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Summary Background Oral anticoagulation reduces the rate of systemic embolism for patients with atrial fibrillation by two-thirds, but its benefits for patients with previous intracranial haemorrhage are uncertain. In the Start or STop Anticoagulants Randomised Trial (SoSTART), we aimed to establish whether starting is non-inferior to avoiding oral anticoagulation for survivors of intracranial haemorrhage who have atrial fibrillation. Methods SoSTART was a prospective, randomised, open-label, assessor-masked, parallel-group, pilot phase trial done at 67 hospitals in the UK. We recruited adults (aged ≥18 years) who had survived at least 24 h after symptomatic spontaneous intracranial haemorrhage, had atrial fibrillation, and had a CHA2DS2-VASc score of at least 2. Web-based computerised randomisation incorporating a minimisation algorithm allocated participants (1:1) to start or avoid long-term (≥1 year) full treatment dose open-label oral anticoagulation. The participants assigned to start oral anticoagulation received either a direct oral anticoagulant or vitamin K antagonist, and the group assigned to avoid oral anticoagulation received standard clinical practice (antiplatelet agent or no antithrombotic agent). The primary outcome was recurrent symptomatic spontaneous intracranial haemorrhage, and was adjudicated by an individual masked to treatment allocation. All outcomes were ascertained for at least 1 year after randomisation and assessed in the intention-to-treat population of all randomly assigned participants, using Cox proportional hazards regression adjusted for minimisation covariates. We planned a sample size of 190 participants (one-sided p=0·025, power 90%, allowing for non-adherence) based on a non-inferiority margin of 12% (or adjusted hazard ratio [HR] of 3·2). This trial is registered with ClinicalTrials.gov (NCT03153150) and is complete. Findings Between March 29, 2018, and Feb 27, 2020, consent was obtained at 61 sites for 218 participants, of whom 203 were randomly assigned at a median of 115 days (IQR 49–265) after intracranial haemorrhage onset. 101 were assigned to start and 102 to avoid oral anticoagulation. Participants were followed up for median of 1·2 years (IQR 0·97–1·95; completeness 97·2%). Starting oral anticoagulation was not non-inferior to avoiding oral anticoagulation: eight (8%) of 101 in the start group versus four (4%) of 102 in the avoid group had intracranial haemorrhage recurrences (adjusted HR 2·42 [95% CI 0·72–8·09]; p=0·152). Serious adverse events occurred in 17 (17%) participants in the start group and 15 (15%) in the avoid group. 22 (22%) patients in the start group and 11 (11%) patients in the avoid group died during the study. Interpretation Whether starting oral anticoagulation was non-inferior to avoiding it for people with atrial fibrillation after intracranial haemorrhage was inconclusive, although rates of recurrent intracranial haemorrhage were lower than expected. In view of weak evidence from analyses of three composite secondary outcomes, the possibility that oral anticoagulation might be superior for preventing symptomatic major vascular events should be investigated in adequately powered randomised trials. Funding British Heart Foundation, Medical Research Council, Chest Heart & Stroke Scotland.

Summary Background Surgical site infection (SSI) is the most common postoperative complication worldwide. WHO guidelines to prevent SSI recommend alcoholic chlorhexidine skin preparation and fascial closure using triclosan-coated sutures, but called for assessment of both interventions in low-resource settings. This study aimed to test both interventions in low-income and middle-income countries. Methods FALCON was a 2 × 2 factorial, randomised controlled trial stratified by whether surgery was clean-contaminated, or contaminated or dirty, including patients undergoing abdominal surgery with a skin incision of 5 cm or greater. This trial was undertaken in 54 hospitals in seven countries (Benin, Ghana, India, Mexico, Nigeria, Rwanda, and South Africa). Patients were computer randomised 1:1:1:1 to: (1) 2% alcoholic chlorhexidine and non-coated suture, (2) 2% alcoholic chlorhexidine and triclosan-coated suture, (3) 10% aqueous povidone–iodine and non-coated suture, or (4) 10% aqueous povidone–iodine and triclosan-coated suture. Patients and outcome assessors were masked to intervention allocation. The primary outcome was SSI, reported by trained outcome assessors, and presented using adjusted relative risks and 95% CIs. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT03700749. Findings Between Dec 10, 2018, and Sept 7, 2020, 5788 patients (3091 in clean-contaminated stratum, 2697 in contaminated or dirty stratum) were randomised (1446 to alcoholic chlorhexidine and non-coated suture, 1446 to alcoholic chlorhexidine and triclosan-coated suture, 1447 to aqueous povidone–iodine and non-coated suture, and 1449 to aqueous povidone–iodine and triclosan-coated suture). 14·0% (810/5788) of patients were children and 66·9% (3873/5788) had emergency surgery. The overall SSI rate was 22·0% (1163/5284; clean-contaminated stratum 15·5% [454/2923], contaminated or dirty stratum 30·0% [709/2361]). For both strata, there was no evidence of a difference in the risk of SSI with alcoholic chlorhexidine versus povidone–iodine (clean-contaminated stratum 15·3% [223/1455] vs 15·7% [231/1468], relative risk 0·97 [95% CI 0·82–1·14]; contaminated or dirty stratum 28·3% [338/1194] vs 31·8% [371/1167], relative risk 0·91 [95% CI 0·81–1·02]), or with triclosan-coated sutures versus non-coated sutures (clean-contaminated stratum 14·7% [215/1459] vs 16·3% [239/1464], relative risk 0·90 [95% CI 0·77–1·06]; contaminated or dirty stratum 29·4% [347/1181] vs 30·7% [362/1180], relative risk 0·98 [95% CI 0·87–1·10]). With both strata combined, there were no differences using alcoholic chlorhexidine or triclosan-coated sutures. Interpretation This trial did not show benefit from 2% alcoholic chlorhexidine skin preparation compared with povidone–iodine, or with triclosan-coated sutures compared with non-coated sutures, in preventing SSI in clean-contaminated or contaminated or dirty surgical wounds. Both interventions are more expensive than alternatives, and these findings do not support recommendations for routine use. Funding National Institute for Health Research (NIHR) Global Health Research Unit Grant, BD.

We investigate the magnetization reversal of single-domain magnetic nanoparticle driven by the circularly polarized cosine chirp microwave pulse (CCMP). The numerical findings, based on the Landau–Lifshitz–Gilbert equation, reveal that the CCMP is by itself capable of driving fast and energy-efficient magnetization reversal. The microwave field amplitude and initial frequency required by a CCMP are much smaller than that of the linear down-chirp microwave pulse. This is achieved as the frequency change of the CCMP closely matches the frequency change of the magnetization precession which leads to an efficient stimulated microwave energy absorption (emission) by (from) the magnetic particle before (after) it crosses over the energy barrier. We further find that the enhancement of easy-plane shape anisotropy significantly reduces the required microwave amplitude and the initial frequency of CCMP. We also find that there is an optimal Gilbert damping for fast magnetization reversal. These findings may provide a pathway to realize the fast and low-cost memory device.

We investigate the influence of shape anisotropy on the magnetization reversal of a single-domain magnetic nanoparticle driven by a circularly polarized linear down-chirp microwave field pulse (DCMP). Based on the Landau-Lifshitz-Gilbert equation, numerical results show that the three controlling parameters of DCMP, namely, microwave amplitude, initial frequency and chirp rate, decrease with the increase of shape anisotropy. For certain shape anisotropy, the reversal time significantly reduces. These findings are related to the competition of shape anisotropy and uniaxial magnetocrystalline anisotropy and thus to the height of energy barrier which separates the two stable states. The result of damping dependence of magnetization reversal indicates that for a certain sample shape, there exists an optimal damping situation at which magnetization is fastest. Moreover, it is also shown that the required microwave field amplitude can be lowered by applying the spin-polarized current simultaneously. The usage of an optimum combination of both microwave field pulse and current is suggested to achieve cost efficiency and faster switching. So these findings may provide the knowledge to fabricate the shape of a single domain nanoparticle for the fast and power-efficient magnetic data storage device.

This study was conducted to see the frequency of hormone receptors and Her-2/Neu positivity in different histology in breast cancer patients.It was a cross-sectional study conducted at the Department of Medical Oncology, Jinnah Postgraduate Medical Centre from June 2018- March 2019. Total 373 patients of age 22-81 years of which 360 female and 13 males, with histopathological proven diagnosis of breast cancer were included in the study using non-probability consecutive sampling technique. The immunohistochemistry (IHC) was performed on biopsy sample for the status of PR, ER and HER-2/Neu and the confirmation of Her-2/Neu was done by Fluorescent In situ Hybridization (FISH) technique if HER-2/Neu was equivocal by IHC testing. Information regarding demographics, family history, histology, grade, stage, metastatic site and other histopathological parameters were noted on predesigned proforma by the researcher. SPSS-23 was used to analyse data.Total of 373 patients were included in the study. The mean patient age was 45.34±12.28 years. ER, PR, Her 2 Neu (IHC)Her 2 Neu (FISH) were found positive in 206 (55.2%), 182 (48.8%), 121 (32.4%)23 (6.2%) patients, respectively. The histology with PR receptorgrade of tumour with ERPR receptor showed statistical significance (p0.05).ER, PRHER-2/NEU expressions in breast cancer vary among different population and it is very important to find out the frequency among different histopathological types as it is of predictive and prognostic value. So, it is recommended to look for these markers and treat them accordingly.

In deep neural network (DNN) inference, researchers have been trying to reduce the number of computations and connections without performance degradation, departing from a bit-parallel to a bit-serial mode of arithmetic. In this regard, approximations translated as the mixed-precision profile for among-layer-mixed-precision through bit-serial architecture have been adopted in the literature. However, the introduction of within-layer mixed precision through controlled approximations for low-latency DNN architecture is yet to be studied. For DNN inference in this study, we apply an unconventional computation technique of online arithmetic, which serially generates the most significant digits first(MSDF) and then terminates computation according to the required precision. Specifically, Taylor expansion-based sensitivity analysis guides the within-layer-mixed-precision method for the choice of approximation intensity (desired bits) for weights and activations of convolutional layers. In turn, the within-layer-mixed-precision method drives the termination of the convolution operation carried out using an online multiplier. Hence, we aim to reduce the data footprint by early terminations achieved thanks to the insightful nature of within-layer-mixed-precision instead of among-layer-mixedprecision for online convolution. In this manner, convolution operations compute not-more-than-necessary most significant digits to overcome the bottleneck of data footprint for in-demand edge computing devices.

Management of temporomandibular joint (TMJ) ankylosis is mainly through surgical intervention. Interpositional materials are a necessity when it comes to prevention of TMJ re-ankylosis after arthroplasty. Early aggressive postoperative physiotherapy is essential for the prevention or treatment of TMJ hypomobility or ankyloses. Recently, it has been shown that abdominal dermis fat helps promote smooth, pain-free joint function and it is stable after interposition and less prone to fragmentation. The purpose of this study was to assess that whether dermal fat is a good choice of interpositional material when it comes to decreased pain perception during aggressive physiotherapy after release of ankyloses thus ensuring good compliance by the patient. We also assessed the fate of the graft material on computed tomography to evaluate any volume changes if occurred after interposition.

This study was conducted to determine the frequency of amenorrhea after chemotherapy among breast cancer patients".Total 201 premenopausal females (having menstruation during the past 6 months at the time of diagnosis) of age 15-45 years and had confirmed diagnosis of breast cancer requiring chemotherapy were included in the study using non-probability consecutive sampling technique. Amenorrhea within 6 months after the completion of chemotherapy was labelled as chemotherapy induced amenorrhea. Data was entered and analysed using SPSS-23.The mean age of the patients was reported as 37.06±5.68 years. Majority of the females were married (86.6%)multigravida (81.1%). Most of the patients (23.9%) received neoadjuvant chemotherapy followed by surgery and radiotherapy. A total of 129 patients received Adriamycin plus cyclophosphamide followed by paclitaxel as chemotherapy regimen. Out of 201 females, 184 (91.5%) experienced amenorrhea after start or completion of chemotherapy.The frequency of CIA was very high among breast cancer patients in our study, long term follow-up is needed to see input of CIA on future fertility.

Acute myeloid leukaemia (AML) is malignant neoplasms of myeloid cells categorized by clonal expansion of hematopoietic blasts of myeloid lineage in peripheral blood and bone marrow. The aim of current study is to identify the common cytogenetic abnormalities in AML patients presenting at a tertiary care hospital of Pakistan.It was a cross-sectional study conducted at the department of Medical oncology of the Jinnah Postgraduate Medical Center, Karachi from Jun 2017- Jan 2019. The non-probability consecutive sampling technique was used to select patients. Total 92 cases of AML of age 15-55 years of either gender were included in the study. The detection of cytogenetic abnormality was done on the bone marrow biopsy. The cytogenetic abnormalities were classified into the three cytogenetic risk groups as favourable, intermediate and unfavourable. For analysis of data SPSS 23 version was used.The cytogenetic abnormalities were detected in 34 (37%) of the AML patients while 58 (63%) patients had normal cytogenetic. Thirty-two females (34.8%) had a normal cytogenetic (46; XX), and 15 females (16.3%) had various cytogenetic abnormalities. Twenty-six males (28.3%) had normal cytogenetic (46; XY) and 19 males (20.7%) had various cytogenetic abnormalities. Most of the patients were in intermediate risk group (67.4%), followed by favourable (17.4%) and unfavourable risk group (15.2%). The most frequent chromosomal abnormalities observed were complex cytogenetic which was detected in 5 AML patients.In the present study cytogenetic abnormalities were found in 37% of AML patients. Sixty-seven of the AML patients were in intermediate risk group and five patients had complex cytogenetic. Hence the cytogenetic analysis provides significant information regarding prognosis of AML patients and the cytogenetic abnormalities are less than international literature.

This work focuses on the usability of Ultraviolet (UV) on humans as an economical way of contesting against COVID-19. Specifically, far-UVC is presented as a promising candidate against COVID-19 since it can inactivate pathogens including viruses and bacteria without harming mammalian skin or eyes. Furthermore, the work also points out the applicability of far-UVC lights for public spaces and treatment of selective region in COVID-19 patients by using fiberoptic as the medium for high-risk cases where chances of survival are low and such treatment may avoid fatality due to the COVID-19.

Approximate triple modular redundancy (ATMR) is sought for logic masking of soft errors while effectuating lower area overhead than conventional TMR through the introduction of approximate modules. However, the use of approximate modules instigates reduced fault coverage in ATMR. In this work, we target better design tradeoffs in ATMR by proposing a heuristic method that effectively utilizes a threshold for unprotected input vectors to generate good enough combinations of approximate modules for ATMR, which accomplishes higher fault coverage and reduced area overhead compared with previously proposed approaches. The key concept is to employ logic optimization techniques of prime implicant (PI) expansion and reduction for successively obtaining approximate modules such that the combination of three approximate modules appropriately functions as an ATMR. For an ATMR to function appropriately, blocking is used to ensure that at each input vector, through the prime implicant (PI) expansion and reduction technique, only one approximate module differ from the original circuit. For large circuits, clustering is utilized and comparative analysis indicates that higher fault coverage is attained through the proposed ATMR scheme while preserving the characteristic feature of reduced area overhead. With a small percentage of unprotected input vectors, we achieved substantial decrease in transistor count and greater fault detection, i.e., an improvement of up to 26.1% and 42.1%, respectively.

Objectives: This study aims at investigating lime and wheat straw as a chemical approach to improve clayey soils as an alternative to the traditional physical process of soil improvement. Methods/Statistical Analysis: A series of tests were conducted on clayey soils mixed with various percentages of lime and wheat straw. The readings were taken on the daily, weekly and monthly basis. The soil and water sample testing was based on pH, TDS, water hardness, Organic Content (OC) and Electrical conductivity (EC). Findings: The test results suggest that there are significant chemical changes resulting due to the addition of lime and/or wheat straw into the water and soil. An increase in pH, TDS and organic contents and a decrease in the electrical conductivity of soil was noticed both in short-term and long-term effects. The results indicate that by knowing chemical process some of the undesirable chemical changes could be seized to only permit the useful chemical changes in a particular process of the addition of soil stabilizing agents. Moreover, it has been noticed that a single soil stabilizing agent may not be sufficient to improve several engineering properties; therefore, combined soil stabilization techniques might be adopted for a wider range of soil improvement where necessary. Application/Improvements: The outcomes of present study would be of potential applications in the ground improvement field. The outcomes provide useful information about the chemical changes involved in process of ground improvement. Keywords: Chemical Analysis, Decomposition, Reinforced Soil, Soil Stabilization

Background: The presence of myeloid-derived inflammation is associated with different malignancies, including Leukemia. Certain risk factors (i.e., age, exposure to carcinogens including chemical and radiation), common gene mutations (such as the BCR-ABL fusion gene), and inflammatory markers (such as C-reactive protein (CRP)) have been associated with the risk of developing Leukemia, however cost-effective and widely acceptable predictor markers are not yet available. This study aimed to investigate the association of standard laboratory inflammatory biomarkers and blood cell counts and the long-term risk of Leukemia in a cohort of healthy individuals. Methods: Individuals from the Swedish Apolipoprotein Risk Study (AMORIS) cohort (n=124609, Male 56.7% vs. Female 43.3 ,>20 years of age) with baseline measurements of C-reactive protein (CRP), albumin, haptoglobin, white blood cell count, mean corpuscular volume (MCV) and platelets were included in the study. Multivariable cox proportional hazard regression analysis adjusted for age, sex, comorbidities (CCI), and socioeconomic status was performed to assess the association of the biomarkers and leukemia diagnosis (ICD-7 (204) Swedish National Cancer Register linkage). Individuals with a leukemia diagnosis within a year of the blood measurement were excluded to account for reverse causation. Considering the time of diagnosis and version of ICD, which was used, it was not possible to stratify patients based on current leukemia classification, including myeloid/ lymphoid or acute/ chronic. Results: A total of 218 participants (0.2%) developed leukemia over a median follow-up time of 17.54 years. Albumin (leukemia free mean=43.23 vs leukemia mean=42.90 (g/l); p Conclusion: The present study presented a positive association between increasing albumin levels and high numbers of WBC and risk of Leukemia, while a negative association was found with high platelet counts, which highlight these markers as potential markers of long-term risk of Leukemia. The potential clinical use of these markers in the early detection of leukemia needs to be evaluated in further studies. Disclosures Kordasti: Alexion: Honoraria; Beckman Coulter: Honoraria; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Research Funding.

The incidence of seizure in first year of life is very high. Considerable research on neonatal seizures has been done; however information regarding the profile of patients with first time seizure in the age group of 1 to 12 months is scarce. Our study was a prospective observational study undertaken at a tertiary pediatric care hospital in north India with objectives of finding the epidemiological, clinical, and aetiological profile of patients in the age group of 1 to 12 months presenting with first time seizure and to ascertain their electroencephalography (EEG) and imaging findings. Seizure recurrence and developmental delay was also studied during the first six months post seizure. Fifty patients were included in the study. There were 31 male patients (62%) and 19 female patients (38%). Mean age at seizure occurrence was 5.3 ±2.1 months. Forty one patients (82%) presented with generalized tonic seizures. Only two patients (4%) had focal seizures. Seizures in 7 patients (14%) could not be classified. Electroencephalography and brain imaging were done in 42 patients as indicated. Among these 42 patients, EEG abnormalities were noted in 15 patients (35.7%), while imaging abnormalities were noted in 10 patients (23%). Fifteen patients (35.7%) were found to have developmental delay on follow-up. 16 (38%) patients developed recurrence of seizures. Statistical analysis revealed significant association between abnormal imaging and developmental delay at six months and seizure recurrence within six months of first seizure, however the association with abnormal EEG was not statistically significant.

Area overhead reduction in conventional triple modular redundancy (TMR) by using approximate modules has been proposed in the literature. However, the vulnerability of approximate TMR (ATMR) in the case of a critical input, where faults can lead to errors at the output, is yet to be studied. Here, identifying critical input space through automatic test pattern generation and making it unavailable for the technique of approximating modules of TMR (ATMR) were focused, which involves a prime implicant reduction expansion. The results indicate that the proposed method provides 75–98% fault coverage, which amounts up to 43.8% improvement over that achieved previously. The input vulnerability-aware approach enables a drastic reduction in search space, ranging from 41.5 to 95.5%, for the selection of candidate ATMR modules and no compromise on the area overhead reduction is noticed.

Approximate Triple Modular Redundancy has been proposed in the literature to overcome the area overhead issue of Triple Modular Redundancy (TMR). The outcome of TMR/Approximate TMR modules serves as the voter input to produce the final output of a system. Because the working principle of Approximate TMR conditionally allows one of the approximate modules to differ from the original circuit, it is critical for Approximate TMR that a voter not only be tolerant toward its internal faults but also toward faults that occur at the voter inputs. Herein, we present a novel compact voter for Approximate TMR using pass transistors and quadded transistor level redundancy to achieve a higher fault masking. The design also targets a better Quality of Circuit (QoC), a new metric which we have proposed for highlighting the ability of a circuit to fully mask all possible internal faults for an input vector. Comparing the fault masking features with those of existing works, the proposed voter delivered upto 45.1%, 62.5%, 26.6% improvement in Fault Masking Ratio (FMR), QoC, and reliability, respectively. With respect to the electrical characteristics, our proposed voter can achieve an improvement of up to 50% and 56% in terms of the transistor count and power delay product, respectively.

Objectives Thiamine deficiency (TD) is frequently suspected and treated at our hospital. In our retrospective study, we aimed at finding the clinical and laboratory spectrum of infantile TD presenting to a single center over a period of time. Methods The diagnosis was made on criterion standard of response to thiamine challenge. Results TD was suspected in 189 infants at admission; 43 infants were diagnosed as having TD in three distinct forms and a fourth group with mixed presentation. The first group (n = 30), which was the youngest (mean age = 67 d), was always associated with lactic acidosis. They had history of reflux and suddenly became irritable and developed acidotic breathing. This further worsened into shock (46%) and acute respiratory failure (50%). The second group (n = 5) presented with pulmonary arterial hypertension. They had hoarseness of voice and irritability. Chest radiograph showed prominent pulmonary conus. Their clinical course was complicated by congestive heart failure in three. Echocardiographic response to thiamine was uniformly seen within 3 d in this group. The clinical presentation of infants with Wernicke's encephalopathy (n = 5) who were the oldest of all (mean age = 190 d) was constantly marked by presence of bilateral ptosis and encephalopathy preceded by occurrence of vomiting. Their head ultrasonography showed presence of hyperechoic basal ganglia. Conclusions Three clinically distinct forms of TD were recognized. Lactic acidosis was a universal finding in acidotic form. Infants with pulmonary hypertension as primary presentation are typically associated with aphonia. Infants with Wernicke's encephalopathy can be clinically diagnosed by presence of encephalopathy and ophthalmic signs (ptosis).

A major concern for the Indian Construction industry is its negligence of energy efficiency aspects of the various building projects being undertaken nowadays. Moreover, it is a concern for the citizens as well. Heat island and climate change phenomenon has led to a massive increment in the ambient temperatures, intensified reliance on energy resources, created discomfort conditions. By 2030, India’s dependence on energy imports is expected to exceed 53% of the country’s total energy consumption [5]. As growth is inevitable, a multifaceted and scalable solution is needed to temper the environmental impacts of growing cities. The growth in the cities leads to hot urban environments. The temperature variation between urban areas and adjacent rural areas is called the “heat island phenomenon”. It is found that the heat island phenomenon triples the peak electricity demand, doubles the building’s cooling load, and reduces the mechanical cooling system’s coefficient of performance by 25% [5]. To ease our lives in such a climate we need to invent the cooling techniques and those too are energy and cost-efficient. Many of the environmentalists and architects are putting forward their contributions toward it, suggesting solutions to make use of more and more sustainable systems of energy not like those being practiced in earlier times like courtyards and cavities but newer techniques which merges out with the present form of architecture, few of which are namely, the green roof techniques, terracotta pot, outdoor cooling systems. In this paper, we have analysed the Academic Block 4 building of our college and estimated the size of an outdoor cooling plant based on weather data, occupancy, and constructional details of the building such as heat absorbed by various facades due to internal and solar gains, etc.

Background: Enteric fever is a common public health problem with variable clinical presentation. The aim of study was to study the clinical spectrum of enteric fever in children.Methods: This was a prospective study conducted over period of one year from January 2019 to January 2020 in the Department of Paediatrics at Govt Medical College Srinagar. It included all patients in the age group of 1-18 years who were clinically suspected to have enteric fever and had either a positive blood culture for Salmonella or a positive Widal test.Results: This study included total of 76 patients out of which 36 were males and 40 were females. The most common presenting symptoms were fever anorexia, vomiting, diarrohea, abdominal pain, headache and constipation. The most common signs were coated tongue, toxic look, hepatomegaly, splenomeagly, pallor, jaundice and abdominal distension. Complications were seen in in 8 (10.5%) patients. Myocarditis was seen in 3 patients. Encephalopathy and hepatitis was seen in 2 patients each. Pneumonia was seen in 1 patient. Majority of patients had normal white blood cell count (4000-11000/cumm). Leukopenia (11000/cumm) was seen in 15% patients. Thrombocytopenia was seen in 9% patients. Blood culture was positive in 36 (47.36%) patients. Salmonella typhi was seen in 33 patients whereas Salmonella paratyphi A was seen in 3 patients. All culture positive cases were sensitive to ceftriaxone, cefixime and azithromycin. Ciprofloxacin resistance was seen in 11 (14.4%) patients.Conclusions: Enteric fever is a common public health problem with fever as most common presenting symptom. Culture yield can be increased in enteric fever by drawing blood culture prior to administration of antibiotics. Ceftriaxone is highly efficacious as monotherapy in enteric fever.

Background: Severe Acute Malnutrituon (SAM) is a form of malnutrition where there is an imminent threat of death to the child. The chances of complications are very high and in most case child requires hospitalization for stabilization and rehabiliatation. Objective of study the clinicoepidemiological and laboratory profile of children with severe acute malnutrition (SAM) admitted to a Nutritional Rehabilitation Centre (NRC) of our hospital.Methods: A retrospective chart review of admitted patients. Nutritional Rehabilitation centre (NRC) at GB Pant Hospital Government Medical College Srinagar over a one year period between June 2017 and June 2018.Results: Total of 187 patients of SAM was admitted in NRC during the study period. One hundred and eight (57.7%) were males and 79(42.3%) were females .Patients were equally among various districts. Infants (

Recently, concurrent error detection enabled through invariant relationships between different wires in a circuit has been proposed. Because there are many such implications in a circuit, selection strategies have been developed to select the most valuable implications for inclusion in the checker hardware such that a sufficiently high probability of error detection ( P d e t e c t i o n ) is achieved. These algorithms, however, due to their heuristic nature cannot guarantee a lossless P d e t e c t i o n . In this paper, we develop a new input-aware implication selection algorithm with the help of ATPG which minimizes loss on P d e t e c t i o n . In our algorithm, the detectability of errors for each candidate implication is carefully evaluated using error prone vectors. The evaluation results are then utilized to select the most efficient candidates for achieving optimal P d e t e c t i o n . The experimental results on 15 representative combinatorial benchmark circuits from the MCNC benchmarks suite show that the implications selected from our algorithm achieve better P d e t e c t i o n in comparison to the state of the art. The proposed method also offers better performance, up to 41.10%, in terms of the proposed impact-level metric, which is the ratio of achieved P d e t e c t i o n to the implication count.

Aggressive scaling of circuits to achieve smaller feature sizes has led to an increased concern about their reliability as small scale circuits age faster. Thus, an increase in the number of computational errors due to defects is expected in the nanoscale dimensions. Concurrent error detection techniques including logic implication-based checking can detect a partial number of these errors at lower area costs. In this paper, we evaluate the performance of this mode of error detection in implemented circuits, specifically FPGA circuits where it is possible for a single fault to affect multiple logic paths. Fault injection experiments show that the probability of error detection achieved for circuits that are implemented in FPGAs is significantly less than that predicted by fault simulations on their corresponding netlists, almost by half. It is thus shown that the efficiency of implication relationships in detecting errors not only varies from one circuit to another but that it also depends largely on the implementation of the circuit under test as supported through analytic analyses and experimental results.

Background: Bacterial vaginosis (BV) is thought to be an important risk factor and predictor of preterm labour. Prevention and early detection and treatment of BV can decrease the incidence of preterm labour. Primary objective of this study was to find out correlation of bacterial vaginosis with preterm labour. Secondary objectives were determination of most important criterion among the Amsels criteria and risk factors for BV among literacy, residence and parity. Methods: A Case-control study carried out at a tertiary care hospital in north India. 100 women with preterm labour and 200 women with term labour after fulfilling inclusion criteria were enrolled as cases and controls respectively. Epidemiological and clinical details were recorded. Bacterial vaginosis was diagnosed by Amsels criteria. Prevalence in both groups was calculated. Statistical analysis was then done to find out association between bacterial vaginosis and preterm labour. Results: Among all women enrolled 94 had bacterial vaginosis. The overall prevalence of bacterial vaginosis in both groups combined was 31.33%. It was 42% in cases and 26% in controls. The difference was statistically significant (p=0.007). Whiff test emerged as the strongest criterion if used alone with a sensitivity of 98% and specificity of 81% when compared to whole Amsels criteria. Bacterial vaginosis was found more in illiterate women and those who had given birth previously. Conclusions: Bacterial vaginosis is significantly more prevalent in women with preterm labour. Whiff test can be used alone in centres where the patient load is too high. Illiteracy is a risk factor that can be modified to bring down incidence of bacterial vaginosis.

Stroke Medicine being an independent and recognised sub-specialty in the United Kingdom, is faced with unique challenges across District and Rural Hospitals. Delivering a comprehensive stroke service in the rural areas requires collaborative team work, effective communication, pre planning and efficient leadership. In this article we have summarized these challenges and shared some proposals for future development of a holistic and integrated Stroke Service in district hospitals across United Kingdom.

Background: Diarrheal disorders along with dysentery constitute the second killer infections in childhood. In fact, more than half of the dysentery cases are recorded in children under 9 years of age. Shigella infection comprises well over 60% of dysentery cases in age group of 6 month to 5 years. Shigella flexneri is the commonest etiology encountered in developing nations. E. coli and campylobacter comprises the second important bacterial isolates in childhood dysentery. The objective of this study was to ascertain the clinical spectrum, etiological profile and local antibiotic sensitivity of the enteropathogens isolated.Methods: 147 serial dysentery cases admitted in GB Panth hospital Srinagar, which is an associated hospital of government medical college Srinagar from October 2014 to September 2015 were taken up for the study. A thorough and detailed history and examination was taken and recorded as per the proforma. Freshly collected stool sample was subjected to gross and microscopic examination; and after due bacteriological instructions was cultured on enrichment and selective media as per the need. Antibiotic sensitivity was done using disc diffusion method.Results: Maximum cases occurred in 1-5 years age group. Malnutrition grades II and III recorded the highest admissions. Most of cases had moderate dehydration. Although not frequent severe anemia, paralytic ileus and renal failure were the commoner complications. Shigella was grown in 12.24% of cases. Among them Shigella flexeneri serotype was encountered in 65% patients. Drug resistance was seen for many of the antibacterials like amoxycillin, ampicillin, norfloxacin, cotrimoxazole and nalidixic acid. However, they were susceptible to ceftriaxone and amikacin in well over 80% cases. E. coli isolates had similar antibiotic sensitivity profiles, with most susceptibility to amikacin and ceftriaxone.Conclusions: Drug sensitivity and resistance pattern is a variable phenomenon and changes from place to place and time to time. Hence there is a need to document the local pattern of an area so as to guide a judicious antibiotic administration.