solutions for detectingWAneed special hardware or firmly synchronized clocks or longer processing time in addition to that some solutions can’t even locate the WormHole (WH) and also have low security.This paper proposed an efficient WH detection as well as Optimal Path (OP) selection for safe Data Transmission (DT) in WSN. The proposed workencompasses a '2' phase: i) training, and ii) testing. Here, the WSN values are considered and chosen secure node utilizing the Fit Factor (FF). After selecting the secure nodes, the routes are discovered aimed at the optimal assortment of the optimal routes. Next, the gathered data is tested with a trained system in which feature reduction and classification are performed. Lastly, the MCSC securely transfers the non-attack data. The proposed method’s outcomes are examined and weighed against the other prevailing techniques and the outcomesexhibited the proposed method’s efficiency for attack detection along withdata security.

We provide the South Asian Declaration, containing the consensus guidelines for coronavirus disease 2019 (COVID-19) vaccination in cancer patients.

Exhaustion of natural sources due to expanding usage leads to an increase in global temperature. Heat stress and rising CO2 severely impact crop growth and catastrophic loss of agriculture ecosystem, productivity and quality. The physiological and metabolic processes of plants are affected by heat stress due to denatured proteins, lipid structure, alteration in membrane integrity and inactivation of enzymes incurred at various growth stages. To diminish heat stress losses in plants, many techniques such as conventional breeding, genetic engineering, molecular breeding were used by the agriculturists, which helped develop tolerant varieties of crops with increased quality and production. Recent advancement in seed priming has many fold impacts such as mitigation of stress via improving tolerance mechanisms in plants, reduction in soil and water pollution, improved production and food quality of important agriculture crops. It is one of the low-cost, reliable and profitable crop improvement techniques. Nitrates have several roles in modulating the plant processes. Priming with nitrate salts improves nitrate reductase and amylase activity, nitrogen, amino acid and chlorophyll content in leaves, causes increase in proline, sugar content, antioxidant metabolism, grain yield, protein and nutrient content in various crops. Despite positive responses of nitrate seed priming, this technology has been less applied in the area of crop production in the field condition. Considering these facts, this review depicts responses of the plants under heat stress and their management through nitrate seed priming.

Elbow is an uncommon joint to be affected by Mycobacterium tuberculosis infection. It is involved in approximately 1–5% of all cases with musculoskeletal tuberculosis (TB). Early diagnosis of TB of the elbow joint can be easily missed due to an indolent natural history, delay in presentation, and varied clinical features. Delay in diagnosis can lead to irreversible osteoarticular destruction and loss of joint function. Careful clinical assessment, adequate imaging, microbiological, and/or histopathological confirmation of Mycobacterium tuberculosis infection is essential for early diagnosis of TB of the elbow joint. Judicious and early administration of anti-tubercular therapy can lead to preservation of the joint and a satisfactory functional outcome. Surgical intervention may be needed in later stages of the disease to achieve control of the infection, correction of deformity, instability, and restoration of function.

The surgical margin status of breast lumpectomy specimens for invasive carcinoma and ductal carcinoma in situ (DCIS) guides clinical decisions, as positive margins are associated with higher rates of local recurrence. The "cavity shave" method of margin assessment has the benefits of allowing the surgeon to orient shaved margins intraoperatively and the pathologist to assess one inked margin per specimen. We studied whether a deep convolutional neural network, a deep multi-magnification network (DMMN), could accurately segment carcinoma from benign tissue in whole slide images (WSIs) of shave margin slides, and therefore serve as a potential screening tool to improve the efficiency of microscopic evaluation of these specimens. Applying the pretrained DMMN model, or the initial model, to a validation set of 408 WSIs (348 benign, 60 with carcinoma) achieved an area under the curve (AUC) of 0.941. After additional manual annotations and fine-tuning of the model, the updated model achieved an AUC of 0.968 with sensitivity set at 100% and corresponding specificity of 78%. We applied the initial model and updated model to a testing set of 427 WSIs (374 benign, 53 with carcinoma) which showed AUC values of 0.900 and 0.927, respectively. Using the pixel classification threshold selected from the validation set, the model achieved a sensitivity of 92% and specificity of 78%. The four false-negative classifications resulted from two small foci of DCIS (1 mm, 0.5 mm) and two foci of well-differentiated invasive carcinoma (3 mm, 1.5 mm). This proof-of-principle study demonstrates that a DMMN machine learning model can segment invasive carcinoma and DCIS in surgical margin specimens with high accuracy and has the potential to be used as a screening tool for pathologic assessment of these specimens.

(1) Background: The older adult population of society is exposed to multiple stressors daily, such as the loss of loved ones, dysfunctional mobility, financial dependence, and suffering from numerous chronic illnesses. The present study aimed to assess the psychometric properties of the Anxiety about Aging Scale among older adults in Iran. (2) Methods: A sample of 703 community-dwelling older adults was recruited and screened using a standardized tool. The mean age of participants was 69.4 ± 8.1 years. The majority of participants were male (59.2%), married (66.6%), and illiterate (79.7%). A ‘forward-backward’ translation method was used in developing the Iranian version of the AAS for assessing the psychometric properties among older adults. Confirmatory factor analysis (CFA) and the Rasch model were used for construct validity. (3) Results: Applying CFA indicated that the model’s four original factors are the best solution, representing 55% of the total variance. The result of the CFA showed that this four-factor model had a good fit for the data. The findings were also confirmed by Rasch analysis. (4) Conclusions: The Persian version of the AAS is valid and reliable for measuring aging anxiety among Iranian older adults.

To evaluate the role of 99mTc-labelled glucosamine [99mTc-ECDG] as a clinical biomarker for the early detection of interstitial lung disease (ILD) in systemic sclerosis (SSc). In this prospective pilot study, glucosamine scanning (GS) was performed in 15 SSc patients, with and without ILD. Collected data included patient disease characteristics, autoantibody profile, GS results, high-resolution computerised tomography [HRCT], pulmonary function tests [PFT], and transthoracic echocardiogram [TTE]. Glucosamine results were correlated with patient clinical profile, HRCT, and PFT’s findings. Lung uptake of 99mTc-ECDG was high in 4 patients, moderate in 3, mild in 5, and normal in 3 with SSc, respectively. Of the patients with high and moderate uptake there was a 100% correlation between 99mTc-ECDG uptake and HRCT showing ILD. Of the 5 patients with mild 99mTc-ECDG uptake, 4 patients had aspiration pneumonia, and 1 had early ILD using HRCT. Of the 3 patients with normal 99mTc-ECDG, 2 had normal HRCTs; the third had severe pulmonary arterial hypertension with minimal HRCT changes of ILD. High and moderate 99mTc-ECDG lung uptake predicted abnormal PFT’s in 100% of cases. In 3 patients, there was less extensive disease depicted on the 99mTc-ECDG scans than on the HRCT. These patients demonstrated a more favourable outcome than would have been expected from the HRCT scans alone. Mild 99mTc-ECDG lung uptake correlated with abnormal PFT’s in 60% of cases. The pattern of 99mTc-ECDG uptake was excellent (100%) at distinguishing metabolically active ILD from aspiration pneumonia. Diffuse uptake was noted in the former and patchy uptake in the latter disease entity. Increased 99mTc-ECDG uptake in scleroderma lung correlated positively with both structural and functional changes. 99mTc-ECDG is a useful adjunct helping elucidate inflammation secondary to aspiration pneumonia and/or other causes of abnormal PFT’s.

D-penicillamine (D-pen) is a copper-chelating drug and has immune-modulatory properties. D-pen is used to treat rheumatoid arthritis, Wilson's disease, and kidney stones (cystinuria). However, associated adverse events (AEs) of D-pen treatment are frequent and often serious. Therefore, a comprehensive assessment of the safety profile of D-pen is urgently needed.We identified and analyzed AEs associated with D-pen between April-1970 to July-2020 from the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) databases and calculated the reported odds ratio (ROR) with 95% confidence intervals (CI) using the disproportionality analysis.A total of 9,150,234 AEs related to drugs were reported in the FAERS database, of which 542 were related to D-Pen. We report that D-pen was associated with dystonia (ROR: 20.52; 95%CI: 12.46-33.80), drug hypersensitivity (ROR: 5.42; 95%CI: 3.72-7.90), pancytopenia (ROR: 10.20; 95%CI: 5.61-18.56), joint swelling (ROR: 9.07; 95%CI: 5.51-14.94), renal-impairment (ROR: 6.68; 95%CI: 3.67-12.15), dysphagia (ROR: 5.05; 95%CI: 2.76-8.89), aggravation of condition (ROR: 4.16; 95%CI: 2.60-6.67), congestive cardiac failure (ROR: 4.04; 95%CI: 2.22-7.35), peripheral edema (ROR: 3.77; 95%CI: 2.17-6.55), tremor (ROR: 3.46; 95%CI: 2.00-6.01), pyrexia (ROR: 3.46; 95%CI: 2.00-6.01), and gait disturbance (ROR: 2.41; 95%CI: 1.29-4.52).Patients taking D-pen require close monitoring of renal function, blood counts, immunity, liver, cardiac function, and neurological function. D-pen suppresses immune system which maximizes the risk of infection.

In settings with limited resources that lack standards to ensure the quality of childbirth and newborn care, the use of antenatal corticosteroids is potentially harmful. Safe, effective use of antenatal corticosteroids requires providing standardized evidence-based practices and supportive supervision, training staff, and a facility-level actionable health information system., Key Findings Most of the 37 public health facilities in northern India that we assessed were not readied for providing quality care for threatened preterm birth and ensuring the safe use of antenatal corticosteroids (ACS).Deficiencies were identified in areas of evidence-based practices, competent workforce, actionable health information system, physical resources, and communication.The existing ACS guidelines were not up-to-date with current evidence and were not disseminated or implemented uniformly across facilities.Attention to accurate gestational age estimation and the quality of childbirth and preterm care were inadequate in all the facilities. Key Implications Increasing uptake of ACS for threatened preterm birth without providing adequate-quality maternal and newborn care and meeting essential preconditions outlined by World Health Organization recommendations will not improve preterm outcomes.Facility-level actions are needed for the safe and effective use of ACS in support of the delivery of quality care., Introduction: In 2014, the Government of India (GOI) released operational guidelines on the use of antenatal corticosteroids (ACS) in preterm labor. However, without ensuring the quality of childbirth and newborn care at facilities, the use of ACS in low- and middle-income countries is potentially harmful. This study assessed the readiness to provide ACS at primary and secondary care public health facilities in northern India. Methods: A cross-sectional study was conducted in 37 public health facilities in 2 districts of Haryana, India. Facility processes and program implementation for ACS delivery were assessed using pretested study tools developed from the World Health Organization (WHO) quality of care standards and WHO guidelines for threatened preterm birth. Results: Key gaps in public health facilities’ process of care to provide ACS for threatened preterm birth were identified, particularly concerning evidence-based practices, competent workforce, and actionable health information system. Emphasis on accurate gestational age estimation, quality of childbirth care, and quality of preterm care were inadequate. Shortage of trained staff was widespread, and a disconnect was found between knowledge and attitudes regarding ACS use. ACS administration was provided only at district or subdistrict hospitals, and these facilities did not uniformly record ACS-specific indicators. All levels lacked a comprehensive protocol and job aids for identifying and managing threatened preterm birth. Conclusions: ACS operational guidelines were not widely disseminated or uniformly implemented. Facilities require strengthened supervision and standardization of threatened preterm birth care. Facilities need greater readiness to meet required conditions for ACS use. Increasing uptake of a single intervention without supporting it with adequate quality of maternal and newborn care will jeopardize improvement in preterm birth outcomes. We recommend updating and expanding the existing GOI ACS operational guidelines to include specific actions for the safe and effective use of ACS in line with recent scientific evidence.

Background: Lithium has been used for decades as mood-stabilizing agents in the management of bipolar disorder and other condition with a manic component. However, some studies have also reported varying degrees of thyroid abnormalities associated with lithium therapy and effect of such therapy on thyroid function is unclear in this part of world. Therefore, we aimed to determine the effect of long term use of lithium on thyroidfunctionin the individual with bipolar disorder receiving lithium therapy. Methods: A total of 75 bipolar disorder patients (24 males, 51 females) who are under lithium therapy and equal number of control were recruited for this study. Diagnosis of bipolar disorder was made by psychiatrist according to ICD-10-DCR guidelines and DSM-IV criteria. Serum fT3, fT4 and TSH were measured by enhanced chemiluminescence immunoassay. Statistical analysis was performed using SPSS 20.0 version. Results: The prevalence of primary hypothyroidism and subclinical hypothyroidism were found significantly increased in lithium treated group (12% and 17%, respectively) which was further increased with duration of treatment. The mean fT3 and fT4 concentration is low in lithium treated group compared to control group.Butmean TSH level was found significantlyhigher in lithium treated group compared to control (9.67±12.47 vs. 3.41±3.69, p

Background: Do combined inhalers offer additional benefits or harms in people with chronic obstructive pulmonary disease compared with the bronchodilator alone? The present study was conducted to evaluate the effectiveness of inhaled corticosteroid/long acting beta agonist combination and to assess the health related quality of life among COPD patients. Methods: A prospective, comparative study was conducted in department of Pulmonary Medicine, Government Medical College and Rajindra Hospital, Patiala. A total of 80 patients were enrolled, and randomly allocated in two groups with 40 patients in each group. In group 1- Budesonide/formoterol (200/6 µg or 400/6 µg), and in group 2- Fluticasone/salmeterol (250/50 µg) was prescribed. The effectiveness was evaluated by assessing exacerbation rate, and breathlessness Modified Medical Research Council (mMRC) grade. Health related quality of life was assessed using St. George’s Respiratory Questionnaire (SGRQ). All the observations thus made were statistically analyzed using chi-square test and t-test. Results: In present study, male patients (n=63) were more than female patients (n=17). In group 1 significant improvement was observed in breathlessness mMRC grade between visit 0 and 2 nd (x2 = 8.50, p=0.004), and between visit 1 st and 2 nd (x2 = 7.24, p=0.007). Similarly, among group 2, significant improvement was seen in mMRC grade between visit 0 and 2 nd (x2 = 8.39, p=0.004), and between visit 1 st and 2 nd (x2 = 5.05, p=0.025). But, no significant difference was seen between group 1 and 2 mMRC grade (p > 0.05). There was no statistically significant difference between group 1 and group 2 exacerbation episodess (x2 = 2.13,p>0.05). In SGRQ mean total score, no significant difference was present between group 1 and 2 (p>0.05). Conclusions: Budesonide Formoterol (BFC) and Fluticasone Salmeterol (FSC) belongs to same group of drug class i.e. inhaled corticosteroid with long acting beta agonist combination and are used to treat exacerbations in moderate to severe COPD patients. BFC and FSC are equally effective in present study.

The purpose of this study is to evaluate prevalence risk factors, symptoms, signs, objective tests of dry eye diagnosis in patients attending to Out Patient Department of Mamata General Hospital, Khammam.All patients presenting with dry eye symptoms to ophthalmology outpatient department, Mamata Medical College over a period of one and half year. A prospective study was conducted for a period of 18 months from June 2018 to Jan 2021 among patients attending ophthalmology Out Patient Department unit with symptoms of dry eye. Among the 100 patients studied, prevalence of dry eye was found to be as high as 23%.The prevalence of dry eye increased with increase in age and was significantly higher among people more than 40 years of age. Prevalence was higher among females when compared to males. Conjunctival congestion was found to be reliable sign of dry eye with a strong positive association. Foreign body sensation was found to be the most common symptom associated with dry eye. People with refractive errors, with or without history of spectacle use, had a higher incidence of dry eye compared to emmetropes. OSDI was found to be reliable measure of dry eye symptoms. Higher, scores of OSDI, indicating severe dry eye, correlated well with diagnostic tests for dry eye. TBUT test showed a high sensitivity and specificity, followed by Schirmers test and impression cytology. Impression cytology was a reliable measure for detecting ocular surface changes. Many patients showed grade 2 or 3 changes. These changes were more among those with schirmer less than 5mm. Dry eye evaluation with an appropriate and standard questionnaire along with standard tests for dry eye helps in diagnosis and treatment. This will go a long way in the effective and successful management of patients with dry eye, specially so as the disease is chronic and needs long term treatment. Early and appropriate management will provideocular comfort and satisfaction with a better quality of life.