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BACKGROUND: Treatment with high-dose chemotherapy and stem cell transplantation has prolonged survival in patients of multiple myeloma (MM). A dose-response relationship between number of CD34+ cells infused and leukocyte and platelet recovery, exists. Patients receiving dose of 5 × 10(6)/kg (category 3), the mean (SD) neutrophil engraftment time was 11.3 (0.5) days, 10.6 (0.9) days, and 10.2 (1.3) days respectively. Platelet engraftment time was 12.4 (2.60) days, 10.6 (1.14) days, and 11.2 (1.64) days for category 1, 2, and 3 patients, respectively. Correlation co-efficient between CD 34+cell dose and days for neutrophil and platelet engraftment was found to be −0.24 and −0.20, respectively. Time for neutrophil engraftment was found to be significantly associated with CD34+ cell dose category. CONCLUSION: CD 34+ cell dose appears as the strongest predictor of leukocyte and platelet engraftment. CD 34+ cell dose of >5.0 × 10(6) cells/kg leads to an accelerated neutrophil and platelet engraftment in patients of MM.

Plasma density in a magnetized, capacitive-coupled, radio frequency (RF) discharge has been determined using the electrical impedance characteristics of the discharge. The effective impedance between the parallel plate electrodes has been treated as an equivalent electric circuit consisting of resistive and reactive components, expressed in terms of high-frequency plasma conductivity. Hence the model is used to connect the externally measured RF voltage, current, and their relative phase to plasma density. Additionally, a triple Langmuir probe (TLP) is used to substantiate the results of the electrical impedance model. The plasma density obtained using the direct probe measurement is found to be in good agreement with those determined from the passive measurements based on electrical impedance of the discharge as outlined in this article.

Parachute deformity of atrioventricular valve occurs when chordae tendineae arise either from one papillary muscle or a closely placed muscle group. Preoperative detection is easier with mitral involvement than with tricuspid valve. We present two cases of parachute tricuspid valve (PTV) which were successfully repaired.

Background : Hemodynamically significant patent ductus arteriosus (PDA) is frequently encountered in preterm infants sometimes requiring surgical attention. Although PDA ligation is regularly performed in the operating room, conducting it at the bedside in a neonatal intensive care unit (NICU) and its anesthetic management remains challenging. Aim : We aim to discuss the anesthetic considerations in patients undergoing bedside PDA ligation and describe our experience highlighting the feasibility and safety of this procedure. Setting and Design : The study was conducted in the NICU in a tertiary care hospital; This was a retrospective, observational study. Methods : Preterm infants scheduled for bedside PDA ligation using a predefined anesthesia protocol between August 2005 and October 2020 were included. Statistical Analysis Used: Quantitative data were presented as median with interquartile range and categorical data were presented as numbers and percentage thereof. Results : Sixty-six premature infants underwent bedside PDA ligation. Thirty-day mortality was 4.5% (3 infants), but there were no procedural deaths. One (1.5%) patient had intraoperative endotracheal tube dislodgement. Three (4.5%) infants had postoperative pneumothorax requiring an additional chest tube insertion. Twenty-one (32%) patients required initiation of postoperative inotrope/vasodilator therapy within 6 h. Three postligation cardiac syndromes (≥ Grade-III mitral regurgitation with left ventricular dysfunction and hypotension) occurred. Conclusions : Although anesthesia for preterm neonates undergoing bedside PDA ligation poses unique challenges, it can be safely conducted by following a predetermined standardized anesthesia protocol. Its successful conduct requires utmost vigilance and pristine understanding of the principles of neonatal and cardiac care.

Agricultural dependency on insect-mediated pollination is increasing at the same time that pollinator populations are experiencing declines in diversity and abundance. Current pollinator research in agriculture focuses largely on diurnal pollinators, yet the evidence for pollination by moths and other nocturnal pollinators is growing. Apples are one of the most valuable and important fruits produced globally, and apple production is dependent on insect-mediated cross-pollination to generate a profitable crop. We examined contributions to apple production provided by nocturnal insects via an exclusion experiment. We compared the relative contributions to apple production provided by nocturnal and diurnal pollinators using fruit set, the likelihood of cluster pollination, and seed set. We found nocturnal pollinators capable of facilitating the production of as many apples at similar levels of pollination as diurnal pollinators. We further found evidence that nocturnal and diurnal pollinators pollinate synergistically, with pollination contributions being additive in one year of our study. Our research identifies significant contributions to apple production provided by nocturnal pollinators, which may interact with diurnal pollinators in ways that are currently unrecognized. Expansions of this research into additional pollinator-dependent crops and focused investigations on specific nocturnal insects will provide more accurate assessments of nocturnal-pollinator roles in agriculture and improve our overall understanding of pollination in agriculture.

Photovoltaic (PV) conversion of solar energy appears to be the most promising way of meeting the increasing energy requirements of the future, at a time when conventional sources of energy are bein...

Highlights • A knowledge-based planning model was configured for VMAT of cervical cancer. • Knowledge-based plans were comparable, and for some OARs, outperformed clinical plans. • Improved organ sparing was observed, when individual patient geometry was considered., Background and Purpose Knowledge-based planning (KBP) is based on a model to estimate dose-volume histograms, configured using a library of historical treatment plans to efficiently create high quality plans. The aim was to report configuration and validation of KBP for Volumetric Modulated Arc Therapy of cervical cancer. Materials and methods A KBP model was configured from the institutional database (n = 125), including lymph node positive (n = 60) and negative (n = 65) patients. KBP Predicted plans were compared with Clinical Plans (CP) and Re-plans (Predicted plan as a base-plan) to validate the model. Model quality was quantified using coefficient of determination R2, mean square error (MSE), standard two-tailed paired t-test and Wilcoxon signed rank test. Results Estimation capability of the model was good for the bowel bag (MSE = 0.001, R2 = 0.84), modest for the bladder (MSE = 0.008) and poor for the rectum (MSE = 0.02 R2 = 0.78). KBP resulted in comparable target coverage, superior organ sparing as compared to CP. Re-plans outperformed CP for the bladder, V30 (66 ± 11% vs 74 ± 11%, p

Background: The growing increase in the rate of antibiotic resistance is a major cause for concern in both non-fermenting bacilli. b -lactams have been the mainstay of treatment for serious infections, and the most active of these are the carbapenems. Acquired metallo-b -lactamases (MBL) have recently emerged as one of the most worrisome resistance mechanisms owing to their capacity to hydrolyze all β -lactams, including carbapenems.We have undertaken this investigation to ascertain the incidence of MBL-producing non-fermenting bacilli, like Pseudomonas Spp. and Acinetobacter Spp. Aim: To determine the incidence of MBL in Nosocomial infections of non-fermenters and their clinical correlation. Objectives: Screening of nosocomial isolates for multidrug resistance by antibiotic sensitivity tests as per CLSI guidelines as a reference. To perform phenotypic confirmatory test of potential MBL isolates by double disc synergy test Clinical correlation with detection of these enzymes and the patients morbidity/mortality correlation with age, immunocompromised status and hospital stay. Materials and Methods: The study was conducted over a period of 12 months in a teaching hospital, in Navi Mumbai. Isolates included in the study were screened for imipenem resistance by conventional methods. The isolates that showed imipenem resistance were tested for MBL production by imipenem (IMP)-ethylene-diamine-tetra-acetic acid (EDTA) combined disc test. Imipenem-resistant non- MBL isolates also were tested for Modified Hodge test and AmpC β -lactamases production to detect other mechanisms of carbapenem resistance. Results: Total number of isolates tested were 107.Out of 107, 29 (27.1%) were MBL producers and 78(72.9%) were non- MBL producers. Among both types of non-fermenters , 66(61.68%) were Pseudomonas aeruginosa and 41(32.23%) were of Acinetobacters. In the sex distribution, 65.5% were males and 34.5% were females.18.18% were MBL positive Pseudomonas an

The stress hormone cortisol modulates fuel metabolism, cardiovascular homoeostasis, mood, inflammation and cognition. The CORtisol NETwork (CORNET) consortium previously identified a single locus associated with morning plasma cortisol. Identifying additional genetic variants that explain more of the variance in cortisol could provide new insights into cortisol biology and provide statistical power to test the causative role of cortisol in common diseases. The CORNET consortium extended its genome-wide association meta-analysis for morning plasma cortisol from 12,597 to 25,314 subjects and from ~2.2 M to ~7 M SNPs, in 17 population-based cohorts of European ancestries. We confirmed the genetic association with SERPINA6/SERPINA1. This locus contains genes encoding corticosteroid binding globulin (CBG) and α1-antitrypsin. Expression quantitative trait loci (eQTL) analyses undertaken in the STARNET cohort of 600 individuals showed that specific genetic variants within the SERPINA6/SERPINA1 locus influence expression of SERPINA6 rather than SERPINA1 in the liver. Moreover, trans-eQTL analysis demonstrated effects on adipose tissue gene expression, suggesting that variations in CBG levels have an effect on delivery of cortisol to peripheral tissues. Two-sample Mendelian randomisation analyses provided evidence that each genetically-determined standard deviation (SD) increase in morning plasma cortisol was associated with increased odds of chronic ischaemic heart disease (0.32, 95% CI 0.06–0.59) and myocardial infarction (0.21, 95% CI 0.00–0.43) in UK Biobank and similarly in CARDIoGRAMplusC4D. These findings reveal a causative pathway for CBG in determining cortisol action in peripheral tissues and thereby contributing to the aetiology of cardiovascular disease.

Background: Anchorage control is a major concern in the design of orthodontic treatment planning. Even the best known methods to reinforce the anchorage result in taxing of the anchor unit. Control of anchorage is primarily important in “critical anchorage” situations where no anchor loss is acceptable. Temporary anchorage devices (TADs) offer to solve one of our greatest dilemmas of “anchorage control” and have been compared in this study with conventional intraoral anchorage in situ. Materials and Methods: The study involved a total of 60 subjects; 26 males and 34 females with a mean age of 16.7 years having Angle's Class I malocclusion with severe crowding who were divided randomly into two groups; Group A - TADs and Group B - Nance palatal button (NPB) for anchorage preparation. Amount of anchor loss was determined at maxillary first molar using the pre- and post-treatment lateral cephalograms. Results: The mean range of difference between pre- and post-values of the maxillary molar position in Group A was 0.02–0.09 mm (P = 0.005) and in Group B was 1.18–1.26 mm (P = 0.0001). Hence, the anchorage loss during the initial phase of leveling and alignment was approximately 1.22 mm with the use of NPB and minimal when TADs were placed and engaged before leveling and alignment. Conclusion: Minimal mesial movement of the maxillary first molars was observed when TADs were placed and engaged before leveling and alignment, thus proving their efficacy in maximum anchorage situations.

Aim: This study aims to study the frequency and severity of dry eye in diabetic patients and their correlation with duration of diabetes. Materials and Methods: This cross-sectional prospective study was conducted on all patients with diabetes mellitus presenting to ophthalmology department of a tertiary care hospital between November 1, 2019, and December 31, 2019. The study population included diabetic patients who were above the age of 40 years. Detailed ocular history including diabetic history was recorded and comprehensive ocular clinical examination to assess the dry eye status was done. Schirmer's I test and Tear film Break-Up Time (TBUT) tests were performed and results were recorded. Results: In this study, 100 eyes of 50 diabetic patients were subjected to dry eye tests. Varying degree of dryness was seen in 34 patients (68%). Schirmer's test was abnormal (

Introduction: Cataract surgery demands refractive accuracy. To achieve this, accurate biometry is required. So two biometry methods should be compared for accuracy. Aim: To compare accuracy of immersion USG and optical biometry with reference to AXL measurement and postphaco refraction. Materials and Methods: Prospective study was done involving 60 eyes of 60 patients undergoing phaco with foldable IOL implantation under LA. Biometry of Group A was done by immersion USG and that of group B was done by optical biometry (30 patients in each group). Detailed preop examination was done. Calculations of IOL power in all patients were done by using SRK/T formula. At 1 month f/up, spherical equivalent was noted. Using regression formula, emmetropic IOL powers and their differences with implanted IOL powers were calculated. Statistical analysis was done using unpaired t test. Results: Mean AXL in group B (23.2157 mm) was slightly longer than that in group A (23.2093 mm), {P=0.9754}. Mean spherical equivalent at 1 month f/up in group B (0.4583) was slightly lesser than that in group A (0.4625),{P=0.973}. Mean of differences between emmetropic IOL and actual IOL implanted was lesser in group B(0.6877), than that in group A(0.6932), {P=0.9762}. Conclusion: Difference in mean AXL and mean postop spherical equivalent between two methods of biometry were not statistically significant. Immersion USG biometry has accuracy comparable to optical biometry. Keywords: Cataract, Emmetropia, Intraocular lens, Visual acuity.

Every year the use of detergent is increasing and safety concerns about detergent are also increasing. However, in developing countries safety concerns about detergent is still a neglected topic. Therefore, the purpose of this study is to evaluate the knowledge, attitude, and practices (KAP) of the general public towards the use of detergent. An online-based cross-sectional study was performed via sharing self-developed online KAP questionnaires and filled out by participants. The basic knowledge about detergent, its safety concern, and other related questions were used for the KAP assessments. A total of 510 participants took part in this study. The participants had mixed responses to the questions such as; [1] the majority were using powder detergent (87.45%); [2] perceptions about detergent (an agent for cleansing clothes (48.04%), a chemical agent (39.02%)); [3] the purpose of using detergent (to remove dirt (48.04%), for easiness of cleaning (45.1%)); [4] the cost of detergent (affordable (80%), expensive (10.98%)); [5] the selection of detergent (based on previous satisfaction (60.98%), brand name (19.02%)); [6] cause of not using particular brand detergent next time is (poor quality (75.1%), expensive (18.04%)); [7] mostly used brands (Wheel (35.69%), Ghadi (16.08%) and Patanjali (7.06%)); [8] safety concerns (only 8.82% used gloves during using detergent and only 50% realized the detergent can harm their skin, 67.84% have awareness that the detergent contaminates the environment, 10% experienced dryness of skin, 0.98% redness/allergy)); [9] 77.06% don’t have a washing machine; [10] soaking practice (21.37% start washing immediately after the addition of detergent, only 32.16% soak clothes for 20 to 60 minutes)); [11] waste water management (80.4% throw the detergent waste water to the normal sewage, 19.6% throw separately); [12] 37.45% always use soap along with powder detergent while washing clothes; [13] detergent stability problem (absorb moisture and get wet easily (64.31%) color change (16.08%) and dryness (10.78%)); [14] 28.63% prefer colorful detergent and 42.94% observed the color transfer from detergent to clothes; only 37.45% have experience of using herbal detergent; [15] laundry detergent also used for other purposes (wash dishes (19.61%), to wash hands (5.49%) and even body washing (1.76%)); [16] 19.61% of the participants’ mothers wash their clothes; [17] the majority of the participants realized the dirtiness of country people is due to poverty (58.04%). This study shows moderate awareness regarding the KAP of detergent use, management, and toxicity. Therefore, it can be derived that continuous education is needed about detergent.

BACKGROUND: Post-operative nausea and vomiting (PONV) affects 30-40% of patients after general anaesthesia.[11] AIMS: To compare the effect of Ondansetron and Dexamethasone for prevention of nausea and vomiting in diagnostic gynaecological laparoscopy. METHODS: Ethical committee approval was taken. Consent was obtained. Patients were divided into 2 groups of 30 each. General anaesthesia was administered to all patients. Inj. Ondansetron 0.15 mg/kg i.v. was given to patients of group O. Injection Dexamethasone 0.2 mg/kg IV was given to patients of group D. Patients were monitored for nausea, vomiting, retching, pain score, side effects and requirement of rescue antiemetic. RESULTS: Inj. Dexamethasone is better than Inj. Ondansetron for prevention of P.O.N.V. in diagnostic gynaecological laparoscopy.

The principal aim of Ayurveda is to maintain and promote positive physical and mental health as well as ensure the prevention of diseases. Sandhigata Vata is the commonest form of articular disorder. It is a type of Vatavyadhi which mainly occurs in Vriddhavastha due to Dhatukshaya, which limits everyday activities such as walking, dressing, bathing etc. It occurs due to change in lifestyle like unsuitable sitting, sleeping, standing and look upwards or obliquely in various professions. Osteoarthritis (OA) is degenerative joint disorder, represents failure of the diarthrodial (movable, synovial lined) joint. OA of the joints comes under the inflammatory group which is almost identical to Sandhigata Vata described in Ayurveda with respect to etiology, pathology, and clinical features. Marma therapy is one which gives instant relief from pain by balancing local Vata and Kapha Dosha without any untoward effects. In the present research work, total 15 diagnosed case of Sandhigata Vata were randomly selected from OPD and IPD of department of Shalya Tantra, Rishikul Campus, Uttarakhand Ayurveda University, Haridwar (U.K.) India, all these patients were treated with the application of Marma therapy. Result was observed on the basis of subjective and objective parameters and analysed statistically. No complications were observed in this clinical study.

Background: There is a paucity of literature regarding the association of high oncotic priming solutions for pediatric cardiopulmonary bypass (CPB) and outcomes, and no consensus exists regarding the composition of optimal CPB priming solution. This study aimed to examine the impact of high oncotic pressure priming by the addition of 20% human albumin on outcomes. Methods: Double-blinded, randomized controlled study was done in the pediatric cardiac intensive care unit of a tertiary care hospital. Consecutive children with congenital heart diseases admitted for open-heart surgery were randomized into two groups, where the study group received an additional 20% albumin to conventional blood prime before CPB initiation. Results: We enrolled 39 children in the high oncotic prime (added albumin) group and 37 children in the conventional prime group. In the first 24-hour postoperative period, children in the albumin group had significantly lower occurrence of hypotension (28.2% vs 54%, P = .02), requirement of fluid boluses (25.6% vs 54%, P = .006), and lactate clearance time (6 vs 9 hours, P < .001). Albumin group also had significantly higher platelet count (×103/µL) at 24 hours (112 vs 91, P = .02). There was no significant difference in intra-CPB hemodynamic parameters and incidence of acute kidney injury. In subgroup analysis based on risk category, significantly decreased intensive care unit stay (4 vs 5 days, P = .04) and hospital stay (5 vs 7 days, P = .002) were found in the albumin group in low-risk category. Conclusion: High oncotic pressure CPB prime using albumin addition might be beneficial over conventional blood prime, and our study does provide a rationale for further studies.

Neurofibromatosis type 1 (NF1) manifests itself in many ways in the spine. This study aims to report the types of spinal lesions, clinical and demographic data in a large cohort from a complex NF1 centre. The characteristics of those with spinal neurofibromatosis, where neurofibromas are present on every spinal nerve root, were sought for comparison with the wider group of NF1 patients. This is a retrospective review of MDT minutes of 303 patients from a UK NF1 centre and the largest reported series of NF1 patients based on radiological data. Prevalence of each symptom and lesion was calculated and statistically significant associations were established. The most reported findings were cutaneous lesions (44.9%) and neurological deficit (27.4%). 28.4% had dural ectasia, 52.5% had some form of spinal deformity. 57.8% had spinal nerve root tumours, the most common of which were at C2. The most progressive lesions were spinal nerve root tumours (29.1%). The only statistically significant association found was between dural ectasia and spinal deformity (P 0.003), where dural ectasia is associated with a 32.6% increase in spinal deformity incidence. This is the largest descriptive study of spinal lesions in NF1. Spinal tumours and spinal deformity are prevalent in NF1. The predilection of spinal tumours for flexible spinal regions suggests that repetitive movement might be an important factor in pathogenesis. Physicians and patients should be alert to the observation that although many spinal neurofibromatosis patients display no neurological deficit, they often have significant lesions which require monitoring and sometimes surgery.

Introduction: Infective corneal ulcer is an important cause of visual impairment in developing countries. The present study was conducted to know demographic, clinical, and microbiological patterns of infective corneal ulcers in a tertiary hospital in western Maharashtra. Materials and Methods: This is a retrospective analytical study involving 68 eyes of 68 cases of infective corneal ulcer visited in the last two years. From medical records of all cases, details of history, clinical findings, and investigations were noted and data were analyzed. Results: Male to female ratio of study cases was 1.61:1 with age groups ranging between 18 to 90 years (mean 50.81 years). The main occupations of study cases were farming (28 i.e. 41.17%) and construction work (12 i.e.17.64%). Thirty-two (47.05%) cases had to present BCVA of

Infectious laryngotracheitis (ILT) is a highly contagious upper respiratory tract disease of chicken caused by a Gallid herpesvirus 1 (GaHV-1) belonging to the genus Iltovirus, and subfamily Alphaherpesvirinae within Herpesviridae family. The disease is characterized by conjunctivitis, sinusitis, oculo-nasal discharge, respiratory distress, bloody mucus, swollen orbital sinuses, high morbidity, considerable mortality and decreased egg production. It is well established in highly dense poultry producing areas of the world due to characteristic latency and carrier status of the virus. Co-infections with other respiratory pathogens and environmental factors adversely affect the respiratory system and prolong the course of the disease. Latently infected chickens are the primary source of ILT virus (ILTV) outbreaks irrespective of vaccination. Apart from conventional diagnostic methods including isolation and identification of ILTV, serological detection, advanced biotechnological tools such as PCR, quantitative real-time PCR, next generation sequencing, and others are being used in accurate diagnosis and epidemiological studies of ILTV. Vaccination is followed with the use of conventional vaccines including modified live attenuated ILTV vaccines, and advanced recombinant vector vaccines expressing different ILTV glycoproteins, but still these candidates frequently fail to reduce challenge virus shedding. Some herbal components have proved to be beneficial in reducing the severity of the clinical disease. The present review discusses ILT with respect to its current status, virus characteristics, epidemiology, transmission, pathobiology, and advances in diagnosis, vaccination and control strategies to counter this important disease of poultry.

Myelodysplastic syndromes (MDS) represent a large group of rare and diverse clonal stem cell disorders. These are classified into several different phenotypes and typically arise following a multistep genetic process, whereby genetic mutations alter the DNA damage and cellular stress responses, impacting transcription, RNA splicing, epigenetics, and cytokine signaling. However, despite the advances made regarding molecular pathophysiology and prognostic criteria and the influx of new treatment modalities, management is primarily based on prognostic scores, such as the Revised International Prognostic Scoring System. This poses a significant challenge to current healthcare professionals due to poor comprehension of the underlying pathophysiology. Hence, this review integrates the latest research and treatment modalities for MDS and discusses the different genetic mutations outlined in the revised World Health Organization 2016 MDS classification system and the associated treatment modalities. Additionally, future directions of research and clinical management of MDS are discussed.

Acromegaly is a complex endocrinological disorder commonly caused by hypersecretion of growth hormone (GH) typically due to pituitary gland tumors. Patients with acromegaly who are successfully treated and biochemically managed have a reasonably average life expectancy. However, it causes a cascade of multi-systemic involvement throughout the patient’s life, including cardiovascular, neuropsychiatric, respiratory, metabolic, neurological, neoplastic, and gastrointestinal involvement, resulting in a higher rate of hospitalization, lower quality of life, and a shorter life expectancy. Although cardiovascular complications are the primary cause of death in patients with acromegaly, malignancy is now emerging as a major killer in these individuals. Colorectal carcinoma has been reported to be prevalent in acromegaly individuals. This review article has compiled studies to demonstrate a link between acromegaly and colorectal neoplasia, intending to provide a strong foundation for their clinical relationship. This article has summarised a potential pathogenic mechanism and provided insights into the clinical presentation of such patients. Furthermore, this article has provided a brief overview of current screening recommendations for colorectal neoplasia in acromegaly patients.

A stroke is a cerebrovascular medical emergency characterized by the sudden loss of neurological function due to interruption to the blood supply. A serious and common complication of stroke is pneumonia. This review article outlined various studies in order to understand the pathogenesis pathways that lead to the development of stroke-associated pneumonia, as well as therapeutic and preventive options to reduce pneumonia. The article looked for risk factors that increase the risk of developing pneumonia among stroke patients. In addition, it has reviewed various therapeutic modalities, such as postural modifications, pharmacological treatment, and other unique treatments, in an attempt to find which of them are efficient to decrease the occurrence of pneumonia and which of them are not. The article also attempts to emphasize the importance of early screening for dysphagia among stroke patients and demonstrates the importance of preventive strategies that can be easily implemented, such as routine oral care and behavioral modifications.

Hereditary hemochromatosis (HH) is a common genetic metabolic disorder characterized by excessive iron absorption and elevated serum iron levels, which accumulate in various organs, such as the heart, pancreas, gonads, and damage these organs. There are only a few articles and clinical studies describing the characteristics of cardiac involvement in HH along with the significance of early diagnosis and management in preventing complications. In this review article, we have reviewed multiple pieces of literature and gathered available information regarding the subject. We compiled the data to investigate the importance of early detection of symptoms, regular monitoring, and prompt management with strict adherence to reverse or prevent complications. This article has reviewed different aspects of cardiac hemochromatosis, such as pathogenesis, clinical presentation, diagnosis, and management. Recognition of early symptoms, diagnosis of cardiac involvement with various modalities, and implementation of early treatment are essentially the foundation of better outcomes in HH.

A powerful astute ground vehicle is planned which can perform different errands like recognizing objects and evading the articles self-rulingly, and furthermore, it can distinguish paths to move itself whenever needed to ride on a street. The vehicle comprises sensors and camera to identify objects to evade them, and it can likewise move on a predefined way because of the utilization of GPS framework on the vehicle. It may be utilized in the midst of catastrophe to help individuals by checking and identifying presence of harmed individuals in a huge region and giving them fundamentals. It can likewise be utilized as a conveyance vehicle in the midst of pandemic like COVID-19 where contactless conveyance of fundamental merchandise should be finished. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.