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Paroxysmal cold haemoglobinuria (PCH) is a rare acquired cause of intravascular haemolysis in children. We are reporting an unusual case of PCH, a 7-year-old boy who presented with acute febrile illness, severe anaemia and passage of red colored urine. His initial haemolytic workup had shown positive direct agglutination test along with evidence of ongoing haemolysis with severe leukocytosis. Further evaluation for autoimmune haemolytic anaemia revealed positivity for Donath Landsteiner Antibody, hence establishing a diagnosis of PCH. During the hospital stay, the child required multiple red blood cells, crossmatched although “P” antigen untyped transfusions. Child gradually improved and became transfusion independent within one week. The child has been under regular follow-up since last six months and all his laboratory parameters are within normal limits.

Introduction: Tuberculous pericarditis continues to be a leading cause of chronic constrictive pericarditis (CCP) in developing countries. Echocardiography plays a key role in the assessment and diagnosis. Methods: Twelve patients who underwent pericardiectomy for CCP in last 18 months of the study period were subjected to clinical and New York Heart Association (NYHA) functional class assessment along with comprehensive echocardiographic evaluation. The data were compared with their preprocedural status. Results: Significant reduction was noted in the incidence of inferior vena cava (IVC) congestion(P < 0.001) and mean left atrial (LA) size from 43.75 ± 4.43 mm to 31.58 ± 3.03 mm (P < 0.001), post pericardiectomy.Respiratory variation of 34.17 ± 8.76 % in the mitral E velocity was significantly reduced to 17 ± 3.69 % (P < 0.001) after surgery. Similarly, respiratory variation in tricuspid E velocities showed significant reduction from 62.17 ± 13.16 % to 32.58 ± 4.7 % (P < 0.001).Prior to pericardiectomy, medial e’ and lateral e’ mitral annular velocities was 15.5±1.24 cm/sec and13.08 ± 1.08 cm/sec, respectively. Following surgery, the medial e’ and lateral e’ was 12.5±1.17 cm/sec(P = 0.001) and 15.42±1.83 (P = 0.004), respectively. Conclusion: Echocardiography provides useful insight in pericardial constriction hemodynamics and worthwhile effects of pericardiectomy.

Acute anterior wall ST elevation MI with reciprocal lead changes are associated with more extensive ischemic area or larger infarction & more complications. The present research was thus conducted to study the occurrence of cardiovascular events in ST elevation anterior wall myocardial infarction in the presence or absence of reciprocal lead ECG changes.

Objective : To assess the early results of surgical and endovascular intervention in peripheral arterial disease Materials and methods : Retrospectively, we analysed the early results of treatment of lower extremity arterial diseases, managed at our institute. Depending up on the lesion characters and the distal run-off as evident from imaging, patients underwent either surgical or endovascular intervention for their disease. Over a period of one-year form July 2018 to July 2019, twenty-two patients were managed in total. Nine of them underwent surgical bypass for either aortoiliac or femoro-popliteal lesions. Another thirteen patients underwent endovascular intervention for lesions at aorto-iliac, femoro-popliteal and “Below the Knee” lesions. Procedure related morbidity, procedural success rate, postoperative pain score, hospital stay, flow patency and symptomatic improvement at follow-up at three and six months were analysed. Results: The results were optimistic with ischemic ulcers showing signs of healing, patients symptomatically better with improved walking distance and relieved of rest pain. Due to a smaller study population, limited study time and the study itself being a non- randomised one, no intragroup comparisons were made. The procedural success was 100% for each group, no periprocedural morbidity. The hospital stay was 9 days for surgical aorto bifemoral bypass patients, 5.8 days for femoropopliteal patients. For those who underwent endovascular intervention, average hospital stay was 3.4, 2.5 and 3 days respectively for the aorto-iliac, femoropopliteal and “Below the Knee” level groups. The average pain score was 6.3 and 5.8 for surgical aortobifemoral bypass and femoropopliteal bypass. Pain scores for the endovascular intervention group was 4.4, 3.2 and 4.7 respectively for the aortoiliac, femoropopliteal and “Below the Knee” level groups. The improvement in the Rutherford gradings at six months were Aorto bifemoral Bypass (4.6 to 3.6), Femoro-popliteal (4.1 to 2.6) in the surgical group and Aortiliac (4.4 to 3.4), Femoropopliteal (4.2 to 2) and no change in the score for the “Below the Knee” group. At six-month follow-up, Doppler interrogation revealed a triphasic flow pattern in surgical and endovascular bypasses involving the aortoiliac and femoropopliteal segments. The doppler interrogation for the “Below the Knee” lesions at six-month follow-up was biphasic (n=3) to monophasic (n=1). Conclusion: Surgical bypass and endovascular intervention either as an independent treatment modality or in combination as a Hybrid procedure looks promising in the management of LEAD. Surgical bypass is no doubt morbid, but early results are satisfactory in terms of patency rates and clinical improvement. The early six months results of endovascular intervention, are particularly encouraging in the femoropopliteal segment with poor distal run off. The results are inconsistent for the “Below the Knee” segment disease. TASC II- A and B lesions are addressed by endovascular interventions, whereas TASC II- C and D lesions are addressed by surgical bypass. Multidisciplinary individualised treatment approach should be adopted in deciding which treatment to be provided for a particular patient based on clinical, imaging findings and institutional protocols

As aircraft systems become increasingly autonomous, the human-machine role allocation changes and opportunities for new failure modes arise. This necessitates an approach to identify the safety requirements for the increasingly autonomous system (IAS) as well as a framework and techniques to verify and validate that an IAS meets its safety requirements. We use Crew Resource Management techniques to identify requirements and behaviors for safe human-machine teaming behaviors. We provide a methodology to verify that an IAS meets its requirements. We apply the methodology to a case study in Urban Air Mobility, which includes two contingency scenarios: unreliable sensor and aborted landing. For this case study, we implement an IAS agent in the Soar language that acts as a copilot for the selected contingency scenarios and performs takeoff and landing preparation, while the pilot maintains final decision authority. We develop a formal human-machine team architecture model in the Architectural Analysis and Design Language (AADL), with operator and IAS requirements formalized in the Assume Guarantee REasoning Environment (AGREE) Annex to AADL. We formally verify safety requirements for the human-machine team given the requirements on the IAS and operator. We develop an automated translator from Soar to the nuXmv model checking language and formally verify that the IAS agent satisfies its requirements using nuXmv. We share the design and requirements errors found in the process as well as our lessons learned., In Proceedings FMAS 2021, arXiv:2110.11527

Introduction: Unique characteristics of vascular injuries in children such as pronounced vascular spasm and lack of tissue support over small, thin-walled vessel make vascular repair challenging. This retrospective study was done to evaluate the management and outcome of pediatric and adolescent peripheral vascular trauma. Methodology: Fifteen patients with peripheral vascular trauma who met the inclusion criteria during the study period (August 2019-July 2020) were included. Data were analyzed retrospectively. Results: Majority, 12( 80%) of patients suffered blunt trauma. Primary repair in 13(86.66%) patients was the most common surgical technique employed. All the patients had associated long bone fracture dealt with internal fixation. Four (26.66%) cases had median nerve injury which was amenable to direct repair. Associated venous injury in 5 (33.33%) was also repaired. No mortality, re-operations, or amputation was noted. Conclusion: Excellent limb salvage rate was achieved. Initial revascularization without delay should be the norm. Associated neurological involvement determines postoperative functional outcome. Clinical evaluation with Doppler assessment saves time and crucial in vascular injuries prone to spasm.

Opening the car lock with the help of mobile based application is one of the great and important features that are missing from most of the cars sold globally. Although some cars support the remote starting functionality, dealers usually limit such feature to cars sold in certain regions such as the INDIA, US, etc. or to high-end models only. Additionally, manufacturers use short-range remote controllers, which limit the benefits of using the system. This idea will help bring this important feature to almost all cars, either old or new, and will add many important features such as GPS tracking in the system, all without compromising the safety and security aspects. The information is passed onto the central processing system which is in the form of the digital signals, the microcontroller unit reads the signal and sends it to the Global Positioning System (GPS) module and using the triangulation method, GPS module feeds the exact location in the form of latitude and longitude to the user's mobile. By reading the signals received by the mobile, one can trace the exact location of car. This project involves hardware and software parts construction and the integration of both parts to create the system. We succeed in achieving the objective and in fact, add another feature to the system which will initiates a call to the owner after sending the SMS. In the end of this project, we will document all the hardware and software development and provide a simulation model of the system. An interfacing mobile app is also connected to the microcontroller, which is in turn, connected to the system. Once, the vehicle is being stolen, the information is being used by the vehicle owner for further processing.

Left coronary artery compression syndrome is characterized by compression of the left main coronary artery between the aorta and an enlarged main pulmonary artery. A 39-year-old woman presented with angina with dyspnea on exertion for two years. Detailed investigations revealed an atrial septal defect, valvular lesions, and severe pulmonary hypertension with left main coronary artery compression. Patch closure of the atrial septal defect, left coronary artery bypass, and valve repair was carried out. The patient recovered well and was asymptomatic on follow-up. The optimal management of such patients is yet to be clarified.

With the popularity of solar energy with the increasing awareness among the people, rooftop PVs are a great utilization of the technology as it puts the production directly in the hands of the consumers. With the concept of net and gross metering, the consumers now have the options to be the producers, by selling the extra back to supplying companies. This method along with the existing method of storing extra in the battery for later use has revolutionized the solar industry. In this paper we have tried to compare the benefits associated with both the methods and also estimated the solar panel output using linear regression and available data.

Prosthesis-patient mismatch after aortic valve replacement is associated with increased morbidity and mortality. A myriad of techniques have been described for aortic root enlargement to circumvent this problem. We review the salient techniques with their merits, demerits, and results.

Digital maps are commonly used across the globe for exploring places that users are interested in, commonly referred to as points of interest (PoI). In online food delivery platforms, PoIs could represent any major private compounds where customers could order from such as hospitals, residential complexes, office complexes, educational institutes and hostels. In this work, we propose an end-to-end unsupervised system design for obtaining polygon representations of PoIs (PoI polygons) from address locations and address texts. We preprocess the address texts using locality names and generate embeddings for the address texts using a deep learning-based architecture, viz. RoBERTa, trained on our internal address dataset. The PoI candidates are identified by jointly clustering the anonymised customer phone GPS locations (obtained during address onboarding) and the embeddings of the address texts. The final list of PoI polygons is obtained from these PoI candidates using novel post-processing steps. This algorithm identified 74.8 % more PoIs than those obtained using the Mummidi-Krumm baseline algorithm run on our internal dataset. The proposed algorithm achieves a median area precision of 98 %, a median area recall of 8 %, and a median F-score of 0.15. In order to improve the recall of the algorithmic polygons, we post-process them using building footprint polygons from the OpenStreetMap (OSM) database. The post-processing algorithm involves reshaping the algorithmic polygon using intersecting polygons and closed private roads from the OSM database, and accounting for intersection with public roads on the OSM database. We achieve a median area recall of 70 %, a median area precision of 69 %, and a median F-score of 0.69 on these post-processed polygons., Comment: 18 pages, single column

For many years main stay of treatment for sickle cell anaemia was transfusion therapy. But repeated transfusions put the patient at risk of iron overload. Automated red cell exchange is an evolving and newer technique which rapidly removes the sickle cells and has benefit in decreasing sickle cell load and related complications. Red cell exchange is a therapeutic procedure in which the patient’s whole blood is processed centrifugally in cell separator. Patient’s red cells are separated from other blood components and removed and replaced with donor red cells and colloids. We report our first experience of automated red cell exchange in 24-year-old female diagnosed case of sickle cell anaemia presented to us with acute chest syndrome with septic shock. Red cell exchange was planned to tide over the acute sickle cell crisis and provide symptomatic improvement. We also highlight that compound heterozygous thalassaemia could be associated with sickle cell disease which could make the diagnosis difficult. New generation automated Apheresis equipment’s provides better monitoring of the procedure that can be useful in severely ill patients also.

The present paper deals with the current scenario of the need of increasing the productivity and monitoring of biogas energy. Drawing energy from the fermentation of waste products such as manure, food and sewage, biogas offers a route towards a ‘circular economy’ in the use of products beyond the end of their service life. Thus, monitoring and controlling bio gas plants remotely by the help of IOT, becomes very important as quality, production and usage of biogas can be monitored. Sustainable agriculture development and increasing the rate of renewable energy sources have become an economic issue under the present economic conditions, the private sector cannot solve its complexity the problem of environment protection and energy from its own sources. Thus, using biogas energy sector with strategic policy and programme it will help us in our future saving as well as to maintain the quality of environment.

ObjectivesConvalescent plasma (CP) as a passive source of neutralizing antibodies and immunomodulators is a century-old therapeutic option used for the management of viral diseases. We investigated its effectiveness for the treatment of COVID-19.DesignOpen-label, parallel-arm, phase II, multicentre, randomized controlled trial.SettingThirty-nine public and private hospitals across India.ParticipantsHospitalized, moderately ill confirmed COVID-19 patients (PaO2/FiO2: 200-300 or respiratory rate > 24/min and SpO2 ≤ 93% on room air).InterventionParticipants were randomized to either control (best standard of care (BSC)) or intervention (CP + BSC) arm. Two doses of 200 mL CP was transfused 24 hours apart in the intervention arm.Main Outcome MeasureComposite of progression to severe disease (PaO2/FiO2< 100) or all-cause mortality at 28 days post-enrolment.ResultsBetween 22ndApril to 14thJuly 2020, 464 participants were enrolled; 235 and 229 in intervention and control arm, respectively. Composite primary outcome was achieved in 44 (18.7%) participants in the intervention arm and 41 (17.9%) in the control arm [aOR: 1.09; 95% CI: 0.67, 1.77]. Mortality was documented in 34 (13.6%) and 31 (14.6%) participants in intervention and control arm, respectively [aOR) 1.06 95% CI: −0.61 to 1.83].InterpretationCP was not associated with reduction in mortality or progression to severe COVID-19. This trial has high generalizability and approximates real-life setting of CP therapy in settings with limited laboratory capacity. A priori measurement of neutralizing antibody titres in donors and participants may further clarify the role of CP in management of COVID-19.Trial registrationThe trial was registered with Clinical Trial Registry of India (CTRI); CTRI/2020/04/024775.

Paroxysmal cold haemoglobinuria (PCH) is an acquired cause of haemolytic anaemia. It is caused by the biphasic IgG antibodies that sensitize and attach the red cells at lower temperature; detach and rebind on rewarming. Donath-Landsteiner antibody test is the diagnostic test for PCH. Management of PCH mainly includes supportive care but sometimes disease becomes severe and life-threatening. We describe a similar severe and life-threatening case of PCH who was managed by plasma exchange followed by packed red cell transfusion.

Various surveys tell us that due to excessive power consumption in the present time there is frequent power cuts in villages and cities of India. The use of solar photovoltaic system can reduce load on utility power and reduce pollution. Solar photovoltaic system may be stand-alone or grid-connected depending on capacity and load requirements. In this paper, a systematic study of the proposed rooftop stand-alone photovoltaic (PV) system on the top of the academic building of Motihari College of Engineering (Govt. of Bihar, India) is carried out. The study tells us the load requirements of the institute, amount of energy produced by using a solar photovoltaic system, and the payback period of the PV system.

Most fungal infections found in wounds are secondary or superadded, and are generally benign in their clinical course in healthy individuals, with the exception of mucormycosis. This is a life-threatening infection caused by fungi of the order Mucorales. Primary cutaneous disease may occur following traumatic implantation of spores, or use of contaminated bandages, or as a complication of extensive burns, diabetic acidosis and other specific immunocompromised conditions. The clinical spectrum is highly non-specific and is often triggered by seemingly innocuous trauma. The superficial vesicles or patchy erythema rapidly degrade to haemorrhagic necrosis and rapidly progressive gangrenous lesion. The problem with diagnosing mucormycosis remains, therefore, that the condition has poor clinical indicators and requires reliance on microscopy and fungal culture. Management starts with a clinical suspicion, taking into account the risk factors and lack of response to first-line agents, as well as an aggressive clinical course. Treatment is multimodal, with medical correction of the risk factors and optimisation of limiting factors, such as diabetes, neutropenia and immunosuppressants. Treatment generally involves radical and repetitive surgical debridement, intravenous amphotericin B with monitoring of the nephrotoxicity, along with adjuvant modalities, such as hyperbaric oxygen therapy, colony stimulating factor, interferons gamma and white blood cell transfusion. Successful courses of therapy typically last 4–6 weeks and require cumulative doses that are equivalent to >2g of amphotericin B deoxycholate.

Background: In the context of different grafts being used for dorsal augmentation, diced cartilage with glue has gained worldwide acceptance. Aims: To develop a system of tools to objectively evaluate the desired dimensions of the required graft for dorsal augmentation and to prepare a corresponding customized-glued-diced cartilage construct. Materials and Methods: A modification of the diced cartilage glue technique called Autogenous control augmentation system (ACAS) was used in ten patients. Results: Of the ten patients, in which this technique was used, eight underwent primary rhinoplasties and two underwent secondary rhinoplasties between July 2017 and December 2017 with a follow-up ranging from 3 to 8 months. In all the cases, the dorsum is straight, and height is maintained. Conclusion: The technique has all the advantages of the diced cartilage glue. The shape resembles alloplastic implant with height and width varying from radix to tip. There is tapering of the cephalic and caudal ends for more natural results. The brow tip aesthetic lines are better defined. The limitation of this study is short follow up.

Superior mediastinal mass excision can be performed by various approaches such as partial sternotomy, mini trapdoor incision, anterior cervical transsternal approach and lateral thoracotomies. However, adequate exposure especially of superior surface seems to be difficult. Total four patients of superior mediastinal mass were admitted in the department of cardiothoracic and vascular surgery, Safdarjung hospital, New Delhi between June 2019 to May 2021. All of them were operated by upper partial sternotomy with right or left chamberlain extension of incision. It is safe and effective in terms of exposure with early recovery as well as cosmesis. Hence, we advocate the use of upper partial sternotomy with left or right chamberlain incision which provides good exposure in addition to ease of patient position, vascular control and emergency institution of cardiopulmonary bypass.

Chest trauma is now the second most common non-intentional traumatic injury. Chest trauma is associated with high mortality. Control of blood loss and stabilization of vital organs is of vital importance over diagnostic and therapeutic measures. Bleeding may arise from chest wall, intercostal or internal mammary arteries, great vessels, mediastinum, myocardium, lung parenchyma, diaphragm or abdomen. Modified early warning signs (MEWS) score of >9 on presentation have shown higher rate of mortality. Diagnostic modalities such as extended-focused assessment with sonography in trauma (eFAST) have been effective. The type of surgical approach alters according to the site of injury. We here presented our experience with six such patients. All the six patients involved in this study had penetrating trauma chest with various sharp weapons including dagger, ice pick, flag post. Time of presentation of all these patients were delayed due to ours being a tertiary centre. The patients were explored on the basis of eFAST findings, intercostal drainage, hemodynamics. Out of the six patients two patients succumbed and the patients who died also had high MEWS score. All the patients were approached surgically with respect to the type of injury sustained. Penetrating chest trauma present a challenging clinical situation which warrants early evaluation and intervention. The cases of chest trauma then be it blunt or penetrating should always be treated within the advanced trauma life support (ATLS) guidelines followed by the definitive management. Regardless of any penetrating object, the foreign body should be left in situ and only to be removed under vision. If in case the penetrating object has already been removed the operative intervention is decided on the amount of drainage. With blunt chest trauma, approximately 15% of the deaths result directly from intrathoracic injury, but with penetrating chest trauma, nearly 100% of the deaths result from intrathoracic injury. Hence, the operative exploration of the chest in penetrating chest trauma and should be done on emergent basis as the mechanism of injury, vital organ damage and hemodynamic status all equate to higher rate of mortality.

Introduction Gender Reassignment Surgery is a general term used to describe all procedures related to surgically converting patients of Gender identity disorder into their desired sex. This may be mastectomy, vaginectomy, penile reconstruction etc in female to male, or breast augmentation, vaginal reconstruction etc in male to female. Material and method We share our experience of twenty cases of Gender identity disorder operated over a period of seven years at our hospital with a minimum follow up of six months Results The most commonly done procedure was mastectomy in female to male sex change followed by vaginal reconstruction in male to female. Conclusion Gender identity disorder is becoming increasingly common nowadays with patients coming forward for surgical intervention. These patients need a sensitive approach and teamwork between the Plastic Surgeon, Psychiatrist, Gynecologist and the Endocrinologist.

People with gender dysphoria have persistent discomfort with their anatomical sex. They are diagnosed according to the criteria proposed by DSM-5. Guidelines for persons with gender dysphoria are periodically published by the World Professional Association for Transgender Health (WPATH), as Standards of Care (SOC). Once mental health professional through their assessment have reached to a conclusion of Gender dysphoria, further procedures for gender affirmation are started. Next in sequence is real-life experience of at least 12months under strict observation of mental health professional to justify affirmation surgery. Following real life experience, hormone therapy is started under supervision of an endocrinologist. The surgeries done to establish their anatomical sex in accordance to their psychological sex are called gender affirmation surgeries (GAS). Not all people with gender dysphoria undergo GAS and among all of those who undergo gender affirmative surgery, only few undergo all surgical procedures depending on the severity of gender dysphoria. Genital and non-genital surgeries are done for both female to male and male to female conversions. After discussion with the patient, staged surgeries are done. Multidisciplinary approach with good communication in between the health professionals gives the best results. Even in 21st century, people with gender dysphoria are still discriminated, looked upon differently and are not accepted as they are in the society. We, as health professionals should provide the highest standards of care with the best possible options to restore their dignity and to improve their acceptance in the society. This article discusses the current concepts in GAS.

Context: Irreversible airway obstruction is important sequelae of pulmonary tuberculosis (TB) that might contribute to a significant proportion of chronic obstructive pulmonary disease (COPD). India has the highest TB burden in the world. However, there are limited data on the prevalence and presentation of TB-associated COPD from this region. Aims: This study aims to evaluate the prevalence of TB-associated COPD among COPD patients presenting to a tertiary care hospital. Settings and Design: It was a case–control study conducted in a tertiary care hospital. Subjects and Methods: Stable COPD patients presenting to chest OPD and an equal number of healthy controls were enrolled. COPD patients were subjected to detailed clinical evaluation and lung function test. History of pulmonary TB was evaluated from both groups through self-reporting and/or checking previous records. TB-associated COPD patients were identified and their prevalence and distinguishing features evaluated. Results: Of 74 COPD patients, 24 (32.4%) had previous history of pulmonary TB. The odds of having a previous TB in COPD patients was 3.96 (95% confidence interval: 1.64–9.55; P = 0.002) as compared to controls. Patients with TB-associated COPD were younger (P = 0.02), had lesser pack-years of smoking (P = 0.027) but had more number of hospitalizations (P = 0.01). The airflow limitation was similar in both groups. Conclusions: TB-associated COPD constitutes a significant proportion of COPD patients. It is a distinct clinical entity with preponderance in young. It may be associated with frequent hospitalizations as compared to other COPD patients.

Parvovirus B19 has rarely been associated with acute liver failure (ALF), which has a high mortality. Plasma exchange that usually acts as a bridge to liver transplantation removes toxins, antibodies, cytokines, and can correct coagulopathy while maintaining a euvolemic state. Pediatric data regarding its use are scarce. We report a case of 16-year-old girl with acute liver failure in stage 4 encephalopathy with coagulopathy due to parvovirus B19 who was successfully managed with high-volume therapeutic plasma exchange (TPE). We tried to use it as a treatment modality due to nonavailability of in-hospital transplant facilities. Parvovirus B19 may be an underdiagnosed cause of acute viral hepatitis. Therapeutic plasma exchange can act as a bridge to liver transplant (LT) or bridge to recovery especially in self-limiting illnesses such as viral hepatitis. How to cite this article Singh DP, Agarwal S, Singh R, Nandan D, Gupta A. Therapeutic Plasma Exchange in Parvovirus B19-induced Acute Hepatic Failure. Indian J Crit Care Med 2020;24(5):361–362.

The association of aortopulmonary (AP) window with total anomalous pulmonary venous connection (TAPVC) has so far not been reported. We report a unique case of an 8-month-old child who presented with congestive cardiac failure and severe pulmonary arterial hypertension. Initial echocardiography revealed supracardiac TAPVC. Cardiac computed tomography showed the presence of Type I AP window along with the TAPVC. In the presence of severe pulmonary hypertension and dilated right ventricle, AP window may easily be missed if not actively looked for.

The present study on cost of a unit of blood was conducted in blood bank of a tertiary care public hospital with an annual collection of 20,748. A retrospective chart review was done to calculate the activity wise annual unit cost of blood, based on WHO guidelines (Blood Safety Unit. safe blood and blood products: costing blood transfusion services, World Health Organization, Geneva, 1998). Cost of blood collection, processing and storage were included. Annualized economic cost of equipments, maintenance, personnel salaries, and consumables were enlisted. It was assumed that all component units prepared carried equal cost. The cost of building, maintenance and office stationary were excluded. Data extracted from records was compiled and analysed using MS Excel. The annual unit cost of blood with component preparation and NAT testing was Rs 1829. Unit cost of blood without NAT testing was Rs 1255. Unit cost of blood if total collection was in-house, that is, excluding expenditure on camps was Rs 1738. The cost of whole blood (that is, if no components were prepared) with ELISA testing, done to ascertain cost at basic functioning was Rs 2521. With NAT testing the unit cost increased by Rs 575, the additional expenditure being equally divided among all components. Expenditure on NAT was high which was 1/3rd of the total expenditure on consumables. The additional cost incurred on each unit due to expenditure on camps was small i.e. only Rs 91 with 30% collection from camps. Voluntary camps ensures safe blood at minimal cost increment and component separation reduces cost and permits judicious use. Hence these activities should be promoted.

Chondrosarcoma is the most common malignancy of the sternum. Removal of the sternum for a malignant tumor results in large defects in bone and soft tissue, causing deformity and paradoxical chest wall movement, making subsequent repair of the thorax very important. Herein we report a rare case of recurrent anterior chest wall chondrosarcoma after surgery 4 years earlier. The patient underwent resection of the chondrosarcoma followed by three-layer chest wall reconstruction with a split rib graft for the bony defect. He had an uneventful postoperative course and was healthy at 9 months postoperatively.

Background: Dearth of expertise to manage vascular trauma spiraled with delay in diagnosis and referral to tertiary care centers continue to plague a developing nation like India. The brachial artery is the commonest artery to be injured in extremity following trauma. Although the patients present late, revascularization to salvage the limb and to maintain its function is advocated. This retrospective study was done to evaluate the management and outcomes of brachial artery revascularization in patients with delayed presentation of traumatic brachial artery injury.Methods: Twenty-six patients of traumatic brachial artery injury who met the inclusion criteria during 1-year study period (August 2019 to July 2020) were included. Patients with iatrogenic vascular injury, severe vascular injury associated with massive orthopaedic neuromuscular injury (i.e., crush injury), mottled upper limb and injury to neck, chest, abdomen, lower limbs or any pseudoaneurysm were excluded. Data were analysed.Results: Amongst 26 patients studied, 24 (92.30%) patients had complete transection of the artery. Of these, 19 (79.16%) had primary repair in the form of end-to-end anastomosis and 7 (29.16%) underwent reverse interposition saphenous vein grafting. Two patients with partial laceration of brachial artery underwent primary (lateral) repair. Associated fracture of humerus was managed with internal fixation following revascularization. Four cases underwent end to end repair of median nerve. Majority, 22 (84.61%) had good functional outcome and 4 (15.38%) had satisfactory functional results. Limb salvage rates was 100%.Conclusions: Revascularization beyond warm ischemia time is still desirable to prevent limb loss. Traumatic neurological injury affects the functional outcome.

Introduction: Aorto-iliac Occlusive Disease (AIOD) involves the infra-renal aorta and the iliac arteries. Recent studies advocate endovascular management in TASC C and D lesions also. It involves balloon angioplasty with or without stent deployment.5 The aim of this retrospective study is to evaluate the results of endovascular balloon angioplasty and primary stenting in patients of AIOD. Methods: Twenty-five patients with Aorto-iliac occlusion disease who met the inclusion criteria during 1-year study period were included. Patients with acute thrombosis, abdominal aorta or iliac artery aneurysm and additional common femoral artery occlusion were excluded. The TASC II classification was used to define the characteristics of the lesions. The baseline data, procedural details and follow-up results were analysed. Results: Amongst 25 patients studied, age ranged from 40-75 years. Self-expanding metallic stent was employed in all patients. Technical success following primary stenting was achieved in all patients. Procedural times for TASC-II A, B, C and D lesions were 90+ 30, 110+ 40, 135+35 and 155+ 45 minutes, respectively. During follow-up, the cumulative primary patency rates at 1 month and 6 months were 100%. Cumulative primary patency rates at 1 year were 91.67%. Conclusion: Short- term outcomes of balloon angioplasty and stenting for Aorto-iliac artery occlusions in terms of primary patency rates were excellent.

Introduction Finger amputations in children can occur due to home accidents, agricultural accidents, and road traffic accidents. In rural North India, amputation due to fodder (Chara) cutting machine is very common. Aims and objectives To emphasize that, the fodder cutting injury is one of the most common causes of amputation of fingers and hand in children in rural North India and to discuss the demographic aspects, outcomes and preventive measures. To further establish that replantation in fodder cutting amputations is a standard procedure with good functional outcome. Results In a span of 3 years, total numbers of patients who underwent replantation of fingers or hand distal to wrist joint due to fodder cutting machine were 28, out of which 08 patients were lost to follow up. Out of 20 patients, 80% (16) were boys and 20% (4) were girls. Most of the children were from Haryana, Punjab and Uttar Pradesh regions. Successful replantation was achieved in 18 out of 20 cases. After a period of follow up with physiotherapy, all patients regained good functional and cosmetic results. Conclusion Chances of success rate is more in replanting a finger cut by fodder cutting machine, as it is a sharp cut, provided it is brought in time and preserved in a proper manner. Educating the children and farmers regarding the precautions, first aid and mode of transporting the amputated part and suggesting guidelines to the machine making industries regarding the prevention would be of great help in avoiding such accidents.

Background "f" antigen is a compound antigen in Rh blood group system. Anti f has haemolytic potential as described in literature. Its occurrence in an infant as autoantibody with another blood group system ie Jka is very rare. Case report We report a case of 10-month-old infant diagnosed with AIHA with autoantibodies directed towards "f" and Jka antigen. Antibody identification was done and antigen negative blood units were crossmatched & transfused with demonstrable haemoglobin rise and subsequent decrease in DAT grading. Result Auto anti f + Jka was identified in a 10 months old infant. Autoantibodies were identified by identification 3 & 11 cell panel and select cell panel. Results were later confirmed by allogenic adsorption & elution. Patient was transfused antigen negative blood unit which lead to haemoglobin rise & gradual decrease in direct coombs test grading Conclusion To our knowledge, this is the first case report of auto anti f + Jka having haemolytic potential in an infant which shows the importance of extensive immmunohaematology workup in providing compatible blood unit in patients with autoantibody.

Often in law enforcement and forensic application it is needed to match scanned facial image with a digital face image. This is because in many scenario, non-digital face images are obtained from the crime scene, news articles etc. that are needed to be identified. Non-digital face images are first scanned and then enhanced to match against the database. Challenges arrives because of poor quality of non-digital image, artifacts introduced in scanning process and high saturation etc. therefore matching becomes difficult. The methods used in literature involve specialized hand crafted pre-processing. In our paper, we propose an automated way of matching by using Siamese networks. The proposed method have been able to achieve an EER of 2.346% that is better than the current state-of-the-art.

Mucormycosis is a serious, potentially deadly fungal infection that is very rare in immuno-competent healthy patients. Mucormycosis following elective cosmetic procedures such as hair transplantation has never been reported. This case details the symptomatology, modes of diagnosis and treatment of this potentially fatal disease in a patient of hair transplantation. Level of Evidence: Level V, diagnostic study

Blunt chest trauma uncommonly results in subclavian artery injuries which are protected by subclavius muscle, clavicle, first rib and deep cervical fascia. Subclavian artery injury presents early after trauma. It may rupture to cause haemorrhage, pseudo-aneurysm and brachial plexus compression. Careful physical evaluation of the upper limb is warranted to look for skin colour, temperature, sensation, motor function and radial artery pulses. Serious vascular injury should be suspected if there is presence of large hematomas or pulsatile mass in supraclavicular region. Contrast-CT represents a key diagnostic investigation, while arteriography offers both a diagnostic a therapeutic approach in case endovascular stenting could be contemplated. But surgical repair is preferred mode of management over endovascular stenting in children as it is difficult to manoeuvre a stent in small children and also because stent does not grow with the vessel leading to size mismatch. We report a case of traumatic 2 nd part of right subclavian arterial rupture after blunt trauma chest with fracture involving right first rib following a 10 meters fall from height, treated by open surgical repair of injured right subclavian artery with an interposition 5 mm PTFE graft.

The present text provides information regarding introductory concept of wireless power transfer by studying some of the existing technologies and evaluate its quality factor as well as deals with certain methods of improving the efficiency of wireless power transfer. In addition to this, calculation and analysis has also been done for its figure of merit, transfer loss, quality factor and efficiency.

We discuss the evaluation of rankings of documents that aim to summarize the overall opinion expressed in product reviews. Such a ranking can be used by e-commerce websites to represent a gist of the public opinion about a product. The inability of traditional IR metrics to reward such a representation is argued for. A matrix based labelling procedure serves as the framework for such evaluation. Three alternative metrics are adapted from previous similar works to evaluate opinion representativeness. Similarly, two metrics are adapted for exhaustiveness. Finally, we compare the robustness of these metrics.

This paper uses a case based study – “product sales estimation” on real-time data to help us understand the applicability of linear and non-linear models in machine learning and data mining. A systematic approach has been used here to address the given problem statement of sales estimation for a particular set of products in multiple categories by applying both linear and non-linear machine learning techniques on a data set of selected features from the original data set. Feature selection is a process that reduces the dimensionality of the data set by excluding those features which contribute minimal to the prediction of the dependent variable. The next step in this process is training the model that is done using multiple techniques from linear & non-linear domains, one of the best ones in their respective areas. Data Remodeling has then been done to extract new features from the data set by changing the structure of the dataset & the performance of the models is checked again. Data Remodeling often plays a very crucial and important role in boosting classifier accuracies by changing the properties of the given dataset. We then try to explore and analyze the various reasons due to which one model performs better than the other & hence try and develop an understanding about the applicability of linear & non-linear machine learning models. The target mentioned above being our primary goal, we also aim to find the classifier with the best possible accuracy for product sales estimation in the given scenario.

Coronary bypass grafting is probably the most extensively studied surgical technique; however, the reported data on its outcome in the younger population are relatively scarce. We present our 10-year experience with young patients undergoing coronary revascularisation. Fifty-one patients, 40 years or younger, underwent coronary bypass surgery in our institution, between January 2003 and December 2012. Relevant preoperative and intraoperative clinical data were retrieved from the patient’s medical records. Follow-up data was obtained by personal or telephonic interview of the patients or relatives. Out of 51 patients (4 females, 47 males), with a mean age of 37.35 ± 3.25 years (range 27–40 years), 47 patients underwent off-pump coronary artery bypass and the rest underwent on-pump beating heart coronary artery bypass. Indication for surgery was triple-vessel disease (TVD) in 24 patients (47 %), double-vessel disease (DVD) in 9 patients (17.7 %) and single-vessel disease (SVD) in 18 patients (35.3 %). A total of 104 grafts (51 with left internal thoracic artery, 10 with radial artery and 43 with saphenous vein) were constructed, with a mean of 2.04 ± 0.94 grafts per patient. There was no in-hospital or 30-day mortality. Mean ICU stay was 2.33 ± 0.76 days and mean hospital stay was 7.2 ± 1.6 days (range 5–13 days). Cumulative follow-up was 256.53 years (mean 5.03 ± 3.19 years); follow-up was 90.2 % complete. Actuarial probability of survival at 10 years was estimated to be 91.1 %. Early and midterm results of coronary artery bypass surgery in young patients are excellent.