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Various attempts are being carried out for automating the applications of house. Automation itself has many limitations with respect to cost and accuracy. In this context, virtual assistant plays a key role. In this work, we are planning a smart virtual assistant to illustrate the implementation of various voice commands and perform various tasks or services to an individual. The functions of these tasks or services are based on user input and mainly depends on the ability to access information from an enormous online sources (such as weather report, time and playing music for us etc). Raspberry Pi is used as the key hardware for implementing this project and its essential primary input considered is user’s voice. Whenever the information is fetched through the voice commands, it will produce the appropriate output. In-addition to this, some extra modules have been used for implementing voice to text conversions and controlling home appliances. This type of application will be more helpful for the persons who are partially or completely blind, by giving them access to Wikipedia, Calculator, Email and Music. From the results, we could attain the features like knowing the time and date, switching on and off of the lights, making a call to a registered mobile number and start/stop of fan. Finally, it can act as a main source of information and entertainment for visually impaired persons.

Nowadays criminal activities are growing at an exponential rate. Crime prevention by effective identification of criminals is the main issue before the police and on the other hand, the availability of police officers is inadequate. There are various technological solutions for detecting criminals but they are not up to the mark. In this project, a face detection and recognition system for criminal identification is developed using the multi-task cascade neural network. This system will be able to detect faces and recognize faces of criminals automatically in real-time. This system would also just require a single image of the criminal to recognize him, also known as one-shot learning. The purpose is to identify the criminal face, retrieve the information stored in the database for the identified criminal and a notification is sent to the police personnel with all the details and the location at which he was under the surveillance of the camera.

Background The Joint Committee on Surgical Training (JCST) have published a series of quality indicators (QIs) which act as a benchmark against which the quality of surgical training can be assessed. This audit aims to compare core surgical training (CST) rotas in our region against the JCST QI 10's minimum standard of 5 consultant supervised training sessions per week. Methods Core surgical trainees in one training region were contacted requesting their on-call rotas from rotations undertaken during the 2019/20 academic year. Rotas were analysed in a protocolised manner, with the number of potential training sessions available calculated and compared against the JCST QI 10 minimum recommendation. Results Twenty-four rotas were assessed across 17 hospitals. Only six (25%) of rotas achieved the JCST QI 10 standard. There was a mean deficit of 18.5 (±29.5) training sessions per 6-month rotation. Rotas compliant with JCST QI 10 used a mean rota pattern of 1 in 11 compared to 1 in 9 for those failing to meet the target. Further analysis, comprising of the addition of expected consultant led training whilst on call, led to an improvement in compliance to 9 (38%) and 13 (54%) of rotas when there was an addition of 0.5 h and 1 h of consultant supervised training time per on-call session respectively. Conclusion Many core surgical trainee rotas in the region are non-compliant with JCST QI 10, indicating a lack of regular consultant-led training opportunities. A move to a reduced on-call commitment with the use of supporting medical practitioners could be considered to improve this.

Hydrocarbons, which are found in plastic, are an excellent energy source due to their high energy density. The disposal of plastic waste presents significant energy saving and recovery opportunities. The purpose of this study is to determine how much energy can be recovered from waste plastics as a possible alternative fuel source for cars. This research aims to assess the performance of waste plastic pyrolysis oil (WPO) generated by polyethylene pyrolysis. Ethanol is an appealing alternative fuel since it is made from renewable bio-resources and works as an oxygenated fuel in diesel engines, allowing for emission reductions. Three different percentages of WPO were combined with ethanol to create a tertiary fuel blend. This research examines the performance and emission requirements of a single-cylinder direct injection diesel engine. With diesel, D70W20E10′s specific fuel consumption reduces by about 7.5 %. Carbon monoxide emissions from D70W20E10 were about 6.5 % lower than diesel and 13.5 % lower than hydrocarbon at various loadings. The most optimum running condition was further examined using the Full Factorial Design method.

Summary Introduction Extralevator abdominoperineal excision (ELAPE) for low rectal tumours necessitates a reliable method of reconstructing the perineum. The senior author developed the partial myocutaneous gluteal (PMG) flap. We present 49 consecutive reconstructions with the refinement of the original procedure. Methods We conducted a retrospective observational review of patients undergoing ELAPE and PMG reconstruction from 2012 to 2019, with at least 1 year follow-up. The procedure was modified iteratively following our original series, to minimise perineal herniation, specifically by greater mobilisation of the inferior gluteus maximus muscle and separation of the muscle and fasciocutaneous components, allowing closure of the defect around the coccygeal remnant. Perineal herniation and wound complications were recorded. Laparoscopic and open resection techniques were compared, as were outcomes before and after modification of the flap. Results There were no flap failures in our cohort of 49 patients. Two patients (4%) required return to theatre acutely for perineal wound complications: one wound dehiscence and one flap-related haematoma. Five patients had evidence of perineal hernia, three prior to any modification of the flap and two following. Three had symptoms of which two required elective repair. The flap modifications were made in response to these cases. There were no significant differences in perineal outcomes for laparoscopic versus open, and before and after flap modification. Conclusions Over the last 8 years, we have refined our perineal reconstruction technique following instances of perineal herniation and major wound dehiscence. We believe that the PMG flap provides robust and reliable option for the reconstruction of perineal extralevator abdominoperineal defects.

Purpose: To establish a better understanding of the variations in pain management protocols and prescribing patterns for pediatric patients undergoing anterior cruciate ligament (ACL) reconstruction or repair. Methods: A 20-question multiple-choice survey was distributed to 3 professional orthopaedic societies to assess the pre-emptive and postoperative pain management prescribing patterns for pediatric patients undergoing ACL reconstruction or repair. Clinical agreement (defined as agreement between >80% of participants) and general agreement (defined as agreement between >60% of participants) were calculated based on responses as previously reported. Results: Clinical agreement was observed among the 68 respondents in use of a single shot nerve block before induction of anesthesia versus continuous use when a peripheral nerve block was used, “always” counseling patients on postoperative pain control, the prescribing of opioids postoperatively, and a lack of change in postoperative protocol when concomitant meniscal repair or meniscectomy was performed. General agreement was observed in the use of a peripheral nerve block, some pre-emptive analgesia practices, and the lack of counseling patients with regard to disposal of unused opioid pain medication postoperatively. Opioids were prescribed by 88% of participants postoperatively, with 48% prescribing 11 to 19 pills and 15% prescribing ≥20 pills. Conclusions: While pain management practices before and following ACL reconstruction and repair in the pediatric population remain varied, opioids are frequently prescribed postoperatively with many providers neglecting to provide instruction on excess opioid disposal. Clinical Relevance: ACL reconstruction and repair is becoming increasingly common in the pediatric population. Clinical guidelines that establish pre-emptive and postoperative pain-control protocols should be considered to determine safe and optimal pain control throughout the duration of care while minimizing opioid prescribing and consumption.

Serous borderline tumor is a rare entity of peritoneum which can lead to diagnostic dilemma due to its resemblance with reactive lesions of peritoneum and ovarian borderline and malignant neoplasms. Complete clinical details, histopathological evaluation and immunohistochemistry aid in arriving at correct diagnosis. Recognizing this entity is important as it carries good prognosis. Keywords: Mesothelial hyperplasia, Primary peritoneal carcinoma, Serous borderline tumor.

Objective There are contradictory reports on the impact of COVID-19 on preterm births (PTBs). We aimed to compare the spontaneous preterm births (SPTBs), and iatrogenic preterm births (IPTBs) rates during both waves of the COVID-19 pandemic. Methods Retrospective analysis of the PregCovid registry of pregnant women with COVID-19 was done at a dedicated COVID-19 hospital in Mumbai, India. The data of 1,630 women was analyzed for this study. between April 4th, 2020 to July 4th, 2021. Prepandemic data were analyzed and compared with pandemic data. Main outcome measures was spontaneous preterm birth rate. Results Preterm deliveries were reported higher during second wave (14%, 46/329) compared to first wave (10.2%, 82/807) of the COVID-19 pandemic (p=0.065). Higher SPTBs were reported during second wave than first wave (12.5% vs 8.3%) [p=0.03] as well as the prepandemic period (12.5% vs 10.5%) (p=0.286). IPTBs were significantly lower in the pandemic period than in the prepandemic period (1.8 vs 3.3) (p=0.012). Conclusions In Mumbai, India, we found an unusual change in SPTBs during the 6 months of the second wave of COVID-19 compared with the previous 10 months of 1st wave of pandemic and one year of prepandemic.

Background/Objective: The study aimed to assess the level of awareness of radiation safety amongst the Healthcare Professionals in the Private Hospital of Vadodara. Radiation protection tries to avoid the detrimental effects of ionizing radiation by reducing unnecessary radiation exposure. With the increased utilization of radiological investigations, it is essential for referrers to be aware of the harms associated with ionizing radiation to avoid unnecessary exposure for Healthcare Professionals. Methods/Statistical Analysis: This descriptive cross-sectional study in nature where the Healthcare Professionals who are willing to participate will be included in the study. In evaluating the level of awareness 62 Healthcare professionals we used close-ended structured questionnaire which include 8 statements was used for evaluating radiation safety status. The questionnaires used included personal and general questions and its validity and reliability had been confirmed. Findings: A total of 62 healthcare professionals participated in the study. The majority of individual participants whose age is between 20-30 Years, their awareness regarding radiation safety is very well. The participants whose experience between 1-5 years having more knowledge about radiation safety as compared to the other groups whose experience is less than 6 months and greater than 5 years. 90% of the participants were aware about the radiation safety policy of the hospital so it can be stated that the p values of the Chi-square Test are higher than the significant value of 0.05. Novelty/Applications: The study addresses an important aspect which is related to the operational quality of the hospital. Radiation safety is an area of concern because of the safety threats faced by the staff, patients and patient relatives. Assessing the level of awareness among the staff will help in better and planned preparedness of hospital with respect to radiation safety. Keywords: Radiation Safety; Awareness; Healthcare Professionals; Hospital

Background: Advanced life support interventions have been modified for patients who have recently undergone sternotomy for cardiac surgery and have new suture lines. We aimed to determine whether the use of in-situ simulation increased adherence to the cardiac surgery unit-advanced life support algorithm (CSU-ALS) for patients with cardiac arrest after cardiac surgery (CAACS). Methods: This was a retrospective chart review of cardiac arrest management of patients who sustained CAACS before and after implementation of in-situ simulation scenarios utilizing CSU-ACLS in place of traditional advanced cardiac life support. We utilized classroom education of CSU-ACLS followed by in-situ high-fidelity simulated scenarios of patients with CAACS.. Interprofessional learners (n = 210) participated in 18 in-situ simulations of CAACS. Two groups of patients with CAACS were retrospectively compared before and after in situ training (preimplementation, n=22 vs postimplementation, n=38). Outcomes included adherence to CSU-ALS for resuscitation, delay in initiation of chest compressions, use of defibrillation and pacing before external cardiac massage, and time to initial medication. Results: Chest compressions were used less often in the postimplementation vs the preimplementation period (11/22 [29%] vs 13/38 [59%], P = 0.02). Time to initial medication administration, use of defibrillation and pacing, return to the operating room, and survival were similar between periods. Conclusion: In this pilot, adherence to a key component of the CSU-ALS algorithm—delaying initiation of chest compressions—improved after classroom combined with in-situ simulation education.

Background: Influenza virus causes a highly contagious febrile illness ranging from mild symptoms to acute respiratory distress syndrome, respiratory failure and death. The H1N1 influenza pandemic caused a worldwide public health challenge. Objectives: This study aimed to record the clinical outcomes and factors associated with poorer outcomes in hospitalized patients. Materials and Methods: Patients with laboratory-confirmed H1N1 infection by real-time polymerase chain reaction were included in this retrospective study. Data regarding the demographics, medical comorbidities, complications, treatment details and outcome were obtained. Statistical analysis was performed using SPSS version 16. Results: Among 295 patients, 143 (48.5%) were males and 152 (51.5%) were females. The majority were in the age group of 18 to 49 years. Pneumonia (8.1%) and respiratory failure (9.2%) were the most frequent complications. A majority (71%) required hospitalization of fewer than 5 days and 32 (10.8%) required ventilatory support. There were no deaths reported in this group. Elderly patients (age>50 years) (P= 0.002) with the presence of comorbidities (P= 0.000) had greater complications. Elderly patients (P= 0.011) with the presence of co-morbidities (P= 0.000) required a longer duration of Oseltamivir treatment. Female patients (P= 0.015) and patients with comorbidities (P= 0.001) had greater ventilator requirements. Elderly (P= 0.002), female patients (P= 0.018), and those with comorbidities (P= 0.000) required a longer hospital stay. Patients with cardiovascular diseases and pre-existing lung diseases had overall poorer outcomes. Conclusion: The main risk factors were old age, female sex, cardiovascular diseases, Chronic Obstructive Pulmonary Disease, and asthma. These parameters were significantly associated with increased Oseltamivir treatment duration, greater complications, prolonged hospital stay and ventilatory support.

Alzheimer's disease (AD) is a neurodegenerative disease characterized by an increasing deterioration of memory, which is concomitant with additional cognitive deficits. Neurofibrillary tangles and senile plaques are two pivotal proteins inside the brain that are considered essential to obstruct the normal cognitive function of the brain. Genetic variations in TREM2 gene disturb the neuroinflammatory action of microglia in reducing the progression of the disease.TREM2 is a transmembrane receptor present on the microglia, which has an important function in neuroinflammation. Genome-wide association studies identified variants of TREM2 gene and linked it with the risk of developing AD, by 2-4 folds. Numerous studies on mice models have revealed the relationship between mutations of TREM2 gene and its effect on amyloid burden and tau pathology in the brain that gets affected by AD. This review summarizes the role of TREM2 and its variants in the progression of AD and tries to delve deep into the role of soluble TREM2 as an effective biomarker and impending neuroprotection in AD. It also focuses on the strategies to develop therapeutic agents against TREM2 by employing its expression, function, and signalling pathways. The current challenges posed against prospective therapy for AD are also discussed.

Multiple cranial nerve palsies have many possible causes, including infective, inflammatory, neoplastic and infiltrative diseases of the meninges or skull base. We present the clinicopathological conference of a 27-year-old man with a smouldering course of sequential cranial nerve palsies. His imaging showed dural thickening and osteosclerosis of the skull base with otomastoiditis. Cerebrospinal fluid showed lymphocytic pleocytosis with reduced glucose and normal protein concentrations. There was a possible response to corticosteroids and anti-tubercular treatment. Initial biopsy from the thickened and enhancing dura was unremarkable. His condition deteriorated after the steroids were tapered; MR imaging showed progression of lesions and positron emission tomography showed intense hypermetabolism. Subsequently, a diagnostic test revealed the final diagnosis. This case was presented at the All India Institute of Medical Sciences’ monthly clinicopathological conference series in February 2021.

Additive manufacturing has gained much popularity in the last decade because of its flexibility and sustainability. One of the leading additive manufacturing processes is laser-directed energy deposition (LDED). In addition to building three-dimensional free-form features, LDED has a huge potential in the repair and reconditioning segment of the industry. A variety of valuable components such as dies, molds, turbine blades, valves, etc. subjected to high thermal and mechanical loads develop surface defects over time. These components can be restored to their functional condition using LDED instead of replacing them. The material similar to substrate material or even better can be deposited using LDED. These components generally possess complex free-form features and contours, which makes it difficult to perform depositions keeping the deposition head vertical and requires the deposition head to be inclined to the desired inclination angle, which may affect the powder catchment and the deposition geometry. The effect of the inclination angle on the catchment and the deposition geometry needs to be studied for a better understanding of the DED process. In this paper, the different strategies of deposition over inclined surfaces have been studied. Based on the experimental results, a phenomenological model is developed to predict the powder catchment efficiencies at depositions with different inclinations. The inclination not only affects the effective powder reaching the melt pool but also affects the shape of the deposition. A two-dimensional computational fluid dynamics (CFD) model has also been developed, which predicts the shape of the deposition cross-section. The model considers the flow of the melt pool, due to inclination, before solidification. The model captures the effect of inclination angle in terms of reduction in powder catchment efficiency (PCE) and the gravity-driven melt flow effectively.

AIM: To evaluate the role of CECT in diagnosis of common and rare complications of pancreatitis.Materials and Methods: Type of study: Retrospective study.Place of study: Dept. of Radio Diagnosis, KIMS, NARKETPALLY. Sample size: 129Duration of study: 1st October 2019-30th September 2020 (12 months).Inclusion criteria: Patients with clinical features and/or laboratory findings and/or ultrasonography findings of acute pancreatitis and chronic pancreatitis.Results: 129 subjects were included in the study, among which 88.3% were males. Most of them belonged to the 31-40years age group. On CECT, Acute peri-pancreatic fluid collection was seen in 43.4%, acute necrotic collection in 5.4%, Pseudocysts in 16.2% including rare locations like renal subcapsular, hepatic subcapsular, splenic subcapsular, perinephric and retrovesical sites and walled-off necrosis in 4.6%. Vascular complications were seen in 24.8%, among which, thrombosis was seen in 20%, pseudo-aneurysm in 0.7%, hemorrhage in 3.1% and collaterals in 10% of the cases. Pancreatico-pleural fistula was seen in 2.3%, Traumatic pancreatitis in 1.5%, groove pancreatitis in 0.7%, ascites in 72.8% and Pleural effusion was seen in 43.4% of the cases. Conclusion: Pancreatitis is associated with a wide variety of complications. Some complications of pancreatitis have atypical presentations. CECT plays an important role in diagnosing these complications, guiding management and reducing morbidity

Erdheim–Chester disease is a rare disease with systemic non-Langerhans cell histiocytosis, the diagnosis of which with conventional imaging modalities is challenging. We describe a case of a 73-year-old woman who was referred with a progressive history of bilateral proptosis. The magnetic resonance imaging (MRI) orbit demonstrated bilateral orbital masses with optic nerve encasement. A subsequent 18F-FDG PET/CT scan showed multi-organ disease with involvement of the orbits, pericardium, aorta, pararenal fascia, and appendicular bones. Metabolically active, easily accessible areas were selected for CT-guided biopsy. The biopsy showed sheets of foamy histiocytes with the expression of CD 68 and CD 163 consistent with a diagnosis of Erdheim–Chester disease. The FDG PET/CT played a pivotal role in establishing the diagnosis with the assessment of disease extent and further guided in the targeted biopsy.

Stroke is classically characterized as a neurological deficit attributed to a vascular cause causing an acute focal injury of the central nervous system (CNS). Stroke is one the leading causes of disability, dementia and death worldwide. The aim of our study is to evaluate carotid arteries of stroke patients with colour doppler ultrasonography and comparison of the results of study with available literature. Material and Methods: This prospective study was approved by the Institutional ethics board and was carried out on 80 patients who presented with complaints of cerebrovascular accident to the Department of Radiodiagnosis at Kamineni Institute of Medical Sciences between June 2019 to February 2020. Written informed consent was obtained from the patients and their family members. Following a detail history and physical examination, a CT scan of the head was performed on a Toshiba Asterion 16-slice CT Imager. Patients then underwent Colour Doppler ultrasonography of bilateral extracranial vessels and all the findings were documented. Patients with hemorrhagic stroke, established carotid artery stenosis, vertebrobasilar insufficiency and those with multiple complicated carotid artery plaques were excluded. Results: 80 patients were included in the study with 61- 70 years being the most commonly affected age group. Many of the patients had varying degrees of atherosclerotic and non-atherosclerotic carotid disease. 70% of the patients showed unilateral carotid plaque disease whilst 30% accounting to bilateral disease. A total of 83 plaques were evaluated for location, morphology and degree of stenosis with the most common location of the plaque was at carotid bulb in ~47% followed by 31% in CCA, 20% in ICA and 1.2% in ECA. Based on morphology, plaques were divided into 5 types. Of these Type I and Type II were the most predominant accounting to 30% and 26.5% respectively. Majority of the patients had a stenosis of

Objective: To evaluate the spectrum and frequency of patients presenting with vitreo-retinal diseases at a tertiary care hospital in Gujarat.Material and Methods: A total of 92922 patients were seen on OPD basis at the Department of Ophthalmology, GMERS Medical College, Gandhi Nagar, from 01 January 2018 to 31 December 2020. Their data was obtained from the OPD register. Demographic details, evaluation of vision with refraction, anterior segment slit lamp examination, dilated posterior segment slit lamp examination with 90 D lens, indirect ophthalmoscopy with 20 D lens were done. When needed ultrasound (B Scan), Fundus Fluorescein angiography and OCT examination were also done. Data was analysed for simple frequency and inter group differences were performed using the Chi-Square test.Results: Out of the total OPD patients, 4952 patients had vitreo-retinal diseases. Diabetic retinopathy was the most common vitreo-retinal disease. Vision threatening DR was found in 884 patients having DR. Age related macular degeneration (ARMD) and Retinal Vascular occlusive diseases were the next common vitreo retinal diseases causing vision impairment. Co-existent DM and Hypertension were the most common associated systemic diseases. Hematological tests, OCT were the most commonly done investigations.Conclusion: Diabetes is major factor contributing to blindness due to vitreo retinal diseases in the form of Diabetic Retinopathy and its association with retinal vessel occlusive disease. With the changing demographic in the coming years, this problem is going to increase. The time has now come to rise up to the situation and plan the establishment of human resources, early screening, timely management and awareness of the disease and to make it affordable and easily accessible to the community.

AIM: Our study aims to identify the role of glycemic control in predicting the CT severity in patients with COVID-19 pneumonia.Materials and Methods: Our study is a single-centre, retrospective, observational study of 60 patients with RT-PCR proven COVID-19 Pneumonia admitted to Kamineni Institute of Medical Sciences, Narketpally from June 2020 to September 2020. 30 patients with diabetes were taken as cases and 30 patients who were non-diabetic were taken as controls. Patient’s age, sex, baseline HbA1c levels and CT severity scores were analysed using Statistical Package for the Social Sciences (SPSS) software version 22.0. The Chi-square test was used to analyse qualitative data and p-value significant at level

In our everyday life, we come across various media that facilitate communication. Photography is one such medium used for visual communication. Although it is easy for human beings to look at a picture and describe it, it is often a hard task for a computer to generate a caption automatically if a photograph is fed to it. The recent development in deep learning and neural network has made this problem easier to work on especially if the relevant datasets are provided. This paper attempts to comprehensively summarize and present a unique perspective of the prevalent systems developed to address this problem of image captioning.

Endoscopic third ventriculostomy (ETV) is a well-established surgical procedure for hydrocephalus treatment, but there is sparse evidence on the optimal choice between flexible and rigid approaches. A meta-analysis was conducted to compare efficacy and safety profiles of both techniques in pediatrics and adults. A comprehensive search was conducted on PubMED, EMBASE, and Cochrane until 11/10/2019. Efficacy was evaluated comparing incidence of ETV failure, while safety was defined by the incidence of perioperative complications, intraoperative bleedings, and deaths. Random-effects models were used to pool the incidence. Out of 1365 studies, 46 case series were meta-analyzed, yielding 821 patients who underwent flexible ETV and 2918 who underwent rigid ETV, with an age range of [5 days–87 years]. Although flexible ETV had a higher incidence of failure in adults (flexible: 54%, 95%CI: 22–82% vs rigid: 20%, 95%CI: 22–82%) possibly due to confounding due to etiology in adults treated with flexible, a smaller difference was seen in pediatrics (flexible: 36%, pediatric: 32%). Safety profiles were acceptable for both techniques, with a certain degree of variability for complications (flexible 2%, rigid 18%) and death (flexible 1%, rigid 3%) in pediatrics as well as complications (rigid 9%, flexible 13%), death (flexible 4%, rigid 6%) and intra-operative bleeding events (rigid 6%, flexible 8%) in adults. No clear superiority in efficacy could be depicted between flexible and rigid ETV for hydrocephalus treatment. Safety profiles varied by age but were acceptable for both techniques. Well-designed comparative studies are needed to assess the optimal endoscopic treatment option for hydrocephalus.

Tizanidine is an α 2 receptor agonist derived from clonidine with primary central myotonolytic action along with antinociceptive and anticonvulsant action. Unlike clonidine, there are few studies evaluating the role of tizanidine as an effective anaesthetic premedication. Hence this study was undertaken to evaluate oral tizanidine [2 mg and 4 mg] administered preoperatively in decreasing the intraoperative consumption of isoflurane. This prospective, randomised, double blind control trial was undertaken in 75 adult patients scheduled for elective laparoscopic surgeries. The subjects were randomly allocated into 3 groups with Group A (2 mg tizanidine), Group B (4 mg tizanidine), Group C (sugar pellet). The study drug was administered orally 90 minutes preoperatively. Intraoperative isoflurane consumption and end tidal isoflurane was recorded. Demographic data was comparable between the 3 groups. We observed a significant fall in isoflurane consumption in the tizanidine groups [Total: group A = 10.24 (2.07) ml, group B = 8.09 (2.17) ml, group C = 15.43 (4.77), p < 0.001; at 30 min: group A = 6.86 (0.91), group B = 5.22 (0.67), group C = 8.10 (1.15), p < 0.001; at 60 min: group A = 9.29 (0.73), group B = 7.92 (1.31), group C = 12.88 (2.45), p < 0.001; at 90 min: group A = 11.13 (0.83), group B = 10.25 (2.63), group C = 17.25 (2.5), p Oral tizanidine [2mg and 4 mg] is as effective and safe anaesthetic premedication in decreasing isoflurane consumption.

Colon cancer is the third most commonly diagnosed cancer and the second leading cause of cancer death in men and women combined in the United States. In this work, we performed mathematical and statistical modelling of Tumour sizes as a function of age for four different races. Mathematically, based on the behaviour of the data for each race, we partitioned ages of subjects into several intervals. The mathematical function that characterizes the size of the Tumour as a function of age was determined for each age interval. Statistically, using quantile regression, we designed models that are more robust at specific quantiles using Tumour size and age as dependent and predictor variables.

Introduction Numerous techniques have been reported in the literature for the reconstruction of gingival recession defects. The purpose of this case series was to evaluate clinically and radiographically the efficacy of sticky bone with i-PRF coated collagen membrane in the treatment of gingival recession. Case presentation Sixteen patients exhibiting isolated Miller's Class I or II recession in the maxillary esthetic zone were treated using sticky bone [i-PRF + Freeze-dried bone allograft] with i-PRF coated collagen membrane using the coronally advanced flap. Clinical parameters including Probing Depth (PD), Width of Keratinized Gingiva (WKG), Gingival Thickness (GT), and Recession Depth (RD) were recorded at baseline and six months post-surgery. The radiographic (ST-CBCT) measurements computed were labial plate thickness (OT1, OT3, and OT5) and gingival thickness (GT1, GT3, and GT5) at baseline and six months post-treatment. Twelve out of sixteen treated cases achieved complete root coverage. An increase in gingival thickness was observed in all the cases. Conclusions Within the limitations of this case series, sticky bone with i-PRF coated collagen membrane showed promising results in the treatment of isolated maxillary Miller's Class I or II gingival recession and serves as an altered approach for root coverage procedure. However, histological analysis and larger sample size are needed to establish definitive proof of soft and hard tissue regeneration. This article is protected by copyright. All rights reserved.

Background The patient acceptable symptomatic state (PASS) represents clinical improvement following surgery that patients deem as satisfactory; however, thresholds for achieving this clinical benchmark have not yet been established beyond 1 year following primary and reverse shoulder arthroplasty. Methods A prospectively maintained registry was retrospectively queried for patients undergoing either a primary TSA or RTSA at a single institution between November, 2015 and October, 2017. All patients completed the ASES, SANE, and Constant patient-reported outcome (PRO) scores at the 2-year time point. PASS threshold scores were calculated using anchor-based methodology with subsequent calculation of achievement rates. Multivariate logistic regression was used to identify demographic and clinical variables associated with the likelihood of PASS achievement. Results A total of 93 TSA (mean age 61.4 ± 8.5 years, 32.3% female) and 111 RTSA (mean age 70.0 ± 8.1 years, 51.4% female) patients met final inclusion criteria. One-hundred sixty-five patients (80.8%) responded to the binary anchor question as “satisfied” regarding their surgical outcome. The PASS cutoffs for ASES, SANE, and Constant were 81.7, 85.7, and 24.0, respectively (AUC > 80%), with PASS achievement rates ranging from 50.7% to 59.9% for the entire study population and 66.7% to 83.3% for a risk-stratified subgroup. Patients undergoing TSA had a significantly higher PASS achievement rate relative to RTSA (P = .010) for ASES. Independent risk factors for decreased PASS achievement included lower preoperative PRO score, prior shoulder surgery, sedentary lifestyle, smoking, workers’ compensation status, and diabetes mellitus (DM). Conclusion The majority of patients reach the PASS benchmark by 2 years after shoulder arthroplasty, with an optimal subgroup of risk-stratified patients achieving PASS at a rate greater than 80% for ASES. Patients undergoing TSA have a higher likelihood of reaching the PASS than patients undergoing RTSA, independent of other variables. Lower baseline outcome scores, prior shoulder surgery, smoking, and sedentary lifestyle are associated with lower PASS rates after TSA. Worker's compensation status and comorbid DM are predictive of reduced PASS rates after RTSA. Primary diagnosis and glenoid morphology did not have a significant impact on the rate of achieving the PASS. This information is valuable for patient selection and counseling prior to shoulder arthroplasty. Level of Evidence Level III; Prognostic Study; Retrospective Case Series.

Squamous cell carcinoma (SqCC) is the most common malignancy of the anal canal, where it is strongly associated with HPV infection. Characteristic genomic alterations have been identified in anal SqCC, but their clinical significance and correlation with HPV status, pathologic features, and immunohistochemical markers are not well established. We examined the molecular and clinicopathologic features of 96 HPV-positive and 20 HPV-negative anal SqCC. HPV types included 89 with HPV16, 2 combined HPV16/HPV18, and 5 HPV33. HPV-positive cases demonstrated frequent mutations or amplifications in PIK3CA (30%; p = 0.027) or FBXW7 mutations (10%). HPV-negativity was associated with frequent TP53 (53%; p = 0.00001) and CDKN2A (21%; p = 0.0045) mutations. P16 immunohistochemistry was positive in all HPV-positive cases and 3/20 HPV-negative cases (p < 0.0001; sensitivity: 100%; specificity: 85%) and was associated with basaloid morphology (p = 0.0031). Aberrant p53 immunohistochemical staining was 100% sensitive and specific for TP53 mutation (p < 0.0001). By the Kaplan-Meier method, HPV-negativity, aberrant p53 staining, and TP53 mutation were associated with inferior overall survival (OS) (p < 0.0001, p = 0.0103, p = 0.0103, respectively) and inferior recurrence-free survival (p = 0.133, p = 0.0064, and p = 0.0064, respectively). TP53/p53 status stratified survival probability by HPV status (p = 0.013), with HPV-negative/aberrant p53 staining associated with the worst OS, HPV-positive/wild-type p53 with best OS, and HPV-positive/aberrant p53 or HPV-negative/wild-type p53 with intermediate OS. On multivariate analysis HPV status (p = 0.0063), patient age (p = 0.0054), T stage (p = 0.039), and lymph node involvement (p = 0.044) were independently associated with OS. PD-L1 expression (CPS ≥ 1) was seen in 30% of HPV-positive and 40% of HPV-negative cases, and PD-L1 positivity was associated with a trend toward inferior OS within the HPV-negative group (p = 0.064). Our findings suggest that anal SqCC can be subclassified into clinically, pathologically, and molecularly distinct groups based on HPV and TP53 mutation status, and p16 and p53 immunohistochemistry represent a clinically useful method of predicting these prognostic groups.

The COVID-19 pandemic has forced hospitals to prioritize admissions. Epilepsy surgeries have been postponed at most centers. As the pandemic continues with no definite end in sight in the near future, the question arises until when such patients should be denied appropriate treatment. A 12-year-old child with left-sided Rasmussen’s encephalitis with drug refractory epilepsy (DRE) presented at the height of the pandemic, with worsening of seizure frequency from 4–5/day to 20/day, with new-onset epilepsia partialis continua. She demonstrated features of progressive cognitive decline. The pros and cons of operating during the pandemic were discussed with the parents by a multidisciplinary team. She underwent endoscopic left hemispherotomy. Postoperatively she became seizure free but developed hospital-acquired mild COVID infection for which she was treated accordingly. Chosen cases of severe DRE, as the one illustrated above, who are deemed to benefit from surgery by a multidisciplinary team of physicians, should be re-categorized into the most severe class of patients and scheduled for surgery as soon as possible. The risk benefit ratio of the seizures being mitigated by surgery on one hand and possibility of acquiring COVID infection during hospital stay has to be balanced and a decision made accordingly.

Purpose This article presents our experience regarding survival benefits in inoperable intermediate stage hepatocellular carcinoma (HCC) and advanced stage HCC treated with 131I-lipiodol. Materials and Methods This is a retrospective study of intermediate stage HCC (Barcelona Clinic Liver Cancer [BCLC] stage B) not responding to prior treatment and/or advanced stage HCC (BCLC stage C) treated with 131I-lipiodol. 131I-lipiodol was injected into the hepatic artery through transfemoral route. Postprocedure, the patient was isolated for 5 to 7 days. All patients underwent tumor response evaluation after 4 weeks. Survival of patients was calculated up to either death or conclusion of the study. Results A total of 55 patients (52 males [94.5%], 3 females [5.4%]) were given intra-arterial 131I-lipiodol therapy. The median overall survival after transarterial radioembolization (TARE) was 172 ± 47 days (95% confidence limit, 79–264 days). The overall survival at 3, 6, 9, and 12 months was 69, 47, 32, and 29%, respectively. A multivariate Cox regression analysis showed the presence of treatment prior to TARE to most significantly influence survival (B = 2.161, p ≤ 0.001). This was followed by size of the lesion which was second in line (B = 0.536, p = 0.034). Among 45 patients, 14 patients (31.1%) showed a partial response, 11 patients (24.4%) showed stable disease, and 20 patients (44.4%) showed progressive diseases. Conclusion TARE with 131I-lipiodol can be a safe and effective palliative treatment in advanced stage HCC and in patients with poor response to prior treatments like transarterial chemoembolization.

Tuberculosis (TB) is a communicable systemic infectious disease with high morbidity and mortality associated with it. Resistance to medications used to treat tuberculosis has been on the rise in recent years. (multidrug-resistant tuberculosis) (MDR-TB) is a significant challenge to (TB) control around the world. An observational research was conducted in a tertiary care teaching hospital to determine the interim pharmacological and microbial results of Rifampicin resistance TB patients. Data from Santhiram Medical College and General Hospital, Nandyal, Kurnool Dist. Andhra Pradesh were obtained from Aug 2020 to Feb 2021, after receiving ethical approval from the Institutional Ethics Committee. The effects of the regimen are determined in terms of cure, finished treatment, treatment failure, number of patients moved to MDR-TB, number of patients who died in long-term MDR-TB regimen patients. Microsoft Excel 2007 was used to analyse the data. There were 82 male and 23 female out of 105 patients included in the study. Of these 75 patients were from rural areas and 40 from urban areas Using the Chi-square test and X2=12.1026, p=0.0005, which was important, the correlation between geographical spread and treatment result was determined. Out of 115 patients, 99 (86.09 percent) were cured of their disease, 06 (5.22 percent) died, 10 (8.69 percent) developed MDR-TB, and 2 (1.74 percent) were deemed medication errors. Males between the ages of 51 and 70 are more vulnerable to TB than females, according to our results. Compared to females of the same age, male patients over 40 years of age are more vulnerable to MDRTB. this was not part of the research objectives, emphasis should not be placed on this as either conclusion or recommendation.

Rice varietal identification is a crucial aspect in breeding, seed production and trade in order to protect the interests of the farmers and consumers. As the number of varieties released is rising every year, the need to identify them unambiguously also increases. Here, we developed a novel barcode system to identify 62 rice genotypes using agro-morphological descriptors and molecular markers. In all, 62 rice genotypes, for 22 agro-morphological traits were recorded. In addition, 19 molecular markers were used for developing genotype-specific DNA fingerprints. The descriptor notes of 10 essential agro-morphological traits and allele codes of the polymorphic markers were used to generate two-dimensional (2-D) barcodes for the rice genotypes. Using agro-morphological traits, 31 rice genotypes were unambiguously distinguished while, with the polymorphic markers we were able to distinguish all rice genotypes except BPT2295 and Jaya. However, using both agro-morphological descriptors and molecular markers in combination, it was possible to distinguish all the rice genotypes used in the present study. These agro-morphological notes and allele codes from the molecular marker data together were used to develop QR (Quick Response) codes for rapid identification of rice genotypes as they facilitate storage of more data. In the present investigation, we have demonstrated the potentiality of agro-morphological traits and molecular markers in distinguishing rice genotypes. The novel QR code system proposed in the present study can also be extended to other crops not only for varietal identification but also for germplasm management and trade.

Image-guided percutaneous thoracolumbar spine biopsy is frequently performed in the setting of suspected septic facet arthritis or discitis osteomyelitis (DOM). There are limited data regarding factors associated with a positive biopsy result among these patients. Patients with suspected DOM who underwent spine biopsy were identified. Samples yielding a positive culture and/or histopathology suggestive of acute osteomyelitis were considered positive. The associations between selected medical comorbidities, laboratory values, pre-biopsy antibiotic administration, imaging findings and biopsy results were investigated. 121 patients underwent percutaneous biopsy with 35.5% yielding positive results. Biopsy results showed no correlation with comorbidities. The only laboratory value that correlated with a positive biopsy yield was blood culture positivity (p = 0.03). The imaging findings that correlated with a positive biopsy yield were the presence of a paraspinal fluid collection or epidural abscess (p = 0.003 and 0.018, respectively). Sampling paraspinal fluid collections, when present, resulted in a higher rate of a positive biopsy yield compared to sampling of bone or disc (p = 0.006). Patients who received antibiotics had a higher rate of a positive biopsy yield (p = 0.014). In those with positive blood cultures, biopsy yielded the same antimicrobial susceptibility profile in 13/14 cases. The presence of a paraspinal fluid collection or epidural abscess is correlated with positive biopsy yield, and paraspinal fluid collections should be targeted for biopsy. Other imaging findings did not correlate with biopsy yield. Biopsy may not offer additional information for patients with positive blood cultures.

OBJECTIVES: To report changes in practice brought about by COVID-19 and the implementation of new guidelines, and to explore factors relating to unscheduled re-presentations for patients discharged from the emergency department (ED). DESIGN: Prospective multicentre national audit over 12 weeks from 6th April 2020. SETTING: UK secondary care ENT departments. PARTICIPANTS: Adult patients with acute epistaxis. MAIN OUTCOME MEASURES: Re-presentation within 10 days for patients discharged from the ED. RESULTS: Eighty three centres from all four UK nations submitted 2631 valid cases. The majority of cases were ED referrals (89.7%, n = 2358/2631). 54.6% were discharged from the ED following ENT review (n = 1267/2322), of whom 19.5% re-presented within 10 days (n = 245/1259) and 6.8% were ultimately admitted (n = 86/1259). 46.7% of patients had a non-dissolvable pack inserted by ED prior to referral to ENT (n = 1099/2355). The discharge rates for ED patients and their subsequent re-presentation rates were as follows: non-dissolvable packs, 29.5% discharged (n = 332/1125), 18.2% re-presented (n = 60/330); dissolvable products, 71.1% discharged (n = 488/686), 21.8% re-presented (n = 106/486); cautery only, 89.2% discharged (n = 247/277), 20.0% re-presented (n = 49/245); and no intranasal intervention, 85.5% discharged (n = 200/234), 15.2% re-presented (n = 30/198). Univariable logistic regression showed that not being packed by ED, antiplatelet medications, failed cautery and recent epistaxis treatment were significant predictors of re-presentation within 10 days. CONCLUSIONS: Management of acute epistaxis was notably affected during the initial peak of the pandemic, with a shift towards reduced admissions. This national audit highlights that many patients who may previously have been admitted to hospital may be safely discharged from the ED following acute epistaxis.

Background: Teleneurology consultations can be highly advantageous since neurological diseases and disabilities often limit patient's access to health care, particularly in a setting where they nee...

The moment we live in today demands the convergence of the cloud computing, fog computing, machine learning, and IoT to explore new technological solutions. Fog computing is an emerging architecture intended for alleviating the network burdens at the cloud and the core network by moving resource-intensive functionalities such as computation, communication, storage, and analytics closer to the end users. Machine learning is a subfield of computer science and is a type of artificial intelligence (AI) that provides machines with the ability to learn without explicit programming. IoT has the ability to make decisions and take actions autonomously based on algorithmic sensing to acquire sensor data. These embedded capabilities will range across the entire spectrum of algorithmic approaches that is associated with machine learning. Here the authors explore how machine learning methods have been used to deploy the object detection, text detection in an image, and incorporated for better fulfillment of requirements in fog computing.

BACKGROUND Appendicectomy is the most common surgery done by a trainee general surgeon. Recent advances like laparoscopic appendicectomy is growing nowadays. We wanted to compare the parameters like operating time, post-operative pain and number of days it takes to come to back to work in patients who underwent laparoscopic and open appendicectomy and give significance of laparoscopic appendicectomy over open appendicectomy. METHODS 120 patients aged between 13 to 60 years of age were studied prospectively under two groups; 60 cases under laparoscopic appendicectomy group and open appendicectomy group. Age distribution, sex distribution, operation time, conversion rate and post-operative pain, intraoperative and post-operative complications, post hospital stay and days to return to normal activity are studied and compared. RESULTS Mean operation time between the two groups is not significantly different between the two groups. Conversion rate was 3.3% for laparoscopic appendicectomy. Postoperative pain, duration of hospital stay and return to normal activity are significantly less in laparoscopic appendicectomy. CONCLUSIONS Laparoscopic appendicectomy is more advantageous to patients in terms duration of hospital stay and less post-op pain and requires less time to return to normal daily activity compared to open appendicectomy. But the learning curve for laparoscopy is the difficult part to the surgeon.

Statistics is the discipline concerning collection, organizing, analyzing, interpretation and presentation of data as the basis for explanation, description and comparison. In clinical trials and in the drug development process, statistics play a key role, from trial design to protocol development. The credibility of a clinical trial can be upheld and cooperation between physicians and statisticians can be strengthened by providing a fundamental understanding of statistical issues. In any phase of clinical research, including trial design, development of procedures, data management and tracking, data processing, and reporting of clinical trials, biostatistics are involved. Statisticians also have roles in formulate hypothesis, develop statistical analysis plan (SAP), choosing the appropriate test, choose an apt sample size, data collection, perform the tests, generating TLGs (tables, listings, and graphs) and reporting the inferences. It is important that the rest of the research team recognizes the statistical approach suggested by the biostatistician, because statisticians can specialize in study designs, therapeutic areas and statistical methods.

PurposeThe intention for this study was to explore any relationship that might exist between quality of learning experience (QLE), the second construct student satisfaction (SS) and the third construct perceived overall experience (POE) among undergraduate students within the higher education context. This study also attempts to explain the path direction between QLE, SS and POE.Design/methodology/approachThe researchers utilized structural equation modeling to analyze the variables considered for this study – QLE, SS and POE and for hypotheses testing. Respondents for this study were medical students' coordinators of the undergraduate level of medical colleges in the 28 states of India. Data collected for the study were possible by utilizing a questionnaire that was emailed to these student coordinators. The emailing effort returned 198 (n) filled questionnaires (complete) representing 198 institutions offering undergraduate-level medical programs out of a total of 542 institutions that offer undergraduate medical programs.FindingsFindings from this study confirm the relationship between QLE with SS, and PLE. Interestingly, the findings established a significant relationship between SS and POE.Practical implicationsDecision-makers and administrators of higher education institutions (HEIs) can utilize the findings from this study to focus on strengthening important elements of QLE in ways that positively impact SS and POE of students taking online courses and program offerings. The study reiterates the importance of course content, course structure, lecture-delivery quality, instructor mentoring and student-instructor interactions on SS and POE. The role of SS in reinforcing confirmation, perceived usefulness, perceived openness of the online courses and the perceived reputation was established. This relationship is key to administrators while they focus on improving SS and building on the institutions' reputation in addition to their efforts to support marketing and enrollments during the pandemic.Originality/valueResearchers in the past have examined the relationships between QLE and another construct of this study – SS. Past research has also examined the relationship between QLE and POE. However, there is not enough research exploring the relationship between SS and POE. This study establishes the relationship between SS and POE that benefits decision-makers in higher education.

Background: Posterolateral corner (PLC) injuries of the knee are being increasingly recognized and treated in current orthopaedic practice. While there are numerous systematic reviews evaluating the management and outcomes after PLC injuries, there are limited data investigating complications after PLC reconstruction or repair. Purpose: To systematically review the literature to determine the incidence of postoperative complications after the surgical treatment of PLC injury. Study Design: Systematic review; Level of evidence, 4. Methods: The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (2008-2019), Embase (2008-2019), and MEDLINE (2008-2019) were queried for literature reporting on PLC reconstruction or repair, with or without concomitant ligamentous or meniscal surgery. Data including type of surgery performed, concomitant procedures, and follow-up time were extracted. Complications recorded included intra- and postoperative complications. Results: After the intra- and postoperative complication data of 60 studies (1747 cases) were combined, surgical management of PLC injuries was associated with an intraoperative complication rate of 0.34% (range, 0%-2.8%) and a postoperative complication rate of 20% (range, 0%-51.2%). The most common postoperative complication was arthrofibrosis (range, 0%-20%). The overall infection rate was 1.3% (range, 0%-10%). Four cases of postoperative common peroneal nerve palsy were reported. Failure of reconstruction or repair was reported in 164 (9.4%) of all cases examined (range, 0%-37.1%). Conclusion: Although the intraoperative rate of complications during PLC reconstructions is low, postoperative complications rates of 20% can be expected, including arthrofibrosis, infection, and neurovascular injury. PLC structures repaired or reconstructed failed in 9.4% of the cases.

Objective. Literature confirms that many physiotherapists suffer from work-related musculoskeletal disorders (WMSDs), but studies mention different, complementary and contradictory findings regarding risk factors. This scoping review aimed at revealing the most frequently examined and contributory WMSD factors mentioned in recent studies about physiotherapists. Methods. Based on specific inclusion/exclusion and appraisal criteria, 11 studies published between 2012 and 2018 were included in the analysis. The factors recorded per publication were grouped into 18 categories, the frequency of their appearance across the sources was counted and the median ranks of their relative reported contribution were calculated. Results. Excessive workload was found to be the most contributory factor, followed by the application of manual orthopaedic techniques. However, demanding and repetitive manual tasks were the most common factors investigated in the publications reviewed. A medium-strength correlation was found between the frequency of examination and reported contribution of factors but with a noticeable range of the confidence interval possibly due to the diversity of the approaches in the studies reviewed. Conclusions. The findings indicate a relative discordance between the level of contribution of each factor to the development of WMSDs and the types of factors most frequently addressed by studies.

Barriers to drug adherence in the developing world are multifactorial and under evaluated. We aimed to evaluate predictive factors of medication adherence in Indian patients with inflammatory bowel disease (IBD) and association of adherence with quality of life (QOL) and relapse free remission.Adherence was assessed in consecutive IBD patients using a self-administered survey questionnaire including Morisky Medication Adherence Scale together with interview and Short Inflammatory Bowel Disease Questionnaire (SIBDQ) to assess QOL. Logistic regression analysis was used to identify variables correlating with adherence, Cox proportional hazards method used for variables associated with relapse and Kaplan-Meier survival curve used for comparing relapse free remission in adherent and nonadherent.A total of 467 consecutive outpatients (279 ulcerative colitis, 188 Crohn's disease, mean age 38.6 y) were mostly on mesalazine 439 (94%) or thiopurines 213 (46%). Self-reported nonadherence was noted in 236/467 (51%). Disease remission was associated with medication adherence [P=0.003, odds ratio (OR): 1.75, 95% confidence interval (CI): 1.21-2.52]. Medication-related factors like high dosing frequency (3/d) (OR: 0.39, P=0.005) and concomitant non-IBD medications (OR: 0.44, P=0.007) were associated with nonadherence. Psychosocial factors associated with nonadherence were lack of drug information (OR: 0.30, P0.001), feeling depressed (OR: 0.43, P0.001), comorbidities (OR: 0.47, P=0.005), doubts about efficacy (OR: 0.49, P=0.001) and perceived poor QOL (OR: 0.61, P=0.01). High-cost perception was associated with nonadherence in univariate analysis (OR: 0.47, P0.001) but lost significance on multivariate analysis (OR: 0.68, P=0.07). Physician imparting disease information (OR: 2.5, P=0.14) and physician reinforcement (OR: 1.8, P=0.049) were associated with adherence.Adherence was associated with improved QOL (SIBDQ, R=0.724). Nonadherence was associated with3-fold risk of recurrence within 2 years (hazard ratio: 3.89, 95% CI: 2.74-5.52, P0.001).Nonadherence is common in Indian IBD patients but adherence is associated with improved QoL and lower probability of relapse. Psychosocial and medication-related factors are important determinants of adherence compared with demographic or clinical variables and should be addressed.

Coronavirus disease 2019 (COVID-19), which is caused by novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged at Wuhan in China in December 2019 and has rapidly spread throughout the world. The droplets expelled during face-to-face exposure, mainly through talking, coughing, or sneezing, are the most common mode of transmission. So far, children have not been affected frequently without deaths. However, the course of this virus in the future is unknown. The diagnosis is mainly made through reverse transcription-polymerase chain reaction (RT-PCR) and serology testing. Treatment with dexamethasone at an early phase of developed acute respiratory distress syndrome (ARDS) caused by SARS-CoV-2 alters the pulmonary and systemic inflammatory response and decreases mortality. Corticosteroid therapy is associated with a sizable reduction in the duration of mechanical ventilation and hospital mortality. One of the major risk factor associated with corticosteroid therapy is associated with acquiring secondary infections. Pulmonary epithelial damage and inflammatory disease are the predisposing risk factors for pulmonary aspergillosis due to the release of danger molecular patterns during severe COVID-19. Galactomannan and culture testing of bronchoalveolar lavage fluid are the most sensitive diagnostic measures for aspergillosis in intensive care unit (ICU). Finally, the treatment of coronavirus associated pulmonary aspergillosis is complex. The only way one can prevent the spread of infection by following precautions such as frequent hand washing, wearing a mask in public places, social distancing, and by avoiding unnecessary gatherings.

Aspergillus flavus is an opportunistic fungal pathogen that produces carcinogenic aflatoxin, a serious constraint for food safety and human health. In this study, to better understand the molecular mechanism/s of peanut resistance to A. flavus growth and aflatoxin accumulation, comparative proteomic analysis was performed in two contrasting peanut genotypes, variety JL 24 (susceptible) and its near-isogenic resistant transgenic derivative expressing an alfalfa defensin gene. Several resistance proteins associated with secondary metabolic pathways were strongly induced in the resistant genotypes including phenylalanine ammonia lyase, cinnamic acid-4-hydroxylase, chalcone synthase, resveratrol synthase, flavanone-3-hydroxylase, lipoxygenase, diacylglycerol-glycerol-3-phosphate-3-phosphatidyltransferase, β-ketoacyl-ACP-reductase, monoacylglycerol acyltransferase, and diacylglycerol acyltransferase, indicating their roles in resistance. Besides, several putative susceptibility-associated proteins were revealed providing knowledge on potential candidate target genes for precise breeding interventions for aflatoxin mitigation. This is the first study to demonstrate comparative proteomics analysis in Aspergillus–peanut interaction using contrasting near-isogenic lines to elucidate the underlying molecular mechanisms of resistance.

The present research investigations in power management fraternity are focused towards the realization of smart microgrid (MG) technologies. Due to intrinsic advantages of Direct Current (DC) system in terms of compatibility with power generation sources, modern loads and storage devices, DC MG has becoming popular over Alternate Current (AC) system. A secondary voltage and current control schemes of DC MG system are mainly based on the distributed consensus control of Multi-agent system (MAS) to balance generation and the demand. The basic concern of the cooperative control of MAS is consensus, which is to design a suitable control law such that the output of all agents can achieve synchronization. The distributed consensus algorithm requires much less computational power and information exchange in between the neighbor’s agent. Meanwhile the other controllers such as model predictive control (MPC) requires accurate dynamic models with high computational cost and it suffers from lack of flexibility. The hierarchical consensus control technique is classified into three levels according to their features, namely primary, secondary, and tertiary. MAS is a popular distributed platform to efficiently manage the secondary control level for synchronization and communication among the power converters in autonomous MGs. In this article, various primary control techniques for local voltage control, voltage restoration in the secondary control level and tertiary control for energy management techniques are discussed. With this, the key emphasis to reduce the voltage deviation and disturbances in a heterogeneous DC MG network solutions are discussed. Furthermore, to analyze the system response and the charging and discharging characteristics of the battery unit, the developed second order heterogeneous consensus controller is compared with the traditional homogeneous consensus control and droop control methods. Finally a detailed discussion on simulation case study using heterogeneous consensus control method over the traditional methods are provided using MATLAB/Simulink platform.

Energy recharging in wireless rechargeable sensor networks (WRSNs) has acquired much attention in recent years. In literature, many recharging path construction algorithms have been proposed. Most of them considered that all sensors are equally important and designed algorithms to increase the number of recharged sensors or decrease the path length of the mobile charger. However, different sensors have different coverage contributions. Recharging the sensors with larger coverage contribution can achieve better surveillance quality. The proposed recharging scheduling algorithm is divided into three phases, including the Initialization, Recharging Scheduling and Path Construction Phases. In the second phase, this paper proposed two recharging scheduling algorithms, namely the Cost-Effective (CE) algorithm and Cost-Effective with Considerations of Coverage and Fairness ( $C^{2}F$ ) algorithm. The proposed two algorithms construct paths for the mobile charger and select the recharging sensors based on the higher weight in terms of larger coverage contribution and smaller path cost. Performance results show that the CE and $C^{2}F$ algorithms yield better performance in terms of the fairness of recharging, recharging stability and coverage ratio, as compared with the existing studies.

Cleft lip and palate is a congenital deformity associated with maxillary sagittal and transverse discrepancies. Feeding is an immediate concern in children born with a cleft as it delays their normal growth. A feeding plate is essential for proper nutrition, and it has a role in craniofacial development and decreases the incidence of otitis media and nasopharyngeal infections. This case report describes a single visit technique for fabrication of feeding prosthesis for a 5- day old new-born infant with cleft lip and palate. The prosthesis helps in reducing the flow of food into the nasopharynx, thus decreasing the incidence of Otis media and oro-nasopharyngeal infections.