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The bulk of skin conditions are seen in Ayurveda as being within the category of Kushtha, or "Ayurvedic dermatology." It is listed as among the “Ashta Mahagada”. Eczema is the most prevalent skin condition with societal repercussions. Up to 20% of children and up to 3% of adults might have eczema, and existing data reveal that it is becoming more common, especially in developing nations. The clinical picture of eczema resembles with Vicharchika – a variant of Kshudra Kustha that Ayurvedic dermatologists frequently meet and is marked by the symptoms of Kandu (itching), Srava (discharge), Pidaka (vesicles), and Shyava varna (discoloration). Aim: to assess how Samshodhana and Samshamana Karma contribute to the treatment of Vicharchika w.s.r. to eczema. Material & Method: A 66 years old male patient came to NIA OPD no 25 on 06/04/2022 with complaints of Atikandu (severe itching with thick edematous skin) on forearms, forehead and anterior to neck region having cracks with discharge for 5 years. He took contemporary medicines for the problem but did not get significant relief. Intervention: We started Aragvadha Patra lepa and Panchtikta Ghrit Pana followed by Virechana Karma by giving Trivrita Avaleha. Marked relief was found in sign & symptoms within 7 days and cured within 21 days of treatment. Conclusion: Study concluded that the above Ayurvedic treatment can prove to be an effective alternate management in eczema with proper diet and regimen.

Aims & Objectives: To find out the predictors of spontaneous term vaginal birth after a previous one lower segment caesarean delivery. Materials & Methods: A prospective study was conducted in the Department of Obstetrics & Gynecology, SMS Medical College, and Jaipur from March 2015 to October 2016. 120 pregnant women with a history of one previous Lower segment caesarean section (LSCS) were enrolled in the study. Results: In our study, 60% cases had a successful Vaginal birth after caesarean section (VBAC) and 40% underwent a repeat emergency LSCS for failed trial of labour after caesarean section. Anterior position of cervix, cervical dilatation ≥ 3cm, effacement ≥ 60-70%, vertex position at or below the ischial spine at the time of admission in labour room were significant factor in favoring a successful VBAC. The incidence of scar dehiscence was 5.83%. There was no maternal or neonatal mortality. Conclusion: Trial of labour after caesarean section (TOLAC) can be given in selected cases with good monitoring of Fetal heart sound (FHS) and progress of labour under supervision of trained staff at a tertiary care hospital.

COVID-19 pandemic has been the major cause of mortality around the globe due to highly infectious nature of the virus and its tendency to cause serious manifestations like pneumonia, acute respiratory distress syndrome (ARDS) and ultimately respiratory failure. The incidence of patients developing pneumothorax and subcutaneous emphysema are also on the rise which has further increased the mortality. We conducted a retrospective analysis of COVID-19 patients who turned RT-PCR negative but still required intensive care, to see the incidence of pneumothorax and subcutaneous emphysema in ventilated as well as non-ventilated patients.: The data was collected from the hospital patient records between October 1, 2020 and May 31, 2021. The hospital medical records were used to furnish the various demographic, clinical and treatment details.: Out of 102 patients received in intensive care unit (ICU) during the study period, 9 developed pneumo-thorax and 4 of them also developed subcutaneous emphysema. 7 patients were male and 2 were female with median age of 52 years. Right sided pneumothorax was found in 7 patients while left lung was involved in 2 patients. Lab investigations of all these patients revealed raised inflammatory markers. Diagnosis was confirmed by clinical findings and chest X-ray findings. 7 patients had associated comorbidities like diabetes, hypertension etc.The occurrence of pneumothorax and subcutaneous emphysema in COVID-19 patients indicate the severity of the illness. Other factors like raised inflammatory markers, male gender, associated co-morbidities like diabetes, hypertension and old age have also been linked with increased incidence of pneumothorax and subcutaneous emphysema.

Ectopic pregnancy is one of the most life threatening emergency has signicant effect on maternal mortality and morbidity. Aim : 1.To study age group, risk factor, parity associated with ectopic pregnancy . 2.To nd incidence of ectopic pregnancy 3.To know clinical presentation and intervention require in ectopic pregnancy. Material and Method This retrospective study of 104 cases of ectopic pregnancy admitted to the Dep. of Obs and Gynae at Mahila Chikitsalya, SMS Hospital Jaipur from Dec. 2021 to 31 May 2022. Data of 104 patients was tabulated and analyzed. Results Majority of patients belongs to age group 20 to 25 years. Maximum no. of cases had PID as risk factor was with ectopic pregnancy (54.8%). The most common symptom was amenorrhea(84.6%) and majority of patients undergone surgical interventions. Conclusion Early diagnosis and treatment is the key to preserve fallopian tube and fertility.

Introduction Rhinocerebral mucormycosis is extremely fatal, with mortality rates ranging from 85-93% despite the best treatment in immunocompromised patients. We emphasize the importance of early diagnosis, repeated debridement, and aggressive antifungal treatment to reduce mortality. Case summary We report six cases (five male and one female), with a mean age of 51 years who were diagnosed to have mucormycosis from 2017 to 2019. All patients were diabetic. Intracranial involvement and orbital involvement were found in four cases. Facial nerve palsy was seen in two cases, one without any apparent otological involvement. Aggressive serial debridement and amphotericin B was started. Posaconazole was added subsequently to the treatment in two cases. One patient succumbed to the disease five months after discharge. The other five patients are on regular follow-up for a mean duration of 14 months at the end of which two had residual disease which was under control. Discussion Repeated surgical debridement with an early aggressive and combination antifungal therapy can result in good outcomes even in advanced mucormycosis. Concurrent management of the underlying pathology, monitoring of liver and kidney functions, and therapeutic drug monitoring are useful to ensure smooth and effective treatment.

Introduction: PPIUCD is an emerging contraceptive method for women which is easily available, safe, efficient, long acting, reversible and available just after birth of baby. Aims and Objectives To study the efficacy of postplacental IUCD insertion in vaginal and cesarean delivaries. Comparative evaluation of postplacental IUCD in vaginal and cesarean insertion in terms of counseling and complications. Material and Method: This study was conducted at Department of Obsterics S& Gynecology ,SMS Medical College,Jaipur .Total 150 Vaginal and Cesarean Deliveries were included in this study.Women counseled for PPIUCD during antepartum, intrapartum or during preparation of cesarean section for post placental IUCD insertion in cesarean delivery or vaginal delivery and followed for any complication. Observation: In our study it was observed that the proportion of parturient accepting post placental IUCD on counseling was 27.98% in vaginal delivery and 36.95% in cesarean delivery. Excessive bleeding through os was seen in 6 to 8% of cases, missing tail was seen in 38.7% of cases in group B and 8.7% of cases in group A had expulsion of IUCD. There was higher acceptance of post placental IUCD with better follow up, with no expulsion and higher continuation rate in cesarean delivery in comparison to vaginal delivery. Conclusion: To conclude post placental IUCD is an effective, reversible method of contraception.specially in area where the situation is of limited access to post-partum care and inability of women to return back for contraceptive measures.

Floods remain a wicked problem and are becoming more destructive with widespread ecological, social, and economic impacts. The problem is acute in mountainous river catchments where plausible assumptions of risk behaviour to flood exposure and vulnerability are crucial. Inclusive approaches are required to design suitable flood early warning systems (EWSs) with a focus on local social and governance context rather than technology, as is the case with existing practice. We assess potential approaches for facilitating inclusiveness in designing EWSs by integrating diverse contexts and identifying preconditions and missing links. We advocate the use of a SMART approach as a checklist for good practice to facilitate bottom-up initiatives that benefit the community at risk by engaging them at every stage of the decision-making process.

Floods remain a wicked problem and are becoming more destructive with widespread ecological, social, and economic impacts. The problem is acute in mountainous river catchments where plausible assumptions of risk behaviour to flood exposure and vulnerability are crucial. Inclusive approaches are required to design suitable flood early warning systems (EWSs) with a focus on local social and governance context rather than technology, as is the case with existing practice. We assess potential approaches for facilitating inclusiveness in designing EWSs by integrating diverse contexts and identifying preconditions and missing links. We advocate the use of a SMART approach as a checklist for good practice to facilitate bottom-up initiatives that benefit the community at risk by engaging them at every stage of the decision-making process.

This study evaluated drug–drug interactions (DDIs) between antibiotic and nonantibiotic drugs listed with warnings of severe outcomes in the British National Formulary based on adverse drug reaction (ADR) detectable with routine International Classification of Diseases, Tenth Revision coding. Data sources were Clinical Practice Research Databank GOLD and Aurum anonymized electronic health records from English general practices linked to hospital admission records. In propensity-matched case-control study, outcomes were ADR or emergency admissions. Analyzed were 121,546 ADR-related admission cases matched to 638,238 controls. For most antibiotics, adjusted odds ratios (aORs) for ADR-related hospital admission were large (aOR for trimethoprim 4.13; 95% confidence interval (CI), 3.97–4.30). Of the 51 DDIs evaluated for ADR-related admissions, 38 DDIs (74.5%) had statistically increased aORs of concomitant exposure compared with nonexposure (mean aOR 3.96; range 1.59–11.42); for the 89 DDIs for emergency hospital admission, the results were 75 (84.3%) and mean aOR 2.40; range 1.43–4.17. Changing reference group to single antibiotic exposure reduced aORs for concomitant exposure by 76.5% and 83.0%, respectively. Medicines listed to cause nephrotoxicity substantially increased risks that were related to number of medicines (aOR was 2.55 (95% CI, 2.46–2.64) for current use of 1 and 10.44 (95% CI, 7.36–14.81) for 3 or more medicines). In conclusion, no evidence of substantial risk was found for multiple DDIs with antibiotics despite warnings of severe outcomes in a national formulary and flagging in electronic health record software. It is proposed that the evidence base for inclusion of DDIs in national formularies be strengthened and made publicly accessible and indiscriminate flagging, which compounds alert fatigue, be reduced.

Background- Polycystic ovary syndrome (PCOS) is major endocrine and metabolic disease in reproductive women. As per latest procedures, letrozole should be taken as the rst-line pharmacological treatment for infertile women with PCOS. This study was planned to study the role of clinical prole in ovulation induction after letrozole therapy among infertile women with poly- cystic ovarian syndrome. This was a prospective analytical observational study carried out at the IVF centre, SMS Medical College,Methods- Jaipur. The present study enrolled 100 patients attending the IVF centre for fertility treatment who were diagnosed with PCOS as per Rotterdam criteria. Anthropometric measurements like Body mass index (BMI calculated as weight in kilograms divided by square of height in meters) and waist circumference (the smallest circumference at the level of umbilicus) was taken. A comprehensive physical examination of all patients was done to note signs of clinical hyperandrogenism like acne, alopecia, and hirsutism. Treatment response was dened as ovulation in response to letrozole in doses from 2.5 mg to 7.5 mg. In this study, women from 20 to 25 years of age with shorter duration of infertility, lower BMI,Results- lower waist circumference, absence of hirsutism, or mild hirsutism on clinical examination showed better response to Letrozole. Conclusion- Letrozole can be considered a suitable ovulation induction agent in infertile PCOS patients with lower BMI, lower waist circumference, and absence of hirsutism. A predictive ovulation score can be developed from basic clinical parameters. Identication of various factors affecting response to letrozole may help the clinician to individualize ovulation induction protocols in PCOS women.

Introduction: Opium and its derivative addiction are one of the most prevalent addictions in western Rajasthan, because it is easily available and is being used openly in social programs as the culture of the same. In western Rajasthan, mainly Doda poppy, opium milk, smack, tramadol, etc. are major forms of opium-derived addictions. Withdrawal symptoms such as nausea, vomiting, diarrhea, chills, body ache, sleeplessness and flu-like symptoms begin, these symptoms can grow severe enough to necessitate emergency medical attention, and in extreme situations, they might have life-threatening consequences for the user as a result of respiration depression, and pupil dilation in the later stages. The assessment was based on Clinical Opiate Withdrawal Scale (cows) before and after the treatment. Intervention: Efforts have been applied to depict 8 cases of opium addiction in form of series who have been treated with Ahiphenmochanadi vati in the dose of 250 mg twice a day and Sameergaja kerari rasa in the tapering method (Padanshika Krama) starting with the dose of 375 mg along with panchakarma procedures, Shirodhara with til tail, Abhayanga, and Swedana with Mahanarayan Tail and Dashmool kwath respectively for a period of 1 month. Reduction in cows scale was observed, about 75-80% of symptoms subsided in all cases and the results have been reported very encouraging within a period of twenty to thirty days. Conclusion: Altogether, multimodal Ayurveda treatment can be an effective and safe solution for smack addictions.

Poisoning is a major public health concern that is becoming more common by the day. Poison can be consumed directly or indirectly from a variety of sources. Poisoning can now be found in a variety of areas, including junk food with chemical preservatives, various sorts of growing products like rice and wheat, and pesticide-laced veggies. As a result of diverse human behaviours, water, air, and soil have become contaminated, posing a hazard to human health. According to Ayurvedic doctrine, there are several sources of obtaining of toxins i.e., either through animate, inanimate or Kritim(artificial). Such toxins are accumulated without eliminating through the body or remains with being the less potent inside the body for several years generally called Dushi Visha. All the sign and symptoms of Dushi Visha looks like that of chronic poisoning and varies from organs to organs, where it becomes deposited. Such accumulated Visha then vitiates Dosha and that leads to vitiation of different kinds of Dhatus respectively. like, Rakta Dusti, Kitiva, Vrana, Kotha are the major manifestations that will see after prolong exposure to Dushi Visha. The main line of treatment of Dushi Visha is through Detoxification (i.e., Vamana, Virechana, Raktamokshana karma) followed by Dushivisari Agad Paana, that has mentioned by Charak. Classical text book has mentioned different level of clinical manifestations including sign and Symptoms and its complication along and its management with specific Justification.

Spinal anaesthesia is being routinely used for lower abdominal and lower limb surgeries. Bupivacaine is the commonly used anaesthetic agent because of its longer duration of action. Various intrathecal adjuvants like midazolam are sometimes added to enhance the anaesthetic effects and increase the duration of analgesia. We, hereby evaluated the effects of intrathecal midazolam 2mg as an adjuvant to bupivacaine during spinal anaesthesia in orthopaedic surgery. A total of 60 patients of age 20-50 years were randomly divided into two groups: BM-who received 3.2ml bupivacaine and 0.4ml(2mg) midazolam; and BS-who received 3.2 ml bupivacaine and 0.4ml normal saline. Mean duration of analgesia was prolonged in the midazolam group (429.33+/-59.54 min) as compared to controls (252+/-42.22 min) (p=0.00). The number of injection diclofenac as rescue analgesic were also significantly less in BM group. Time to achieve maximum sensory level(T4) was also significantly less in BM group. Time to two segment regression and the duration of motor block were more in the midazolam group. Intrathecal midazolam as an adjuvant significantly prolongs the duration of analgesia and decreases the requirement of rescue analgesia when combined with bupivacaine during spinal anaesthesia. The dose of 2mg seems to safe and effective to achieve the desired results.

Pericapsular nerve group (PENG) block is a novel approach for providing peri-operative analgesia wherein the articular branches of femoral nerve, obturator nerve and accessory obturator nerve are blocked. It has been found to be very effective as a regional anaesthesia technique during hip surgeries. We, hereby evaluated the USG guided PENG block with 0.25% bupivacaine (20ml) in 4 patients scheduled to undergo hip fracture surgeries. There was significant reduction in the pain scores both at resting position and 15 degree leg raise after the institution of block in all patients. All patients could sit upright during the institution of spinal anaesthesia.

Patient-reported outcome; Clinical decision support; Quality standards Resultado informado por el paciente; Apoyo a la decisión clínica; Estándares de calidad Resultat informat pel pacient; Suport a la decisió clínica; Estàndards de qualitat The COllaboration on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST) aims to improve the quality of COPD care in primary care. The CONQUEST target population includes patients diagnosed with COPD, and those undiagnosed but with COPD-like exacerbations, who are at high but modifiable risk of COPD exacerbations, increased morbidity, and mortality. Timely diagnosis and optimized management to reduce these risks is vital. There is a need for a quality improvement program (QIP) that enables long-term improvement of patient clinical outcomes via integration of the program into routine clinical care. Core to the CONQUEST program is the adoption of four specifically designed, globally applicable, and expert-agreed quality standards (QS) for modifiable high-risk COPD patients. Translation of the QS into clinical practice, and implementation of the QIP, is guided by the CONQUEST global operational protocol provided to sites meeting the minimum healthcare system requirements. Initial analyses of current practices are conducted to generate baseline assessments of need within healthcare systems and sites looking to implement the QIP. Implementation is supported by the provision of CONQUEST resources and tools, such as clinical decision support, that promote prompt identification and treatment of patients. Utilization of electronic medical record (EMR) and patient-reported data are integral components of the QIP. Regular, automated collection and analysis of data, combined with a cyclical review of the implementation process, will be conducted for long-term, continuous improvement and health impact evaluation. The CONQUEST QIP will be an important resource in the identification and management of patients with modifiable high-risk COPD. Embedding the CONQUEST QS into routine clinical practice with regular evaluation and feedback will result in long-term quality of care improvement. This study was conducted by Optimum Patient Care Global and the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and was co-funded by Optimum Patient Care Global and AstraZeneca. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.

Background: The Ayurveda treatises are collection of vast knowledge regarding medical and environmental aspects. It has a separate branch called Agada Tantra which deals with the toxicological aspects. We aim to evaluate this knowledge regarding dermatological manifestation due to Visha (toxins) vis-à-vis contemporary knowledge. Objective: The objective of this study is to analyze the rationality and applicability of Kushthaghna Mahakashaya in the prevention and management of skin disorders caused by various type of poisons. Data Source: The references available in classical texts, various Nighantu and research articles regarding the various forms of poisons and their dermatological manifestations were analyzed and compared to the knowledge available in contemporary medical literatures. Review methods: A sincere study of classical Ayurveda text-books and their available commentaries along with modern texts, websites and articles has been done to explore the importance of Kushthaghna Mahakashaya in various skin diseases. Result and conclusion: The herbs mentioned in the Kushthaghna Mahakashaya were scientifically evaluated in various preclinical and clinical studies and showed antiviral, immune-modulatory, anti-inflammatory, antioxidant, anti-cancerous, cardio-protective, neuroprotective, anti- fungal, and anti- bacterial activity, according to the results of the literature quest. The proper application of Kushthaghna Mahakashaya plants will aid in the prevention and treatment of skin diseases.

A pivotal development of the obsolescence of conventional methods of sheet forming has enhanced the need of augmenting an agile and novel method of fabricating the tailored components according to the requirements of customers and users. Moreover, businessmen are interested to promote their businesses by manufacturing the tailored and customized parts of intricated and complex geometries at a lower cost and with negligible waste. Single Point Incremental Forming (SPIF), also known as “negative incremental forming”, avoids the direct use of any kind of specific die-sets and produces the user-ready parts. The investigation of the surface quality of the formed specimen is important to study the suitability of this process for industrial applications. This paper explores the effects of the interactions of tool radius and forming angle on the surface roughness of parts formed by the SPIF process. A full factorial approach was taken into account as DOE. The average roughness was found to rise with the rise in forming an angle. On the other hand, the increase in tool diameter resulted in the decrease of Ra value of formed components because the increase in the tool diameter allows the decrease in the waviness on the surface of the specimen. It was observed that the Ra value of formed components was decreased by 83.87% when the experimental condition was changed from the combination of higher levels of wall angle (68°) and lower level of tool diameter (7.52 mm) to the combination of lower levels of wall angle (60°) and a higher level of tool diameter (19.50 mm).

Nowadays due to changing lifestyle, lack of physical activity and long sitting postures lead to a disease called Gridhrasi. Symptoms of Gridhrasi closely resemble the clinical features of Sciatica. Sciatica is a severely painful condition where the sciatic nerve of one or both legs is involved. This study was undertaken to evaluate the clinical efficacy of Aabhadi Churna along with Pathya Aahara and Vihara in Gridhrasi with special reference to Sciatica. The study was conducted on 60 patients who fulfilled the diagnostic and inclusive criteria of sciatica. The clinical assessment was based on subjective parameters (Ruka, Stambha, Toda, Spandana) and objective parameters (Straight leg raising test, standing time and walking time). The subjective and objective parameters before and after treatment were analyzed by using the student "t" test. The t-test results were highly significant for both the groups when the therapy effect was compared before and after the treatment. The inter-group comparison showed that the Group-B treatment method where 84% of patients showed moderate to maximum improvement method was better when compared to Group-A where this percentage was 67% only. Keywords: Gridhrasi, Sciatica, Pathya Aahara, Vihara, Aabhadi Churna.

The gas produced from an oil field is used to inject into the well for enhanced recovery of oil and gas. The injected gas flows through a pipeline called a header to individual wells for gas injection. One such 6” gas injection header at an offshore process complex experienced a leakage during operation just after 2 years of service. The operating pressure of the pipeline was normal, and there was no process disturbance at the time of the failure. There was no localized corrosion and thinning of the header. The material of construction of the header sample was reported to be ASTM A106 Gr B specification. Laboratory investigations revealed that the material did not conform to ASTM A106 Grade B standard. In the present case, the H2S partial pressure was 0.09 psi; this comes under sulfide stress cracking (SSC) region 2 as per ISO 15156-2:2015; therefore, the environment is prone to SSC. During metallography and SEM analysis, cracks filled with corrosion product typical of SSC were observed which propagated intergranularly. Zigzag cracks typical of hydrogen-induced cracking that branched out from the main SSC crack were also observed. As the metal was too brittle in nature, the gas injection header cracked at many sites. When the crack grew to the extent that the pipe could not withstand the operating pressure anymore, it failed in a brittle manner and the header was shattered into pieces.

Background: Klebsiella pneumoniae (Kp), a common multidrug-resistant pathogen, causes a wide spectrum of nosocomial infections with high rates of morbidity and mortality. The emergence of pan drug-...

The key intends of Ayurveda is to maintain the health of healthy persons and make well the ill health of the diseased person. In Swasthavritta it has been clearly mentioned about Hitakara ahara-vihara and Yoga for healthy life. Amlapitta is a very common disease of Annavaha srotas. In present time a huge population is highly affected from Amlapitta due to unhealthy food habits, mental stress, and inactive life style. This paper investigates the effect of Mudga and Kwathita Sheeta Jala (Boiled and cooled water) as a Pathya- ahara and Yoga modalities in Amlapitta. Furthermore, the combined effect of Mudga, Kwathita Sheeta Jala and Yoga modalities in Amlapitta has also studied. In this present study, 60 patients were assigned into three Group A, B and C (20 patients in each group). All the general observations and results with statistical data of 20 patients of each group were illustrated in the form of tables and graphs. In this study, the therapy of Group C shows better result than Group A and Group B. Hence, Mudga Yusha and Kwathita Sheeta Jala (boiled and cooled water) along with Yoga modalities is more effective to control Amlapitta disease.

Kerry L Hancock,1 Sinthia Bosnic-Anticevich,2– 4 John D Blakey,5,6 Mark Hew,7,8 Li Ping Chung,9 Biljana Cvetkovski,3 Scott Claxton,10 Peter Del Fante,11 Eve Denton,7,8 Joe Doan,12 Kanchanamala Ranasinghe,13,14 Lucy Morgan,15– 17 Anita Sharma,18 Peter K Smith,19 Deb Stewart,20 Philip J Thompson,21– 23 Russell Wiseman,24 John W Upham,25 Kwok Y Yan,26 Victoria Carter,27 Kiranjeet Dhillon,28 Florian Heraud,28 Thao Le,27 Rebecca Vella,28 David Price27– 30 On behalf of the OPCA Improving Asthma outcomes in Australia Research Group1Chandlers Hill Surgery, Happy Valley, SA, 5159, Australia; 2Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia; 3Woolcock Institute of Medical Research, Glebe, MSW, 2037, Australia; 4Sydney Local Health District, Camperdown, NSW, 2050, Australia; 5Respiratory Medicine, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, WA, 6009, Australia; 6Curtin University Medical School, Bentley, Western Australia, 6102, Australia; 7Allergy, Asthma & Clinical Immunology, Alfred Health, Melbourne, VIC, 3004, Australia; 8Public Health and Preventive Medicine, Monash University, Victoria, 3800, Australia; 9Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, WA, 6150, Australia; 10Genesis Care Sleep and Respiratory, Joondalup, WA, 6027, Australia; 11Hutt Street General Practice, Adelaide, SA, 5000, Australia; 12HealthPlus Medical Centre, Kogarah, NSW, 2217, Australia; 13School of Medicine, Griffith University, Nathan, QLD, Australia; 14Cannon Hill Family Doctors, Cannon Hill, QLD, 4170, Australia; 15Sydney Medical School, University of Sydney, Sydney, NSW, Australia; 16Department of Thoracic Medicine, Concord Hospital, Sydney, NSW, Australia; 17Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia; 18Platinum Medical Centre, Chermside, QLD, 4032, Australia; 19Griffith University, Southport, QLD, Australia; 20Adjunct Lecturer, School of Medicine, University of Tasmania, Churchill Ave, Hobart, TAS, 7005, Australia; 21The Lung Health Clinic, Hollywood Medical Centre, Nedlands, 6009, Australia; 22The University of Western Australia, Perth, Western Australia, 6009, Australia; 23Curtin University, Bentley, Western Australia, 6102, Australia; 24Suncoast Medical Centre, Coolum Beach, QLD, 4573, Australia; 25Diamantina Institute & PA-Southside Clinical Unit, the University of Queensland, Woolloongabba, QLD, 4102, Australia; 26Department of Respiratory Medicine, W, Camperdown, NSW, 2050, Australia; 27Optimum Patient Care, Cambridgeshire, CB24 3BA, UK; 28Optimum Patient Care Australia, Brisbane, QLD, 4000, Australia; 29Observational and Pragmatic Research Institute, Midview City, 573969, Singapore; 30Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UKCorrespondence: David Price, Optimum Patient Care Australia, 320 Adelaide St, Brisbane, QLD, 4000, Australia, Tel +4 05 764 842, Email dprice@opri.sgIntroduction: Asthma poses a significant burden for the Australian population. Understanding severe exacerbation rates, and steroid-related burden for adults diagnosed with asthma stands to offer insights into how this could be reduced.Methods: Electronic medical records (EMR) and questionnaires from the Optimum Patient Care Research Database Australia (OPCRDA) were utilised retrospectively. OPCRDA is a real-world database with > 800,000 medical records from Australian primary care practices. Outcomes were severe asthma exacerbations in Australian adults, over a 12-month period, stratified by Global Initiative for Asthma (GINA) treatment intensity steps, and steroid associated comorbidities.Results: Of the 7868 adults treated for asthma, 19% experienced at least one severe exacerbation in the last 12-months. Severe exacerbation frequency increased with treatment intensity (≥ 1 severe exacerbation GINA 1 13%; GINA 4 23%; GINA 5a 33% and GINA 5b 28%). Questionnaire participants reported higher rates of severe exacerbations than suggested from their EMR (32% vs 23%) especially in steps 1, 4 and 5. Patients repeatedly exposed to steroids had an increased risk of osteoporosis (OR 1.95, 95% CI 1.43– 2.66) and sleep apnoea (OR 1.78, 95% CI 1.30– 2.46).Conclusion: The Australian population living with GINA 1, 4, 5a and 5b asthma have high severe exacerbation rates and steroid-related burden, especially when compared to other first world countries, with these patients needing alternative strategies or possibly specialist assessment to better manage their condition.Keywords: asthma, exacerbations, oral corticosteroids, adults, Australia

Chlorpyrifos is a broad-spectrum organophosphate pesticide and used frequently on different cropping systems to control phytopathogens. Being a hazardous substance, chlorpyrifos may affect human health as some unutilized pesticide percolates through soil and contaminates ground water. Present study was planned to establish an effective remediation method of chlorpyrifos using two fungal isolates (C1 and C3), recovered from the waste (soil) of a refrigeration industry. C1 and C3, identified as Byssochlamys spectabilis and Aspergillus fumigates respectively were able to tolerate 600 mg L− 1 of chlorpyrifos. “The Half-life of chlorpyrifos (control) was 231 days which could be reduced to 13.6 days” under in vitro condition in the presence of mixture of two fungi in Czapek dox medium (CDM). Consortium of the fungi showed 98.4 % degradation of chlorpyrifos within 30 days in CDM. Degradation of the pesticide was related to specific laccase activity of the fungi and the level of enzyme activity was better in consortium 9.09 and 10.29 U mL− 1 after 6 and 10 days respectively. Immobilized fungal enzymes also showed appreciable biodegradation of the pesticide by providing extra matrix for enzyme substrate reaction. Residual analysis of chlorpyrifos in the soil of onion (Allium cepa) in a phytoremediation experiment revealed a significant decrease in t1/2 value in the presence of fungi. Hence, it is concluded that chlorpyrifos biodegradation ability of fungal consortium reveals the potential of these isolates in biodegradation of toxic compounds from contaminated water and soil. However, further studies are needed to access the biodegradation of the pesticide in different soil types, crops and under varied environmental conditions at molecular level.

Learning outcomes This paper aims to enable the application of Value Proposition Canvas and Business Model Canvas to evaluate an opportunity; understand the commonalities and differences between social and commercial enterprises; and recognize the challenges related to the paradox of the social mission and the financial/economic logic. Case overview/synopsis Neha Arora demonstrated exceptional capabilities of defying the social stigma associated with People with Disabilities (PwDs) to establish Planet Abled, a first in the world venture to provide accessible leisure excursions to PwDs. This entrepreneurial initiative enabling group and solo travel for PwDs as inclusive tourism has created the possibility of social sustainability by bringing change in the lives of PwDs and their family members by ignoring either the insensitive or overprotective societal attitudes and lack of infrastructure concerning travel for PwDs. Its potential growth qualifies for scaling-up, but it can also attract the existing big travel solution providers to enter this domain. Considering these facts, Neha faces multiple dilemmas: How can she sustain and scale up the early momentum created by her enterprise? How can she resolve the challenges related to the paradox of the social mission and the financial/ economic logic while scaling-up Planet Abled? Complexity/Academic level This case study is suitable for both undergraduate or graduate-level programs in the area of entrepreneurship. Supplementary materials Teaching Notes are available for educators only. Subject code CSS 3: Entrepreneurship

Objectives Pleural effusion, defined as an abnormal accumulation of fluid in pleural space, can be of two types: transudative and exudative. The primary aim of the study was to assess the predictive accuracy of procalcitonin (PCT) and pentraxin-3 (PTX-3) in comparison to other biochemical markers such as C-reactive protein (CRP), and adenosine deaminase (ADA) in the differential diagnosis of pleural effusions. Methods A cross-sectional analytical study was conducted on patients with pleural effusion. Multiple comparisons and receiver-operating characteristics (ROC) analyses were made to evaluate the diagnostic significance of biochemical markers. Results Sixty-six patients with exudative pleural effusion classified as malignant, tuberculous, and parapneumonic effusions (malignant pleural effusion [MPE], tuberculous [TPE], and parapneumonic [PPE]) were included. Significant differences in pleural fluid levels in both PCT (p-value: 0.001) and PTX-3(p-value: 0.001), as well as serum levels of PCT (p-value: 0.001), were observed between the three groups. ROC analysis showed both PTX-3 and PCT having favorable discrimination ability with high sensitivity (≥90%) and specificity to predict PPE from TPE and MPE. Conclusions Evaluation of serum and pleural fluid PCT and levels of PTX-3 in the pleural fluid may be used as an early biomarker to differentiate the etiology of pleural effusion.

A healthy mind in a healthy body constitute absolute health. While defining health Ayurveda clarifies the importance of the clarity of the mind, the sense organs as also of the normal physiological function of the body as the criterion of health. They may be occasional or long-lasting (chronic). They can affect individual’s ability to relate to others and function each day. Ayurveda treats the body through the medium of mind or Manas this is the basic difference between the modern and Ayurvedic approach. Modern drugs promote relaxation by blocking awareness of a stressful event, or by diminishing the importance one attaches to it, whereas Ayurveda approach makes one to realize the situation and adopt suitably to solve the stress problems in a refreshing way forever. Purpose: The purpose of this study is the role of Ayurveda in the management of Manasa Roga w.s.r. to mental disorders. Material and Meth- ods: Various Ayurvedic, modern literature, textbooks, articles, journals and internet sources are studied for this review work. Conclusion: This review study describes significant information of Manasa, Roga and its manage- ment through Ayurveda. Keywords: Manasa, Roga, Mental disorder, mental illnesses.

Early case detection by sputum smear microscopy is a crucial step in the control of pulmonary tuberculosis in high burden countries. Due to low sensitivity of this rapid and cost effective method, culture of Mycobacterium tuberculosis (MTB) is considered as the gold standard. Modified Petroff's method using 2%-4% sodium hydroxide (NaOH) and N-acetyl- l-cysteine (NALC) to digest and at the same time to decontaminate the specimen is widely used in developing countries prior to culture. This method is considered tedious and cumbersome. A novel ReaSLR (ReaMetrix's Sputum Liquefying Reagent) methodology has been proposed as a simple and low-cost method for sputum processing. This study was undertaken to evaluate the performance of the ReaSLR method of sputum processing prior to culture in comparison to the modified Petroff's method.Early morning sputum samples, collected from suspected TB patients, were divided into two equal halves and processed by two different methods i.e modified Petroff's method and ReaSLR method. After processing with different methods, each sample was inoculated in Lowenstein Jensen (LJ) medium and Mycobacteria growth indicator tube (MGIT). Smears were also prepared from the samples processed with modified Petroff's method and graded according to Centers for Disease Control and Prevention (CDC) grading after microscopic examination. Culture results of both the methods were recorded and analysed using SPSS 20.0 version.On comparing different methods of sputum processing for culture in solid and liquid media, the rate of contamination in both the media was significantly high with ReaSLR method as compared with modified Petroff's method. Also, the mean time-to-detection of MTB growth in LJ medium was significantly less with modified Petroff's method i.e 30.21 days as compared to ReaSLR method (34.23 days; p 0.001). However, the mean time-to-detection of MTB growth in MGIT was similar with both the methods.Due to the high contamination rate in solid and liquid culture media, ReaSLR method cannot be considered as an alternative to modified Petroff's method for sputum processing prior to culture. The detection of growth of MTB in LJ media was also earlier with modified Petroff's method than ReaSLR method.

Background Older patients undergoing emergency surgery experience higher mortality and morbidity. 'Care of Older People in Surgery' (COPS) is a comprehensive geriatric care model developed for acute surgical units (ASU) to improve clinical outcomes in older general surgical patients. This study aimed to evaluate the impact of COPS on clinical and health service outcomes in an Australian hospital. Methods The before-and-after study was conducted in the ASU, at Nepean Hospital. Data from patients ≥75 years admitted for >24 h into the ASU during the intervention period between April 2017 and March 2018 were compared to patients admitted in the previous year (April 2016 to March 2017) prior to the COPS intervention (n = 212). Health service outcomes measured include the average stay length, medical emergency team response, unplanned intensive care unit admission and 28-day readmission rates. Results The COPS group (n = 214) suffered significantly fewer medical complications, including less acute kidney injuries, arrhythmias and urinary tract infections compared to the pre-intervention cohort (n = 212). Medical emergency team activation was significantly reduced after COPS model implementation and the average length of stay decreased. However, the incidence of postoperative delirium and acute coronary syndrome were higher in COPS cohort. Conclusion Our study demonstrated that comprehensive geriatric assessment and care delivered through a shared model of care in older general surgical patients improved clinical outcome and patient safety measures.

There is an acute need to develop new workforce talent in the Gerontology industry due to (a) a rapidly increasing older population; (b) new and evolving needs of older adults due to increased life spans and the long-term impact of COVID-19, and (c) high attrition rates of the current workforce due to death and retirement. One practical strategy to increase new talent is to develop paid apprenticeship opportunities for undergraduate students from different disciplines. The author developed multiple hybrid apprenticeship opportunities to create an "earn and learn" program through funds received from the Louisiana Board of Regents. The program was open to students from all majors because Gerontology is a multi-disciplinary field and there is a need to provide gerontological training to professionals from different disciplines to prepare them to serve older adults in different types of settings. As a pilot project, ten students were selected after an application process. Students in this project were required to complete two three-credit hour fully online courses in Gerontology with a grade of “B” or better. They were also required to complete an eight-hour orientation to help them develop soft skills to work with older adults during their apprenticeship period. They were then required to complete a 150-hour paid summer-apprenticeship in an organization that serves older adults and/or people with disabilities. The program was successful with a 100% completion rate. The students enrolled in this program completed the final step by presenting their apprenticeship experiences at a conference organized by the author.