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Traumatic dental injuries result in damage to many dental and periradicular structures. They can be conservatively managed depending on the extent of the injury. Maxillary central incisors are most commonly involved in traumatic dental injuries mainly because of their anterior and protrusive positioning. The treatment of immature permanent teeth with severe internal resorption poses a lot of challenges to the clinician. The objective of the present article is to report successful management of traumatised maxillary central incisor with incomplete root formation and severe internal resorption in a 10-year-old boy using triple antibiotic paste, mineral trioxide aggregate and fibre-reinforced composite.

A hybrid approach, namely “entropy-combinative distance-Based assessment (CODAS-E),” is proposed and presented to select and rank software reliability growth models based on multiple performance indexes, which is hitherto not applied in the open literature for the purpose. In the proposed hybrid approach, i.e., CODAS-E, the Shannon entropy approach is used to obtain the performance indexes’ priority weights and the CODAS method is used for optimum selection and ranking. The methodology is illustrated through two previously published different failure datasets. The ranking results depict that “Zhang-Teng-Pham” is the least suited model for software reliability estimation, whereas “Musa Okumoto” and “Yamada Imperfect debugging2” are best suitable for dataset-1 and dataset-2, respectively. The CODAS-E method is validated comparing with existing multicriteria decision-making methods; namely, technique for order preference by similarity to ideal solution and analytic hierarchy process. The significant contributions of the present research article include implementation of efficient, user-friendly, and time effective CODAS-E methodology to find the optimal model and the best overall ranking of employed models for any given dataset, and importance to the taxonomy of NHPP SRGMs rather than adding any new model. The presented model selection strategy will undoubtedly lead to high-quality software development.

Background During the COVID-19 pandemic, disruption of surgical hands-on training has hampered the skills acquisition by budding neurosurgeons. Online and virtual classrooms have not been able to substitute the hands-on experience and learning via direct interaction with senior colleagues. To overcome these challenges, we organized a hybrid workshop where simulation-based learning modules, and direct and virtual interaction with surgeons during live surgeries or didactic lectures were utilized to help delegates in understanding the nuances of neurosurgery. Methods A 3-day hybrid workshop was held in March 2021, which was attended by 133 delegates. A structured questionnaire was utilized to record their feedback. Results An overwhelming majority of the respondents (94.1%, n = 64) found hybrid conferences to be better than an online conference. Most of the respondents (88.3%, n = 60) rated the utility of direct face-to-face interaction to be more satisfying as compared with online interaction with faculty during a webinar. Again, many the respondents (86.8%, n = 59) believed that similar hybrid events will be the new normal given the current situation of COVID-19 pandemic. A large majority (88.2%, n = 60) of the respondents reported that they will prefer a hybrid event over an online conference. Conclusions In this era of the COVID-19 pandemic, “hybrid” microneurosurgery workshops offer unique opportunities to enhance surgical skills acquisition by hands-on simulation-based learning and observing live surgical demonstrations, apart from 2-way interactions with experts under one roof. This may be a stepping stone for what lies ahead in the future of neurosurgical training.

We present a case of recurrent strokes in a patient with absent left internal carotid artery (ICA) and pulmonary arteriovenous malformation. Pulmonary arteriovenous malformations (PAVMs) are abnormal communications between pulmonary artery and pulmonary vein, cause extracardiac right to left shunting of blood and are known to significantly increase the risk of stroke primarily due to paradoxical embolization. They are often hereditary and are commonly associated with hereditary hemorrhagic telangiectasias (HHT). Delayed bubbles seen in the left ventricle (after 3 cardiac cycles) on transthoracic echocardiogram with bubble study is often the first clue to the presence of PAVMs. CT scan of the chest can confirm the diagnosis. Percutaneous embolotherapy is the treatment of choice with reduction in stroke risk post embolization.

Image segmentation is an important process in computer vision. Recently fuzzy logic based edge detection is heavily investigated as by changing the number of rules edge detection can be improved. However, due to large colour variations in the images false edges are detected and even using fuzzy rules they cannot be reduced significantly. These falsely detected edges can be controlled by using smoothen filter while controlling the degree of smoothness. This paper, presents fuzzy logic based edge detection mechanism while using Guided L0 smoothen filter for the smoothening of image under various degree of smoothens. Simulation results for edge detection is presented for Canny, Sobel, Fuzzy logic based edge detection and finally fuzzy logic edge detection with inclusion of L0 smoothen filter. The results are compared with classical and modern methods. Simulation is performed on Berkley Segmentation Database (BSD) and USC-SIPI Image Database while considering more than 100 images. The obtained F-measure is as high as 0.848.

Pituitary apoplexy (PA) is a clinical diagnosis comprising a sudden onset of headache, neurological deficits, endocrine disturbances, altered consciousness, visual loss, or ophthalmoplegia. However, clinically, the presentation of PA is extremely variable and occasionally fatal. While meningitis and cerebral infarcts are themselves serious diseases, they are rarely seen as manifestations of PA and are exceedingly rare when present together.We present the case of a 20-year-old male with a rapid progression of symptoms of meningitis, PA and stroke. The present article seeks to emphasize a rare manifestation of PA with an attempt to understand the intricacies of its evaluation and management.

Background: COVID-19 disease has disproportionately affected ethnic minorities in the US. Objective: To describe the characteristics and predictors of mortality and length of hospital stay (LOS) in patients of Hispanic ethnicity hospitalized for COVID-19 disease. Design: Retrospective cohort study of 162 patients. Setting: Tertiary care teaching hospital in Brooklyn, NY. Patients: Hispanic patients hospitalized with principal diagnosis of COVID-19 disease between March 8, and April 25, 2020. Methods: Patients were classified into mild/moderate, severe/very severe, and critical disease (intubated) based on oxygen requirements. The primary endpoint was overall mortality rate and the secondary endpoint was LOS. Results: Mean age was 55.6 years and 40.1% had critical disease. The overall mortality was 35.8%. Increasing age (OR:1.09, 95% CI:1.04, 1.13, p

This article investigates the design of a 1 kV, 5 kA solid-state circuit breaker by using parallel connection of reverse blocking IGCTs (RB-IGCT). The presented breaker topology is based on the parallel connection of low conduction loss RB-IGCTs which delivers efficiency as high as 99.9%. The focus of this article is on the power loop design and experimental validation of parallel connection of two and three RB-IGCTs with emphasis on current sharing during dynamic events such as short-circuits. A 3-D CAD-based design of power loop busbars was verified by several simulation test cases to represent dynamic current sharing under variations in RB-IGCT package impedances. An optimized busbar design approach and its tradeoffs are also discussed with simulation verification. The experimental results confirm that the parallel topology is able to perform current interruption during overload and short-circuit situations up to 10 kA for two devices in parallel and up to 14 kA for three devices in parallel - with current deviation from the mean as little as 6%.

Causality assessment for suspected drug-induced liver injury (DILI) during drug development and following approval is challenging. The IQ DILI Causality Working Group (CWG), in collaboration with academic and regulatory subject matter experts (SMEs), developed this manuscript with the following objectives: (1) understand and describe current practices; (2) evaluate the utility of new tools/methods/practice guidelines; (3) propose a minimal data set needed to assess causality; (4) define best practices; and (5) promote a more structured and universal approach to DILI causality assessment for clinical development. To better understand current practices, the CWG performed a literature review, took a survey of member companies, and collaborated with SMEs. Areas of focus included best practices for causality assessment during clinical development, utility of adjudication committees, and proposals for potential new avenues to improve causality assessment. The survey and literature review provided renewed understanding of the complexity and challenges of DILI causality assessment as well as the use of non-standardized approaches. Potential areas identified for consistency and standardization included role and membership of adjudication committees, standardized minimum dataset, updated assessment tools, and best practices for liver biopsy and rechallenge in the setting of DILI. Adjudication committees comprised of SMEs (i.e., utilizing expert opinion) remain the standard for DILI causality assessment. A variety of working groups continue to make progress in pursuing new tools to assist with DILI causality assessment. The minimum dataset deemed adequate for causality assessment provides a path forward for standardization of data collection in the setting of DILI. Continued progress is necessary to optimize and advance innovative tools necessary for the scientific, pharmaceutical, and regulatory community. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-021-01051-5.

The development of endoscopy, microscopy, and image guidance system provided the impetus for the adoption of minimally invasive surgery (MIS) techniques in the management of spinal trauma patients. The underlying drive has been an attempt to achieve the functional and biomechanical goals inherent to trauma care but through MIS techniques. Broadly the MIS techniques for spinal trauma can be divided into two categories—fusion and nonfusion methods. Fusion methods include mini-open or keyhole approaches that allow for discectomy and/or corpectomy and cage reconstruction via an anterior/lateral/posterior operative corridor. The nonfusion methods primarily include percutaneous pedicle screw fixation, kyphoplasty, and vertebroplasty, all without placement of bone graft or other attempts at inducing arthrodesis. In this review article, we have stratified the MIS techniques based on the operative corridor used and briefly described the decision-making process, technical nuances, pros, and cons of each technique.

Langerhans cell histiocytosis (LCH) is a proliferation of dendritic mononuclear cells with infiltration into organs locally or diffusely. Most cases occur in children. LCH can also present as chronic otitis media and otitis externa due to involvement of the mastoid and petrous portions of the temporal bone with partial obstruction of the auditory canal. A 4 year old male child presented with complaints of bilateral ear discharge for 4 months and inability to walk and giddiness for 2 days. On otoscopic examination, in right ear, polypoidal tissue was present in the external auditory canal which bled on touch. CECT head and MRI brain was done which showed large altered intensities in the region of bilateral external and middle ears involving the temporal bone. It also showed a well defined ovoid expansile lesion involving the skull vault in left high parietal region. Biopsy was taken from the polypoidal tissue in the right EAC which on HPE showed features suspicious for LCH. On IHC, the tissue was found out to be immunoreactive for CD 68, CD 1a and S-100 with score of 4+ for all three of the IHC markers. Patient was later put on chemotherapy and steroids which resulted in disease remission.

Objectives The ayurvedic literature reports that Dalbergia sissoo, a common medicinal plant for gastric and skin problems, has brain-revitalizing effects. However, the neuroprotective effect of this herb on an amyloid-β (Aβ) 1-42 model of Alzheimer's disease (AD) is yet unknown. The current study describes the protective effect of ethanolic extracts of D. sissoo leaves (EEDS) against Aβ (1-42)-induced cognitive deficit, oxidative stress, and neuroinflammation in rats. Materials and methods EEDS (300 and 500 mg/kg) was orally administered to rats for 2 weeks prior to intracerebroventricular Aβ (1-42) treatment. The neuroprotective effect of EEDS was assessed by evaluating behavioral, biochemical, and neuroinflammatory parameters in the rat hippocampus. Memory function was assessed via the Morris water maze (MWM) task 2 weeks after Aβ (1-42) administration. After 3 weeks, surgery was performed, all biochemical parameters were evaluated, and histopathological examination of the tissues was carried out. Results EEDS improved the cognitive ability of Aβ (1-42)-administered rats in the MWM task. It reduced oxidative stress by significantly decreasing nitrite and malondialdehyde levels and increasing catalase activity and glutathione levels in the rat brain. Moreover, EEDS mitigated neuroinflammation in rats by decreasing the concentration of neuroinflammatory markers in a dose-dependent manner. Conclusion D. sissoo leaf extract has a beneficial role in alleviating cognitive deficits in AD by modulating cholinergic function, oxidative stress, and neuroinflammation.

The ultimate goals of cardiovascular physiology are to ensure adequate end-organ perfusion to satisfy the local metabolic demand, to maintain homeostasis and achieve 'milieu intérieur'. Cardiogenic shock is a state of pump failure which results in tissue hypoperfusion and its associated complications. There are a wide variety of causes which lead to this deranged physiology, and one such important and common scenario is the post-cardiotomy state which is encountered in cardiac surgical units. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an important modality of managing post-cardiotomy cardiogenic shock with variable outcomes which would otherwise be universally fatal. VA-ECMO is considered as a double-edged sword with the advantages of luxurious perfusion while providing an avenue for the failing heart to recover, but with the problems of anticoagulation, inflammatory and adverse systemic effects. Optimal outcomes after VA-ECMO are heavily reliant on a multitude of factors and require a multi-disciplinary team to handle them. This article aims to provide an insight into the pathophysiology of VA-ECMO, cannulation techniques, commonly encountered problems, monitoring, weaning strategies and ethical considerations along with a literature review of current evidence-based practices.

OBJECTIVES We conducted a systematic review and meta-analysis to evaluate the long-term outcomes of PCI compared to CABG in patients with LMCAD. BACKGROUND Recent data from randomized controlled trials (RCTs) has raised concerns regarding the long-term efficacy and safety of percutaneous coronary intervention (PCI) compared with coronary artery bypass grafting (CABG) in patients with left main coronary artery disease (LMCAD). METHODS We searched MEDLINE and EMBASE databases for published RCTs comparing PCI using stenting with CABG in patients with LMCAD. Preferred reporting items for systematic review and meta-analysis guidelines were used for the present study. End-points of interest were all-cause mortality, cardiovascular (CV) mortality, myocardial infarction (MI), stroke, and repeat revascularization at longest available follow-up. Relevant data were collected and pooled odds ratio (OR) with 95% confidence intervals (CI) was calculated using random-effects model. RESULTS Five RCTs including a total of 4,499 patients were included in the final analysis. Mean duration of follow-up was 96 months. The risks of all-cause mortality [OR 1.09 (95% CI 0.88-1.34)] and cardiovascular mortality [1.14 (0.88-1.47)] were comparable between PCI and CABG. There were no statistically significant differences between PCI and CABG for MI [1.52 (0.98-2.37)] and stroke [0.84 (0.48-1.45)]. Conversely, repeat revascularization was significantly higher with PCI as compared with CABG [1.82 (1.49-2.22)]. CONCLUSION At long-term follow-up, PCI is associated with similar risks of mortality but a higher risk of repeat revascularization compared with CABG in LMCAD. Long-term risk of MI with PCI compared to CABG needs to be further explored in future studies.

This paper presents the results and analysis from an interview study conducted with practitioners of architectural regionalism in India. The interviews sought to gain in-depth understanding of the strategies, mechanisms, and tools they employ to realize contextualized architecture that responds to local needs and potential. A sample composed of nine eminent Indian architects who regularly integrate the ideas of critical regionalism in their designs is selected and subsequently interviewed with regard to the varied aspects of their architectural practice. Findings are useful for practitioners and scholars of contemporary architecture in India for understanding the means employed by leading regionalist architects, while placing their work in the context of local building traditions, urban landscape, sociocultural conditions, technology, and climate.

Cavernous sinus meningioma (CSM) with orbital involvement presents a unique challenge to modern-day neurosurgeons. In the modern era of preventive medicine with enhanced screening tools, physicians encounter CSM more frequently. An indolent natural history, late clinical presentation, close proximity to vital neurovascular structures, poor tumor-to-normal tissue interface, and high risk of iatrogenic morbidity and mortality with aggressive resection add to the complexity of decision-making and optimal management of these lesions. The clinical dilemma of deciding whether to observe or intervene first for asymptomatic lesions remains an enigma in current practice. The concepts of management for CSM with orbital involvement have gradually evolved from radical resection to a more conservative surgical approach with maximal safe resection, with the specific goals of preserving function and reducing proptosis. This change in surgical attitude has enabled better long-term functional outcomes with conservative approaches as compared with functionally disabled outcomes resulting from the pursuit of anatomical cure from disease with radical resection. The advent of stereotactic radiosurgery as an adjunct tool to treat residual CSM has greatly shaped our resection principles and planning. Interdisciplinary collaboration for multimodality management is key to successful management of these difficult to treat lesions and tailor management as per individual's requirement.

This case study intends to evaluate the efficacy of Vaman-Virechan in the management of recurrent psoriasis.A 38 year male presenting with psoriasis with mild arthritis was diagnosed as Ekkustha (kapha-pitta dominance) as per Ayurveda. Vaman-Virechana and Panchtiktaghrit gugglu were given to the patient. Symptoms were assessed with PASI at pre and post therapy along with 6 months follow up. Improvement was observed with PASI score (reduced from 37.7 to 8.7). During follow up period no recurrence observed. Ayurveda shodhan & shaman therapy resulted in effective management of Psoriasis as assessed by validated scales.

Data mining can be used to predict the disease for the medical database to authenticate hidden strategies. It normally extracts the useful knowledge domain from medical datasets. Various classifi- cation and feature selection methods are available to predict diseases. This paper examines on five different diseases which include the BCD, PID, HS and CID databases. It normally considered the existing related work to search out important knowledge domains in this field and explained different methods such as ELM, CNN, SVM, PSOA and KNN used in disease prediction. The main discus- sion about the classification methods is used to improve the accuracy rate, recall, and precision rate. Data mining methods are very efficient for the job of classification. The current classification methods are used for classifying the diseases (Medical Databases). Various classification tech- niques have experimented on different databases of the UCI machine learning repository site for managing medical database classification. The simulation result depicts that various methods can attain better performance and compare to the results of other classifiers.

Contract cheating is a growing menace that most academic institutions are grappling with globally. With governments now taking steps to help combat the industry and ban such services, it is also important to encourage students to stay away from such services through proactive strategies to raise awareness so that students stop using such services. This paper uses a case study approach to capture a time-series data from three years of a university campus’s efforts to raise awareness by celebrating the International Centre for Academic Integrity (ICAI)‘s International Day of Action Against Contract Cheating. This is in order to explore if such campaigns can be used as tools to increase student understanding of contract cheating as an academic misconduct issue and what roles students can play in raising awareness among other students on contract cheating. Proposing to look at contract cheating as a social issue, the paper positions the misconduct as such and explores how awareness campaigns can help address contract cheating. Over the three years, results show steep increase in awareness of contract cheating, a type of academic misconduct, and that students themselves have a positive influence on other students when raising awareness. An interesting finding of the study is that graduated students have had an impact by showing responsibility to younger students and by actively denouncing contract cheating companies and their approaches on social media; thus providing solid evidence that awareness campaigns can help increase awareness which is the first step towards building a culture of integrity in any campus.

Edge detection is an important process in many classes of engineering problems. An edge is a boundary between two regions. In the edge detection process, the input is a grayscale image while the output image is a binary image showing edge and non-edge pixels. As a state of art, methods are based on gradient operator, but the accuracy level is poor. Therefore, in recent past soft computing based methods are proposed which are more accurate, still, these methods fail to detect some of the true edges. In this paper, the two-level approach is adopted for edge detection, firstly image edges are enhanced using guided image filtering, and secondly on these enhanced images enhanced ant colony optimization method is applied for edge detection.

Background and Aim: In the wave of COVID-19 pandemic, the whole world has come to a standstill. This led to a major setback for cancer patients jeopardizing their treatment plans. This study analyzes the coping mechanisms of running outpatient and inpatient palliative care services in these COVID-19 times – the New Normal. Materials and Methods: An observational study was conducted in the pain and palliative care unit at a tertiary care hospital, India. The data were collected from March 23, 2020, to May 22, 2020, of all patients coming to the clinic and inpatient referrals. Using manual and electronic records, demographic data was collected along with clinical data. Additional data were compiled with special attention to the patient's pain and its management. Results: Despite complete lockdown and initial low patient load, we saw a progressive increase in the number of patients coming to the clinic. A total of 108 patients visited our clinic (65 male and 43 female), of which 78% of the patients were from Delhi. The median age was 43.94 years (range 6 years to 76 years). We had 33 new and 75 old registered cases coming. The main reason was new-onset pain because of noncompliance of drugs; the opioid stock finished with the patient. We saw a very high number of patients requiring strong and weak opioids. Proper personal protection and social distancing helped in preventing crossinfection. None of our staff or patients fell ill during this time. Communication skills were modified to convey feelings and empathize patients. Telemedicine using phone and video calls was used and found to be useful. Conclusion: We share our experience and challenges of providing palliative care in our clinic which can be modified as per the individual requirements in other setups.

Objective The aim of the study was to investigate the association of urinary albumin:creatinine ratio (ACR) with regard to the outcome of sepsis patients and to study the trends of ACR with severity of disease, organ dysfunction, microcirculation status, the use of inotrope, and mechanical ventilation use, and length of pediatric intensive care unit (PICU) stay. Materials and methods In the prospective observational study, the patients with varying categories of sepsis admitted in the PICU with stay >24 hours were enrolled consecutively. Urine samples were collected at the time of admission (ACR1), 12 hours (ACR2), and 24 hours (ACR3). Results One hundred and thirty-eight patients including 56 cases of sepsis, 31 of severe sepsis, 22 of septic shock, and 29 of multiorgan dysfunction syndrome (MODS) cases were analyzed. There were 29 (21%) deaths. ACR (median, IQR) was significantly higher in nonsurvivors [ACR1 198.9 (111.2–329.4) vs 124.5 (59.37–294.5), p 0.03], [ACR2 213.8 (112.5–350) vs 117.8 (62.6–211.9) p 0.008], [ACR3 231.8 (99.9–441.2 vs 114.4 (44.1–240.3), p 0.005]. The ACR is increased progressively with the increasing severity of sepsis (p < 0.001). The performance of ACR operative characteristics was compared with that of PRISM and PELOD scores. In deceased, ACR was significantly correlated with blood pH, lactate, and base deficit. A cutoff value of ACR 102.7 mg/g had sensitivity 86.2%, specificity 40.4%, positive predictive value 27.8%, and negative predictive value 91.7%. The use of inotropes, mechanical ventilation (>48 hours), and mortality was significantly higher in patients with ACR >102 mg/g. The probability of death varied from 17.6 to 19% in the first 24 hours of admission. ACR was significantly cheaper as compared to PRISM score and PELOD score estimations. Conclusion Urinary ACR, a cost-effective tool, correlates with the severity of sepsis and associated morbidity and mortality in children. How to cite this article Sachdev A, Raheja K, Gupta N, Chugh P. Association of Urinary Albumin:Creatinine Ratio with Outcome of Children with Sepsis. Indian J Crit Care Med 2020;24(6):465–472.

Background: Eczema of foot adversely impacts daily activities, work productivity, and interpersonal relationships. Materials and Methods: This cross-sectional, questionnaire-based study collated epidemiological data of 70 outpatients of foot eczema, evaluated their quality of life by 10-item dermatology life quality index (DLQI) questionnaire, and undertook the correlation thereof. Results: Cases were predominantly males (48; 68.5%); 26 (37.1%) belonged to fifth decade of life and 47 (67%) presented within 12 months of onset. Dorsa of feet was involved in most (59; 84.2%) cases. Itching was a universal complaint followed by scaling (51; 72.9%), dryness (22; 31.4%), and oozing (21; 30%). History of atopy was reported by 15 (21.4%) patients; tobacco and/or alcohol abuse 32 (45.7%) patients; past treatment was received by 37 (52.9%) patients; and winter aggravation in 9 (12.3%) patients. Mean DLQI score was 13.64; with very large effect (11–20) on QoL in 38 (54.3%) patients; moderate (6–10) in 15 (21.4%) patients; extremely large (21–30) in 9 (12.9%) patients; and small (2–5) in 8 (11.4%) patients. Mean scores of questions of DLQI tool were 2.46 in first question (symptoms), 1.99 in fifth (social activities); 1.81 in seventh (working/studying); and 0.17 in fourth (clothes) question. Significant (P < 0.05) impairment of quality of life emerged with respect of burning, scaling, oozing, history of atopy, seasonal variation, and past treatment. Conclusion: Our study reports significant association of atopy, winter aggravation, past treatment, burning, scaling, and oozing with adverse quality of life in our study on cases of foot eczema and appears to be first study from India.

This paper introduces a new circuit topology of power semiconductor switching devices for a high efficiency and cost-effective solid-state switch, especially for motor control applications. The proposed topology involves the combination of Thyristors (SCR) and Field Effect Transistors (FET) in a parallel arrangement. This new configuration permits the maximization of efficiency and enables higher power density through the minimization of the heat load compared to state-of the-art solutions. Whereas power loss during nominal current operation are minimized by the conduction characteristic of Field Effect Transistors, power loss during high current conditions (e.g. occurring during magnetizing inrush currents and motor start overcurrent) are minimized by the conduction characteristic of Thyristors. In this paper, we describe this novel circuit topology and the control circuit, and we validate the performance of the topology through full power experimental validation for a 480 V, 7.5 Hp induction motor in both continuous 12A operation and 8-time rated current of overcurrent capability tests.

To share the recorded ECG data with the cardiologist in Golden Hours in an efficient and secured manner via tele-cardiology may save the lives of the population residing in rural areas of a country. This paper proposes an encryption-authentication scheme for secure the ECG data. The main contribution of this work is to generate a one-time padding key and deploying an encryption algorithm in authentication mode to achieve encryption and authentication. This is achieved by a water cycle optimization algorithm that generates a completely random one-time padding key and Triple Data Encryption Standard (3DES) algorithm for encrypting the ECG data. To validate the accuracy of the proposed encryption authentication scheme, experimental results were performed on standard ECG data and various performance parameters were calculated for it. The results show that the proposed algorithm improves security and passes the statistical key generation test.

A prediction system is affected by numerous factors. The primary factor is the depiction and traits of instance data. In the presence of unnecessary and redundant data or boisterous and deceptive information, it becomes arduous to discover knowledge during the training phase. One of the persistent challenges in data analytics is identifying and rectifying dirty data. The outcomes will be unreliable decisions and inaccurate analytics if an individual fails to do so. It is known by a large mass of people that the machine learning model performances are affected by the quality of data. Consequently, a significant amount of time is spent by the scientists on cleaning data before model training. Data pre-processing is considered the fundamental stage of ML methods by countless researchers. Nevertheless, only a fraction of works have paid emphasis on the consequences of data processing techniques. This paper addresses the serious impact that issues of data pre-processing can have on the generality performance of an ML algorithm and here all the pre-processing techniques like removal of missing values with all the possible methods, data binning, and data normalization, etc. are discussed. After performing all the pre-processing techniques, divide the dataset into training and testing datasets and then apply machine learning algorithms. It is concluded that to achieve a reliable result or better accuracy data preprocessing plays a very important role and to build a machine learning model we must have deep knowledge of all the pre-processing techniques, also where and how to apply them.

Background Racial bias has always been a concern for healthcare. Lack of guideline directed utilization of mechanical circulatory support (MCS) devices in cardiogenic shock (CS) may lead to implicit and racial bias. Purpose To identify the racial differences in the use of mechanical circulatory support in cardiogenic shock and its association with outcomes. Methods National Inpatient Database from 2015–2018 using ICD 10 codes was used. Patients >18 years of age admitted for cariogenic shock were included. Results Among 1,021,274 patients hospitalized for cardiogenic shock, overall MCS was utilized in 11.4% (N=116,539). Use of MCS for patients stratified by race was 12.2% white (N=85543), 8% Blacks (N=14688), 11.3% Hispanics (N=11067), 13.8% Asian (N=4417), 12.3% Native American (N=825). IABP was the most commonly used MCS device, followed by Impella, ECMO and LVAD. Overall odds of MCS insertion was significantly higher in white population [1.18 (1.13–1.23) Conclusion(s) There still exist significant racial differences in the use of mechanical circulatory devices for cardiogenic shock potentially leading to significantly higher mortality in black population compared to whites. This difference in mortality is mitigated with equal use of MCS devices in cardiogenic shock among all races. Funding Acknowledgement Type of funding sources: None.

Limfoma no Hodgkin agressiu; Limfoma del SNC Linfoma no Hodgkin agresivo; Linfoma del SNC Aggressive Non-Hodgkin's Lymphoma; CNS lymphoma The levels of cell free circulating tumor DNA (ctDNA) in plasma correlated with treatment response and outcome in systemic lymphomas. Notably, in brain tumors, the levels of ctDNA in the cerebrospinal fluid (CSF) are higher than in plasma. Nevertheless, their role in central nervous system (CNS) lymphomas remains elusive. We evaluated the CSF and plasma from 19 patients: 6 restricted CNS lymphomas, 1 systemic and CNS lymphoma, and 12 systemic lymphomas. We performed whole exome sequencing or targeted sequencing to identify somatic mutations of the primary tumor, then variant-specific droplet digital PCR was designed for each mutation. At time of enrolment, we found ctDNA in the CSF of all patients with restricted CNS lymphoma but not in patients with systemic lymphoma without CNS involvement. Conversely, plasma ctDNA was detected in only 2/6 patients with restricted CNS lymphoma with lower variant allele frequencies than CSF ctDNA. Moreover, we detected CSF ctDNA in 1 patient with CNS lymphoma in complete remission and in 1 patient with systemic lymphoma, 3 and 8 months before CNS relapse was confirmed; indicating CSF ctDNA might detect CNS relapse earlier than conventional methods. Finally, in 2 cases with CNS lymphoma, CSF ctDNA was still detected after treatment even though a complete decrease in CSF tumor cells was observed by flow cytometry (FC), indicating CSF ctDNA better detected residual disease than FC. In conclusion, CSF ctDNA can better detect CNS lesions than plasma ctDNA and FC. In addition, CSF ctDNA predicted CNS relapse in CNS and systemic lymphomas. This work was supported by research funding from Fundación Asociación Española contra el Cáncer (AECC) (to JS, MC and PA); FERO (to JS), laCaixa (to JS), BBVA (CAIMI) (to JS), the Instituto de Salud Carlos III, Fondo de Investigaciones Sanitarias (PI16/01278 to JS; PI17/00950 to MC; PI17/00943 to FB) cofinanced by the European Regional Development Fund (ERDF) and Gilead Fellowships (GLD16/00144, GLD18/00047, to FB). MC holds a contract from Ministerio de Ciencia, Innovación y Universidades (RYC-2012-12018). SB received funding from Fundación Alfonso Martin Escudero. LE received funding from the Juan de la Cierva fellowship. We thank CERCA Programme / Generalitat de Catalunya for institutional support.

Renewable energy resources like wind, sun, hydropower, geothermal, and biomass are better alternatives for conventional non-renewable energy resources such as fossil fuel reserves. Renewable energy resources are the better technological option to generate clean energy and overcome the depletion of non-renewable energy resources. This paper presents the complete system design of hybrid solar wind charger. The main contribution is to develop a compact system, which utilizes the eternal solar and wind power to solve the major crisis of pollution as well as the scarcity of fossil fuels. The functionality of the proposed system allows a reliable source of power generation for human beings in the energy crisis.

Coagulation dysfunction and thrombosis are major complications in patients with coronavirus disease 2019 (COVID-19). Patients on oral anticoagulants (OAC) prior to diagnosis of COVID-19 may therefore have better outcomes. In this multicentre observational study of 5 883 patients (≥18 years) admitted to 26 UK hospitals between 1 April 2020 and 31 July 2020, overall mortality was 29·2%. Incidences of thrombosis, major bleeding (MB) and multiorgan failure (MOF) were 5·4%, 1·7% and 3·3% respectively. The presence of thrombosis, MB, or MOF was associated with a 1·8, 4·5 or 5·9-fold increased risk of dying, respectively. Of the 5 883 patients studied, 83·6% (n = 4 920) were not on OAC and 16·4% (n = 963) were taking OAC at the time of admission. There was no difference in mortality between patients on OAC vs no OAC prior to admission when compared in an adjusted multivariate analysis [hazard ratio (HR) 1·05, 95% confidence interval (CI) 0·93–1·19; P = 0·15] or in an adjusted propensity score analysis (HR 0·92 95% CI 0·58–1·450; P = 0·18). In multivariate and adjusted propensity score analyses, the only significant association of no anticoagulation prior to diagnosis of COVID-19 was admission to the Intensive-Care Unit (ICU) (HR 1·98, 95% CI 1·37–2·85). Thrombosis, MB, and MOF were associated with higher mortality. Our results indicate that patients may have benefit from prior OAC use, especially reduced admission to ICU, without any increase in bleeding.

BackgroundParasitic fibroids are a rare type of fibroids without direct uterine attachment. They pose a diagnostic dilemma and often present atypically.Case descriptionWe report a rare case of large secondary parasitic fibroid in a 24 year unmarried female who presented with history of lump abdomen for 6 months. She had history of laparoscopic myomectomy done 2.5 years back for the same complaint with histopathology report suggestive of leiomyoma. On examination, it was found to be subserosal pedunculated fibroid. All the tumor markers were negative except CA 125 which was 225 IU/mL. Exploratory laparotomy was done. Uterus was normal size and seen separately. Bilateral tubes and ovaries were normal. A mass of size 30 × 22 × 15 cm, firm in consistency occupying all the quadrants of abdomen, was observed. It had no attachment to the uterus or to the bowel. Mass weighing 6.5 kg was removed completely and sent for histopathology. HPE report confirmed leiomyoma. Her postoperative period was uneventful.ConclusionIf the patient had prior history of myomectomy and mass is separate from the uterus with its blood supply away from uterus, diagnosis of parasitic leiomyoma should be considered.Clinical significanceDuring morcellation procedures, a thorough inspection and washing of peritoneal cavity must be carried out, and endoscopic bag should be used to prevent secondary parasitic leiomyoma.How to cite this articleKurude VN, Gitte V, Raheja A,et al. Giant Parasitic Fibroid Mimicking Gist: A Clinical Dilemma. J South Asian Feder Menopause Soc 2020;8(1):49–51.

Background Improved knowledge of the molecular pathophysiology and immunopathogenesis of cholestatic liver diseases in recent years has led to an increased interest in developing novel therapies. Patients with cholestatic liver disease often require different approaches to assessment and management of suspected drug-induced liver injury (DILI) compared to those with healthy livers and those with parenchymal liver diseases. At present, there are no regulatory guidelines or society position papers, that systematically address best practices pertaining to detection of DILI in these patients. Aims To outline best practices for detection, assessment and management of suspected acute DILI during clinical trials in adults with the cholestatic liver diseases - Primary Biliary Cholangitis (PBC) and Primary Sclerosing Cholangitis (PSC). Methods This is one of the several papers developed by the IQ DILI Initiative, which is comprised of members from 16 pharmaceutical companies, in collaboration with DILI experts from academia and regulatory agencies. The contents are the result of an extensive literature review, as well as in-depth discussions among industry, regulatory and academic DILI experts, to achieve consensus recommendations on DILI-related issues occurring during clinical trials for cholestatic liver diseases. Results Recommended best practices are outlined pertaining to hepatic eligibility criteria, monitoring of liver tests, approach to a suspected DILI signal, and hepatic discontinuation rules. Conclusions This paper provides a framework for the approach to detection, assessment and management of suspected acute DILI occurring during clinical trials in adults with cholestatic liver disease.

Diffuse midline gliomas (DMGs) are rare and devastating tumors with limited therapeutic options. Programmed death-ligand 1 (PD-L1) expression represents a potential predictive biomarker for immunotherapy. One hundred and twenty-six DMGs (89 adult and 37 pediatric) were assessed for immune profile (PD-L1, cluster of differentiation (CD3, CD8) and genetic markers (mutation in 27th amino acid of histone H3 (H3K27M), alpha thalassemia/mental retardation syndrome X-linked (ATRX), isocitrate dehydrogenase 1 (IDH1), p53) by immunohistochemistry. Sanger sequencing was done for IDH1 and H3K27M. The thalamus was the commonest site. Four molecular subgroups of DMGs were identified. H3K27M mutation was more frequent in children (P = 0.0001). The difference in median overall survival (OS) was not significant in any of the four molecular subgroups (P 0.05). PD-L1 expression was significantly higher in H3K27M/IDH1 double-negative adult glioblastomas (GBMs) (P = 0.002). Strong PD-L1 expression was more frequent in grade IV tumors and thalamic location, although the difference was not significant (P = 0.14 and P = 0.19 respectively). Positive PD-L1 expression was significantly associated with high tumor-infiltrating lymphocytes count (P 0.05). There was no significant difference in median OS in PD-L1-positive versus negative cases among four genetic subgroups (P 0.05). On univariate analysis, there was no direct correlation of PD-L1 with any genetic alteration, except H3K27M mutation (P = 0.01). CD3 infiltration was similar in both adults and pediatric ages (84.3% and 78.4%, respectively) while CD8 expression was significantly greater in adults compared to children (74.1% vs 37.8%, P = 0.0001). This is the first comprehensive analysis highlighting molecular and immune profiles of DMGs. Despite molecular and clinicopathological diversity, overall survival in DMGs remains dismal. Multicentric studies with larger numbers of cases should be undertaken for stratifying DMGs according to their age, immune and molecular profiles, to develop effective immunotherapies.

Edge detection is an important phenomenon in computer vision. Edge detection is helpful in contour detection and thus helpful in obtaining the important information. Edge detection process heavily depends on chosen technique. Soft computing techniques are considered as powerful edge detection methods due to their adaptability. This paper presents a fuzzy logic based edge detection method where the quality of edges is controlled using sharpening guided filter and noise due to the sharpening is controlled using Gaussian filter. The accuracy of the method is judged using a variety of statistical measures. It has been found that by proper selecting the smoothening parameters a significant improvement in the detected edges can be obtained.

This paper takes as its starting place the rich context of many knowledge workers today—highly distributed, increasing project focused, typically atypical days, infrastructural—and attempts to push past extant descriptions of their practices as ‘flexible’. Using empirical data informed by a practice theory lens, we expand the understanding of flexibility with regard to work by augmenting how worker disposition, as well as the ability to engage with agility in dynamic circumstances, should be considered as a factor when examining and designing for this population. We make several contributions of interest to the wider CSCW community. First, we distinguish between those who showcase flexible practices and those who proactively orient around flexibility. We call this second group ‘elastic workers’. Second, we raise new questions for us as scholars and designers keen to exploit the conceptual and pragmatic intersection of technology and work. These questions create opportunities to explore different methods for understanding complex phenomena such as flexibility, as well as understanding how we might design for this phenomenon with more foresight in the future.

Background Optimal management of complex anterior circulation aneurysms is an enigmatic challenge because of frequent involvement of major vessel bifurcation, choroidal vessels, and lenticulostriate/thalamostriate perforators. Cerebral ischemia associated with prolonged clipping time is a major concern pertinent to their surgical management, especially in patients with poor cross-flow. To circumvent this hurdle, single/double-barrel low-flow superficial temporal artery (STA) to middle cerebral artery (M3/M4-MCA) can be performed, which can maintain distal cerebral perfusion while facilitating safe clip reconstruction of complex MCA and supraclinoidal internal carotid artery (ICA) aneurysms involving ICA bifurcation or supraclinoidal ICA aneurysms with poor cross-circulation—insurance bypass, as well as supplement/alter blood flow after MCA aneurysm trapping—flow-alteration bypass. Methods A retrospective chart review of consecutive neurosurgical patients operated over 2 years at this center was performed. Patients with complex MCA and ICA aneurysms who were treated with STA-MCA bypass were included. The clinical profile, pre- and postoperative images, intraoperative imaging, and patient outcomes were recorded. Surgical reconstruction of aneurysm was the treatment of choice due to involvement of choroidal/thalamostriate perforators, MCA/ICA bifurcation, complex aneurysm morphology, or dissecting/thrombosed nature of aneurysm. STA-MCA low-flow bypass was performed using M3/M4 segment of MCA as the recipient in anticipation of prolonged temporary clipping time on M1-MCA, supraclinoidal ICA aneurysms with suspected ICA terminus involvement, or need for possible trapping of fusiform MCA aneurysm. The saccular/fusiform part of aneurysm was clip reconstructed and the partially thrombosed dissecting segment was opened for thrombectomy and trapped using proximal and distal clips after good patency of bypass was confirmed. The distal MCA flow was restored adequately and confirmed intraoperatively using indocyanine green angiography and micro-Doppler ultrasonography. Results MCA (n = 4) and supraclinoid-ICA (n = 1) aneurysms were managed successfully using this strategy, which involved 6 STA-MCA bypass procedures (insurance and flow-alteration bypass, 3 each). Postoperative check angiograms demonstrated patent bypass in all 5 patients. Four patients had favorable outcome (modified Rankin Scale score 0/1); one had recovering hemiparesis and aphasia (modified Rankin Scale score 4). Conclusions This series highlights the surgical strategy and safety for successfully managing complex MCA and ICA aneurysms using low-flow STA-MCA revascularization procedures.

An approach to accurately recognize various Yoga asanas using deep learning algorithms has been presented in this work. A dataset of six Yoga asanas (i.e. Bhujangasana, Padmasana, Shavasana, Tadasana, Trikonasana, and Vrikshasana) has been created using 15 individuals (ten males and five females) with a normal RGB webcam and is made publicly available. A hybrid deep learning model is proposed using convolutional neural network (CNN) and long short-term memory (LSTM) for Yoga recognition on real-time videos, where CNN layer is used to extract features from keypoints of each frame obtained from OpenPose and is followed by LSTM to give temporal predictions. To the best of our knowledge, this is the first study using an end-to-end deep learning pipeline to detect Yoga from videos. The system achieves a test accuracy of 99.04% on single frames and 99.38% accuracy after polling of predictions on 45 frames of the videos. Using a model with temporal data leverages the information from previous frames to give an accurate and robust result. We have also tested the system in real time for a different set of 12 persons (five males and seven females) and achieved 98.92% accuracy. Experimental results provide a qualitative assessment of the method as well as a comparison to the state-of-the-art.