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In this article, we have studied passive voltage amplification in FE-FE-DE heterostructure. We have stacked two different ferroelectric oxides; one is second-order transition ferroelectric material (continuous transition ferroelectric material) and the other is first-order transition ferroelectric material (discontinuous transition ferroelectric material). Both ferroelectric materials have different polarities of anisotropy constant $(\beta)$ , which is tuned by varying the ferroelectric thickness and thus leads to its cancellation. The nullification of the anisotropy constant will reduce the non-linearity of the ferroelectric oxide and provide efficient matching between the ferroelectric and dielectric capacitance, which in turn delivers the higher voltage amplification in the heterostructure. Also, dynamic response and temperature analysis of heterostructure are studied further. It is observed that dielectric when added in series with the isolated ferroelectric capacitor the curie temperature shifts to a lower value.

An effective performance enhancement model for the thin film solar cell conjointly based on extraordinary transmission and nanoantenna is proposed and investigated. The absorber layer of the extraordinary transmission based solar cell contains a metallic thin film with periodic holes. Maximum extraordinary transmission is accomplished as the metallic film has the same refractive index on both sides. Increased light transmission causes the absorber layer to absorb more light, which increases short circuit current density and subsequently the efficiency of the thin film solar cell. The presented analysis demonstrates that adding a square nano patch on the top surface of the absorber layer can further boost the extraordinary transmission. The extraordinary transmission is increased because of the formation of cavity nanoantenna. Cavity nanoantenna increases the coupling of light into the hole due to the excitation of surface plasmons polaritons. The proposed design of solar cell exhibits around 98% absorption and the short circuit current density is increased by a factor of 3.23. The study has been carried out using finite difference time domain (FDTD) method.

Rheumatoid arthritis (RA) is a chronic disabling disease where continued disease activity translates to irreversible articular damage. Seropositivity for rheumatoid factor (RF) and anticitrullinated protein antibody (ACPA) are markers of poorer prognosis; with increased disease activity, radiographic progression and even mortality.1 However, other than ACPA, no other biomarker has emerged for clinical use in the last 10 years.

Introduction: Dengue is an important viral infectious disease, mostly seen in tropical countries during the rainy season, and is emerging as a public health hazard for healthcare facilities. The most common parameters used to assess the severity of dengue are platelet count and haematocrit. However, new haematological parameters have emerged to predict the severity of dengue fever and assist clinicians, especially in resource-limited settings. Aim: To highlight the significance of Neutrophil-Lymphocyte Ratio (NLR), Neutrophil-Platelet Ratio (NPR), and Neutrophil-toLymphocyte and Platelet Ratio (NLPR) in predicting outcomes in patients with dengue infection. Materials and Methods: A retrospective observational study was conducted in rural central India in the Department of Medicine at Jawaharlal Nehru Medical College, Wardha, Maharashtra, India. A total of 540 patients infected with the dengue virus between June 2021 and December 2021. Data analysis was conducted from January to April 2022. Neutrophil, platelet, and lymphocyte counts were used to calculate NLR, NPR, and NLPR, and their roles in predicting the final outcome were studied. The final analysis was performed using the Statistical Package for Social Sciences (SPSS) software, version 21.0. The p-value

Abstract Background Various laboratory parameters like C-reactive protein (CRP), Cortisol, and Von Willebrand factor antigen have been evaluated independently in foreseeing outcomes of cirrhotic patients. As these parameters lack cost-effectiveness in a rural setup, there is a need for a cost effective and feasible prognostic marker for cirrhotic patients. The present study was aimed at evaluating the role of Absolute Eosinophil Count (AEC) as a prognostic marker in cirrhotic patients. Methods This cross-sectional study was conducted at a rural tertiary care teaching hospital in central India from August 2019 to September 2021. AEC was measured from counter report as a part of automated complete blood counts. Child-Turcotte-Pugh (CTP) score and Model for end stage liver disease (MELD) score were calculated at the time of admission. AEC levels on admission were correlated with mortality and with CTP score and MELD score. Results A total of 110 patients were enrolled with mean age of 46.37 ± 11.6 years. AEC was the significant predictor of mortality at cut off point of ≤ 120 with 80.30% (AUC 0.803; 95% CI: 0.716 to 0.873). AEC was the significant predictor of CTP score ≥ 11 at cut off point of ≤ 148 (AUC 0.726; 95% CI: 0.633 to 0.807). AEC was the significant predictor of MELD score ≥ 25 at cut off point of ≤ 136 (AUC 0.74; 95% CI: 0.647 to 0.819). Significant negative correlation was seen between AEC with Child–Pugh score and MELD score with correlation coefficient of -0.257 and -0.258. Conclusion Low level of AEC on admission fairly predicted raised CTP score and MELD score on admission. Low AEC levels predicted increased mortality in cirrhotic patients making it a cheap and reliable prognostic marker in a rural setup.

Introduction: Prediabetes is a state of impaired glucose tolerance that often precedes overt diabetes mellitus and is frequently underdiagnosed. Glycation of platelet proteins leads to increased platelet reactivity which can be an essential predisposing event in the pathogenesis of coronary artery disease (CAD). Although research has been conducted to diagnose CAD in prediabetes and to assess platelet indices in prediabetes, there has been no attempt to assess platelet indices in prediabetic patients who have CAD. Methods: This cross-sectional study was carried out in a rural tertiary care center in Central India from September 2019 to August 2021. A total of 180 patients were enrolled in this study, having documented CAD in coronary angiography (CAG) and blood glucose levels in the diagnostic range of prediabetes by the criteria set by the World Health Organization. Platelet indices, glycosylated hemoglobin, blood sugar levels, and CAG findings were documented for all participants. Results: The mean platelet volume (MPV) in our study population was 9.58 ± 1.14 fL, platelet distribution width (PDW) was 15.69% ± 1.36%, plateletcrit was 0.3% ± 0.07%, and platelet count was 319 ± 44 × 103 cells/mm3. PDW was the best tool to predict double-vessel disease (P < 0.0001), while MPV (P = 0.6146) and PDW (P = 0.0266) were best predictors of triple-vessel disease. Conclusion: Platelet indices that are readily available investigations prescribed by clinicians routinely are significantly associated with blood sugar levels and can predict the severity of CAD in prediabetics in terms of the number of vessels involved. Early assessment of platelet indices in prediabetics can aid in the diagnosis and prognosis of CAD, thereby helping in planning early intervention.

Microalbuminuria is a well-established, strong, and independent risk factor of cardiovascular disease. Patients with microalbuminuria are also said to have a higher atherosclerotic load in the form of multivessel coronary artery disease (CAD) than those who do not. In this study, we tried to correlate microalbuminuria with the severity of CAD. In this cross-sectional study, 100 patients with CAD diagnosed on the basis of coronary angiography were enrolled from August 2019 to August 2021. Triple-vessel CAD was observed in 79.4% of cases with the presence of microalbuminuria compared with 3% of cases without microalbuminuria. The association of microalbuminuria with the severity of disease was statistically significant (P

Introduction Prompt recognition and aggressive management of acute intoxication due to organophosphorus poisoning are essential to minimize the morbidity and mortality. The present study was undertaken to know the prognosis and outcome of organophosphorus poisoning patients with the estimation of low-cost enzymes like the serum amylase level in a population with financial constraints. Methods In this cross-sectional study, we had enrolled 100 cases that had a history of exposure to organophosphorus compounds, and the serum amylase level was measured in all the patients. We assessed the outcome of all the patients in the form of discharge, need of ventilators, intensive care unit stay, and death. Results The mean serum amylase level in discharge patients was 335.40 ± 192.45, and in the patients who died it was 843.37 ± 22.60. It was significant to predict the outcome (t-value 7.07, p-value 0.0001, statistically significant). Conclusion Serum amylase level shows significant correlation with clinical outcomes in organophosphorus poisoning.

Introduction: Obesity, defined on the basis of anthropometric measures is a global epidemic and threatening to healthy population worldwide. A research from China among young adults (20--44 years) recorded six and two times the risk of hypertension (HTN) in individuals who were obese and overweight, respectively, relative to normal weight individuals. This study highlights about anthropometric indices and its association with HTN among young medical students at rural medical college. Methods: In this cross-sectional study, 1,000 medical students had been enrolled. Anthropometric indices like body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), neck circumference (NC) as per South East Asian guidelines were measured in all students. Results: Among young medical students, the prevalence of obesity defined by BMI, WC, WHR, and NC was 46.5%, 32.4%, 57.3%, and 8.4%. Among males, there was significant positive correlation of BMI with SBP (P < 0.0001) and DBP (P < 0.0001), whereas WC (P < 0.0001) and WHR (P = 0.012) had positive and significant correlation with SBP but not with DBP. Correlation of NC with SBP and DBP was negative but did not reach statistical significance (P = 0.266 and P = 0.670, respectively). Among females, there was significant positive correlation of BMI with SBP (P < 0.0001) and DBP (P < 0.0001), WC had significant positive correlation with SBP (P < 0.0001,) and DBP (P < 0.0001). Correlation of WHR was significant with DBP (P = 0.002) but not with SBP (P = 0.055). Conclusion: The prevalence of HTN in this study was 9.8% in young medical students overall and varies according to anthropometric indices. The prevalence rate varies in males and females depending on the anthropometric measures.

Introduction Anion gap (AG) metabolic acidosis is common in critically ill patients. The relationship between initial AG at the time of admission to the medical intensive care unit (MICU) and mortality or length of stay is unclear. This study was undertaken to evaluate this relationship. Materials and Method We prospectively examined the acid–base status of 500 consecutive patients at the time of MICU admission and outcome was measured in terms of mortality, length of ICU stay, need of ventilator, and laboratory parameters. The patients were divided into four stages based on the severity of AG. Outcome based on the severity of AG was measured, and comparisons that adjusted for baseline characteristics were performed. Results This study showed that increased AG was associated with the higher mortality. Patients with the highest AG also had the longest length of stay in the MICU, and patients with normal acid–base status had the shortest ICU length of stays (p < 0.05). Conclusion A high AG at the time of admission to the MICU was associated with higher mortality and length of stays. Initial risk stratification based on AG and metabolic acidosis may help guide appropriate patient disposition (especially in patients without other definitive criteria for MICU admission) and assist with prognosis.

Introduction The red blood cell distribution width (RDW) is a measurement of variations in the size of red blood cells. As the width increases, the rate of mortality also increases, although the reason for it is still not known. On the other hand, platelet distribution width (PDW) is also useful in predicting morbidity and mortality in sepsis and other critically ill patients. In our study, we planned to study the impact of both RDW and PDW and evaluate their prognostic importance with outcome in patients admitted in medicine intensive care unit (MICU). Material and Method In these cross-sectional observational studies, 1,300 patients were included who were admitted in MICU. Critically ill patients were defined on the basis of qSOFA score greater than 2. PDW and RDW were obtained from Coulter report of complete blood count. Parameters included in Acute Physiology and Chronic Health Evaluation (APACHE) IV scores were taken and APACHE IV score was calculated. Correlation of RDW and PDW with outcomes such as length of ICU stay, use of mechanical ventilator, and discharge/death was done. Result The mean RDW (%) for the entire study population was 15.17 ± 3.01. The RDW (%) was significantly on the higher side in patients who succumbed to the disease as compared with the patients who were discharged. The correlation between the length of ICU stay (days) and RDW (%) was moderately positive and was significant (rho = 0.37, p ≤ 0.001). The correlation between the length of ICU stay (days) and PDW (%) was moderately positive and was significant (rho = 0.5, p ≤ 0.001). Conclusion RDW and PDW were found as significant indicators for period of stay in ICU, requirement for mechanical ventilation, and mortality rate in patients admitted to ICUs. As these are simple, easy to conduct, universally available tests, they can be regularly incorporated in patients admitted in ICUs.

Background: The anemia not only negatively affects physical function but also the cognition, mood, and quality of life in adult patients due to hypoxic condition as per its severity. This study has been planned to investigate the cross-section association of anemia with cognitive function in neurologically intact patients. Methods: In this study, a total 200 subjects were enrolled out of which 100 were cases and 100 age and sex matched controls. Mini-mental status examination (MMSE) and short portable mental status questionnaire (SPMSQ) scales were used to assess cognition in all the subjects. Results: This study showed that there was a significant correlation between the anemia and the cognitive skills in the neurologically intact patients. Conclusion: The cognitive functions were strongly related to hemoglobin levels as seen by low MMSE score and higher SPMSQ error in those with low hemoglobin levels compared with those with higher hemoglobin levels.

A 61 year old gentleman had a large renal cyst, thought to be causing a ‘pseudo-hydrocalyx’ leading to recurrent stones. Definitive treatment with laparoscopic deroofing was planned, however intra-operatively this was abandoned due to complex anatomy and scared adherent tissue. Patient went on to have a flexible ureteroscopy and ‘through and through’ puncture of an intrarenal cyst with PCNL to treat his stones and renal cyst simultaneously. CT scan 12 months later showed no new stone formation and no residual cyst. Percutaneous puncture of a renal cyst combined with flexible ureteroscopy is an effective method when treating large renal cysts. Keywords: Holmium laser, Ureteroscopy, Renal stones, Renal cyst

Introduction: Electrocardiography (ECG) is the most common investigation for evaluation of Left Ventricular Hypertrophy (LVH), an important parameter of cardiovascular morbidity and mortality. This can also be evaluated by Echocardiography (Echo), which is superior to ECG but costlier, thus a major constraint in rural set ups. Aim: To correlate the relationship of ECG and Echocardiography for the diagnosis of left ventricular hypertrophy and to find out sensitivity and specificity of various electrocardiographic criteria. Materials and Methods: A total of 500 patients showing left ventricular hypertrophy by any of the mentioned ECG criteria, were enrolled in the study. Eight ECG criteria (Sokolow Lyon index, Romhilt Estes point score system, Talbot Criteria, Roberts’s criteria, Cornell Criteria, McPhie criteria, Casale criteria and Criteria of Koitos & Spodick) and Echocardiogram were taken into account for the diagnosis. The statistical tests were performed using SPSS version 10.0. Diagnostic validity tests such as sensitivity, specificity Positive Predictive Value (PPV), Negative Predictive Value (NPV) and diagnostic accuracy were calculated. Results: Out of 500 patients, 270 (54%) had LVH on Echo which was the gold standard investigation for the diagnosis of LVH in this study. Sokolow Lyon criteria showed sensitivity of 77.78%, specificity of 60.87%, PPV of 70%, NPV of 70% and accuracy of 70%. Comparison of Combined or either one of Sokolow Lyon and Romhilt Estes point score system on ECG with Echo for LVH showed sensitivity of 100%, specificity 60.87%, PPV 75%, NPV 100% and diagnostic accuracy of 82%. Conclusion: Adding two, three or four criteria except Sokolow Lyon and Romhilt Estes point score system does not increase the diagnostic efficacy of the electrocardiography for left ventricular hypertrophy.

INTRODUCTION: Organophosphorus poisoning (OPP) is a major public health problem in developing countries like India. Leukocyte count is a simple and inexpensive test, and elevated count is associated with acute inflammation and increased oxidative stress-like OPP. This study was done to correlate the severity of acute OPP with leukocyte count and also to assess the prognosis. MATERIALS AND METHODS: A prospective, observational clinical study was done on 80 patients suspected of OPP of age >15 years admitted to emergency unit at a tertiary rural teaching health-care center of Central India. Serum cholinesterase level and leukocyte count were estimated at the time of admission in all patients and severity of OPP was assessed according to Peradeniya organophosphorus poisoning (POP) scale. RESULTS: The mean age of the patients was 33.52 years (standard deviation [SD] 11.62) in males and 27.30 years (SD 7.33) in females. Among them, 57 (71.25%) were males and 23 (28.75%) were females. The severity of poisoning was directly correlated with serum cholinesterase level (P = 0.0001). Leukocyte count had a sensitivity of 60%, specificity of 76%, and negative predictive value of 85% if counts were more than 12,000 and 30% sensitivity, 95% specificity, and 80% negative predictive value if counts were more than 15,000 in predicting mortality in patients with OPP. CONCLUSION: Leukocyte count levels on admission can be used a prognostic marker in patients with OP poisoning.

Introduction: Cardiovascular autonomic neuropathy (CAN) is a least understood complication of diabetes which is often underdiagnosed. It causes resting tachycardia, orthostatic hypotension, and exercise intolerance and is associated with higher cardiovascular mortality in diabetic patients. This stresses the need of early diagnosis of CAN to prevent higher mortality rates. Materials and Methods: Fifty cases of diabetes mellitus with no clinical evidence of cardiac disease were subjected to cardiac autonomic function (CAF) tests according to Ewing's criteria which included heart rate (HR) variability during deep breathing, Valsalva maneuver ratio, HR response on standing, blood pressure (BP) response to standing, and BP response to sustained handgrip to find the prevalence of CAN. Results: In this study, among 100 patients (50 case and 50 control), we found CAN in 52%. Out of which, parasympathetic neuropathy was seen in 52% of cases, and sympathetic neuropathy was seen in 26% of cases. CAF tests of HR variability during deep breathing, Valsalva maneuver ratio, HR response to standing, BP response to standing, and BP response to sustained handgrip found abnormal response in 68%, 40%, 52%, 12%, and 14%, respectively. Diabetic retinopathy and nephropathy were significantly associated with CAN (P = 0.0001, S). Conclusion: Prevalence of CAN among diabetics was 52%, and parasympathetic CAF tests are more sensitive for the detection of CAN than sympathetic CAF tests. Development of CAN in diabetic patients may lead to increased morbidity; thence, they should be routinely evaluated for CAN using these bedside tests.

Hydatid Cyst (HC) disease is a zoonotic infection caused by larval stage of Echinococcus granulosus. The disease poses an important public health hazard not only because it is endemic to many parts of the world but also because of migration and travel related spread. HC may develop in almost any part of the body, most commonly found in the liver, followed in frequency by the lung, kidney, brain and bone. Involvement of other organs is rare. In this case report, we describe a rare occurrence i.e., primary HC of pancreas along with review of literature and possible differential diagnosis. Pancreatic HC disease may be associated with complications such as jaundice, cholangitis, and pancreatitis which develop as a result of fistulization of the cyst content into pancreato-biliary ducts or external compression of those ducts by the cyst. Pancreatic HC may mimick pseudocyst or cystic neoplasm of pancreas such as cystadenoma, intraductal papillary mucinous neoplasm, cystic islet cell tumour etc.

In this study, a rectenna operating at the GSM-900 frequency band has been fabricated and tested. This rectenna composed of a 2 × 1 T-shaped monopole array antenna and an energy processing circuit. In order to reduce the gap between adjacent antenna elements in the array structure, the proposed array antenna uses a ground stub. Compared with other array antennas, the proposed array antenna with the ground stub reduces the size up to 50% without affecting the gain and bandwidth. An antenna prototype is fabricated and experimentally tested. The measured antenna's gain and bandwidth are 3.2 and 152 MHz, respectively, hence showing its suitability for radio-frequency (RF) energy harvesting application. For this to be feasible, the developed array antenna is matched with the rectifier at GSM-900 using a single stub matching network. The measured result demonstrates that the proposed rectifier circuit offers the conversion efficiency of 21.2 and 63.6% for an input power of −20 and 0 dBm, respectively. Finally, the rectifier performance is attested experimentally with the developed array antenna. The rectenna's measured RF-to-dc conversion efficiency was found to be 60% at the far-field distance from the transmitting antenna.

A novel compact rectifier for dual-band operation in the RF energy harvesting is presented. The circuit comprises a 4th order dual-band impedance matching and a single-series circuit with one double diode, both are integrating into a compact shape to occupy a small area of $ 30\times 35 \, \text{ mm}^{2} $. The merit of the proposed rectifier circuit is that it can be extended to n number of the frequency band by using only $ 2\times n $ matching elements. To validate the design method experimentally, a prototype of a dual-band rectifier is fabricated for two public telecommunication bands of GSM-900 and 1800. In order to reduce the circuit complexity and sensitivity arising due to lumped elements, the meander line and the open stub are used to realize the proposed circuit. A good agreement is obtained between the simulation and the measurement. The measured results show that the proposed rectifier circuit exhibits the conversion efficiency of 25.7 and 65% for an input power of $ -20 $ and 0 dBm, respectively. In addition, diode nonlinearity which affects the performance of the rectifier in terms of impedance matching is also investigated.

Objective: To understand the temporal trends in mortality in Rural Central India. Design: Retrospective review of physician issued death certificates from a rural teaching hospital. Materials and Methods: Physician issued death certificates from 1979 to 2008, available with a rural teaching hospital were analyzed and information on age, gender, date, and cause of death was abstracted. We estimated cause-specific, proportional mortality ratio (PMR) stratified by age, and gender. We compared the difference in PMR in first fifteen years of the study period (period A, 1979-1993) with the later (period B, 1994-2008). Results: We found 20494 death certificates between 1979 and 2008. Proportion of infectious disease related mortality declined from 35% in 1979-1983-26% in 2004-2008. In the same periods, injury related mortality increased from 4.6% to 13.4%, and chronic disease mortality from 19% to 28%. The absolute difference in PMR (per 1000 deaths) was statistically significant between period B and period A, for infections (a decline of 80.67 [95% CI 66.97-94.03]), chronic diseases (an increase of 45.85 [95% CI 33.49-58.55]), and injuries (an increase of 42.98 [95% CI 33.87-52.26]). Conclusion: Temporal trend in mortality from a single hospital in rural Central-India over the past three decades shows decline in infectious diseases, and rise in injuries and chronic diseases.

Lymphoma of the peripheral nerve, particularly of the T-cell variety, is an extremely rare subtype of extra nodal lymphoma that has a variable response to current therapeutic regimens. Here, we present a patient with natural killer (NK)/T-cell lymphoma in remission who presented with a two-month history of right forearm swelling and paresthesia in the ulnar nerve distribution. Magnetic resonance imaging (MRI) showed an ulnar nerve mass identified as a nerve sheath tumor. Frozen section and postresection biopsies showed an Epstein-Barr virus-positive NK/T-cell lymphoma, nasal type. Consequently, the patient received chemotherapy following resection. Four months later, the patient developed a proximal leg mass, which was diagnosed as tibial nerve lymphoma. The patient was then treated with chemotherapy and follow-up was done by positron emission tomography-computed tomography (PET-CT). In conclusion, lymphoma should be considered in the differential diagnosis of a peripheral nerve mass. MRI is a useful imaging tool together with PET-CT, which plays a beneficial role in the follow-up of

A pilot study was done in 18 adults to assess the significance of ureteral dilatation having no apparent cause seen on Intravenous Urography (IVU). A clinicoradiological evaluation was undertaken to evaluate the cause of ureteral dilatation, including laboratory investigations and sonography of the genitourinary tract. This was followed, if required, by CT Urography (using a modified technique). In 9 out of 18 cases, the cause of ureteral dilatation on laboratory investigations was urinary tract infection (6) and tuberculosis (3). In the remaining 9 cases, CTU identified the cause as extrinsic compression by a vessel (3), extrinsic vascular compression of the ureter along with ureteritis (2), extrinsic vascular impression on the right ureter and ureteritis in the left ureter (1), ureteral stricture (2), and ureteral calculus (1). Extrinsic vascular compression and strictures did not appear to be clinically significant in our study. Hence, ureteral dilatation without any apparent cause on intravenous urogram was found to be clinically significant in 12 out of 18 (66.6%) cases. We conclude that ureteral dilatation with no apparent cause on IVU may indicate urinary tract tuberculosis, urinary tract infection (E. coli), or a missed calculus. Thus, cases with a dilated ureter on IVU, having no obvious cause, should undergo a detailed clinicoradiological evaluation and CTU should be used judiciously.

Vitamin D functions as a prohormone that promotes bone mineralization by regulating calcium and phosphate levels in the skeletal system. It is a fat-soluble vitamin that is required for immunomodulation, cytokine regulation, and cell proliferation. As a result, Vitamin D is a powerful hormone with pleiotropic effects that improve overall health. Sepsis is the leading cause of death in critically unwell people. According to a recent study, numerous trace minerals and nutrients have the ability to alter the human body, and supplementing these nutrients can improve the prognosis of sepsis patients. A considerable number of patients in the intensive care unit (ICU) have low vitamin D levels, a frequent condition that can increase the risk of infectious diseases. According to various studies, severely ill patients admitted to the ICU who have a vitamin D deficiency are at a higher risk of requiring mechanical ventilation and facing a higher likelihood of mortality. Nonetheless, the connection between insufficient vitamin D levels and mortality in sepsis patients remains a topic of debate.