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The solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas is a relatively uncommon entity. The aim of the present study was to summarize our experiences with regard to diagnostic dilemma, surgery, postoperative follow-up, and management. This retrospective data were collected during the period from January 1, 2018 to December 31, 2020. A total of four patients (three females and one male) were identified within an age range of 13 to 25 years. All the patients were presented with nonspecific symptoms such as abdomen lumps, swelling in the abdomen, and abdominal pain. To reach a definite diagnosis, imaging studies were conducted along with endoscopic ultrasound fine-needle aspiration (EUS-FNA) and biopsy. After confirmation of SPEN on biopsy, all the patients underwent surgery without any complications. Patients are on follow-up, and to date, no metastasis has been detected. SPEN is a rare pancreatic tumor with unusual pathological features leading to a diagnostic dilemma. The pathologist should be familiar with SPEN and its salient histological characteristics that differentiate it from other look-alike pancreatic tumors and can help in timely surgery and management.

Purpose Here, diazo coupling reaction was imparted on chemically inert lignin isolated from natural resources. Activated lignin was coupled with the diazotised aniline, m-nitroaniline, p-nitroaniline-, and p-anisidine gives organic pigments. Design/methodology/approach The continuous increase in particle size of pigments confirms addition of diazotised salt to lignin by coupling reaction. Further, the dispersing ability of these coloured pigments were exploited in polymer matrix. Epoxy-polyamine cross linking system was doped with difference percentage of pigments and coated on mild steel metal surface. The morphology of these composites was understood by SEM, particle size, differential scanning calorimeter and thermo gravimetric analysis. Findings The synthesised organic pigments were characterised by FT-IR, 1H NMR and UV-visible spectroscopy. It was observed that hiding power of aniline- and m-nitroaniline–based azo pigments was more than p-nitroaniline- and p-anisidine–based azo pigments. Thermal properties as well as water contact angles of coatings were improved with pigment concentration. The chemical resistivity of coating was observed to be improved with the increasing % of lignin-based azo pigment. Originality/value Lignin-based azo pigment has great potential to replace metal oxide pigment and provide strategy for utilisation of lingo-cellulosic biowaste material.

Mucormycosis is an aggressive and deadly fungal infection, which is invariably associated with an immunocompromised patient. Mucormycosis in the head and neck region presents as skeletal necrosis, with or without soft tissue involvement. Early identification and treatment with combination of surgical debridement and parenteral antifungal therapy is critical for a favourable outcome. This paper reports an unusual presentation of mucormycosis, mimicking a localised sino-orbital pathology involving the infraorbital subcutaneous tissue and the maxillary sinus, in a 35 years old immunocompetent man. Despite aggressive antifungal therapy and surgical management, the course of disease was fatal, reiterating the high mortality associated with mucormycosis.

Objective: To assess the safety and efficacy of Novel tapered (BioMime™ Morph) sirolimus- eluting stent (SES) for left main PCI in a real-world scenario. Background: Currently, no data is available on clinical usefulness of tapered ultrathin stents in left main PCI. Methods: This was a prospective, non-randomised, single centre study carried out between February 2018 and May 2020 at a tertiary cardiac care centre in southern India. The study included patients treated with BioMime Morph tapered stent for distal de novo LMB lesion or ostial LAD/LCX lesions with significant size disparity between reference segments based on the eligibility criteria. Primary endpoint of the study was the cumulative incidence of major adverse cardiovascular events (MACE) composed of cardiac death, myocardial infarction, and clinically driven target-lesion revascularisation at follow-up. Results: A total of 41 patients (average age of 54.83±9.81 years) were included in the study. Average SS-2 score was 23.17±5.42. Majority of the lesions (n=31; 75.61%) were of medina class (0.1.0). Provisional single stent strategy was adopted for treatment of LMB lesions. TIMI flow-3 was achieved in 40 patients (97.56%). Median clinical follow-up was 20 months (range 6-34 months). There was no periprocedural complication or MACE during follow-up. Conclusion: Tapered stents may be an acceptable alternative for LM intervention in an anatomical subset of patients with tapered vessels.

The study of multi-story building behaviour always depends on strength, durability, stiffness and adequacy of the regular configuration of the structures. Understanding the seismic behaviour of asymmetric structures is a challenging task, considering the aspect of irregularity (either in the plan or elevation) is generally known as asymmetric. Various researchers had studied the behaviour of this asymmetrical building by taking into considerations of different approaches such as plan configuration, vertical irregularity, mass and stiffness, in different methods of analysis. The irregular structures are less prone to the seismic forces, hence there is a need to study and specify some improvements in codal provisions for this type of asymmetrical structures. In the present study, we have considered a plan irregular structure (which replicates the Microsoft building at Hyderabad). The overall structural behaviour of asymmetrical building is investigated under different earthquake cases, such as with El-Centro, Loma and Uttarkashi database. Analysis of structure (using software program E-TABS V-17) for various earthquake intensities and checking for multiple criteria at every level for essential practice. The non-linear methods Time History analysis is carried over to find the structural behaviour. Keywords: multi-story building, plan irregularity, Time history analysis

The exploration of electrocatalysts with high catalytic activity and long-term stability for electrochemical energy conversion is significant yet remains challenging. Zeolitic imidazolate framework (ZIF)-derived superstructures are a source of atomic-site-containing electrocatalysts. These atomic sites anchor the guest encapsulation and self-assembly of aspheric polyhedral particles produced using microreactor fabrication. This review provides an overview of ZIF-derived superstructures by highlighting some of the key structural types, such as open carbon cages, 1D superstructures, hollow structures, and the interconversion of superstructures. The fundamentals and representative structures are outlined to demonstrate the role of superstructures in the construction of materials with atomic sites, such as single- and dual-atom materials. Then, the roles of ZIF-derived single-atom sites for the electroreduction of CO

The brake discs are subjected to thermal load due to sliding by the brake pad and fluctuating loads because of the braking load. This combined loading problem requires simulation using coupled thermo-mechanical analysis for design evaluation. This work presents a combined thermal and mechanical finite element analysis and evolutionary optimization-based novel approach for estimating the optimal design parameters of the ventilated brake disc. Five parameters controlling the design: Inboard plate thickness, outboard plate thickness, vane height, effective offset, and center hole radius were considered, and simulation runs were planned. 27 brake disc designs with design parameters as recommended by the Taguchi method (L27) were modeled using SOLIDWORKS, and the FEA simulation runs were carried out using ANSYS thermal & structural analysis tool. The fatigue life results were analyzed using a 3D surface plot for the effect of the design parameters on the response, contour plots for the determination of maximum response, and statistical regression analysis for model interpretation and predictive modeling. Finally, the two most accurate and widely used evolutionary optimization algorithms: genetic algorithm (GA) and particle swarm optimization (PSO) were applied to determine the optimal design parameters for the ventilated brake disc. The brake disc of design parameters predicted by GA and (PSO), gives 12.74% higher fatigue life compared to parametric analysis. These results have shown that the developed approach can be utilized effectively and reliably for solving, design ventilated brake disc problem in the industry.

Background: Admissions for acute myocardial infarction (MI) have declined significantly during the COVID-19 pandemic. The changes in the presentation, management, and outcomes of MI during the pandemic period are not well recognized, and data from low- and middle-income countries are limited. Methods: In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with MI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We sought to determine the changes in the number of admissions, management practices, and outcomes. Findings: We included 41,832 consecutive adults with MI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India with the North zone reporting greater decline (-44·8%) than the South zone (-27·7%). The weekly average decrease in MI admissions in 2020 which peaked around the mid- study period, correlated negatively with the number of COVID cases (r = -0·48; r 2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r 2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume, and teaching programs. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. However, the in-hospital mortality rates did not differ. Interpretation: The magnitude of reduction in MI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing MI admissions during the pandemic. Funding Statement: The study is funded by cardiological society of India. Declaration of Interests: Nothing to declare for all the authors. Ethics Approval Statement: Individual participating centres either obtained an ethical approval from respective Institutional ethics committees or a no objection certificate from the administration.

Introduction Coronary artery disease (CAD) follows a different pattern in women and men, more so in the young (< 40 years). The gender differences in the risk factors, clinical presentation and diagnosis need to be understood, so that appropriate and timely treatment can be given. Objective The study contemplates to analyze the gender differences in the presence of major coronary risk factors, clinical presentation, diagnosis and immediate outcomes in patients who present with premature CAD (PCAD). Patients and Methods We evaluated 1,062 consecutive registry patients who presented with diagnosis of PCAD between 2018 to 2019 at our institution after satisfying the inclusion criteria. Results The study analyses 82 females and 980 males. The mean age of females was 35.4 ± 4.68 years and males was 34.2 ± 4.25 years. Males smoked more often (55.1%, p p p p Conclusions Conventional risk factors play a major role for CAD in Indians. Smoking was common in males and metabolic syndrome in females. Also, females had a higher threshold for seeking treatment and referral. Measures have to be taken for early diagnosis and referral of females. Recanalized and thrombotic coronaries were common, indicating predominant thrombus burden in the young

The brake discs are subjected to thermal load due to sliding by the brake pad and fluctuating loads because of the braking load. This combined loading problem requires simulation using coupled thermo-mechanical analysis for design evaluation. This work presents a combined thermal and mechanical finite element analysis and evolutionary optimization-based novel approach for estimating the optimal design parameters of the ventilated brake disc. Five parameters controlling the design: Inboard plate thickness, outboard plate thickness, vane height, effective offset, and center hole radius were considered, and simulation runs were planned. 27 brake disc designs with design parameters as recommended by the Taguchi method (L27) were modeled using SOLIDWORKS, and the FEA simulation runs were carried out using ANSYS thermal & structural analysis tool. The fatigue life results were analyzed using a 3D surface plot for the effect of the design parameters on the response, contour plots for the determination of maximum response, and statistical regression analysis for model interpretation and predictive modeling. Finally, the two most accurate and widely used evolutionary optimization algorithms: genetic algorithm (GA) and particle swarm optimization (PSO) were applied to determine the optimal design parameters for the ventilated brake disc. The brake disc of design parameters predicted by GA and (PSO), gives 12.74% higher fatigue life compared to parametric analysis. These results have shown that the developed approach can be utilized effectively and reliably for solving, design ventilated brake disc problem in the industry.

Background Overexpression of anti-apoptotic MCL-1 protein in oral squamous cell carcinoma (OSCC) is linked to disease progression, therapy resistance and poor outcome. Despite its characteristic short half-life owing to ubiquitin-proteasome-dependent degradation, oral tumours frequently show elevated MCL-1 protein expression. Hence, we investigated the role of deubiquitinase USP9X in stabilising MCL-1 protein and its contribution to oral tumorigenesis. Methods Expression of MCL-1 and USP9X was assessed by immunoblotting and immunohistochemistry in oral cancer cell lines and tissues. The association between MCL-1 and USP9X was confirmed by coimmunoprecipitation and immunofluorescence. Cell death assessment was performed by MTT, flow cytometry and clonogenic assays. Results Both USP9X and MCL-1 are significantly elevated in oral premalignant lesions and oral tumours versus normal mucosa. USP9X interacts with and deubiquitinates MCL-1, thereby stabilising it. Pharmacological inhibition of USP9X potently induced cell death in OSCC cells in vitro and in vivo. The elevated expression of USP9X and MCL-1 correlated with poor prognosis in OSCC patients. Conclusion We demonstrate the oncogenic role of USP9X in driving early-to-late stages of oral tumorigenesis via stabilisation of MCL-1, suggesting its potential as a prognostic biomarker and therapeutic target in oral cancers.

The aim of the present study was to evaluate the prognostic value of the inflammatory response biomarkers and their impact on survival outcomes in the patients with sarcomatoid carcinoma (SC) of oral cavity, a rare variant of squamous cell carcinoma (SqC). Seventeen patients diagnosed with SC of oral cavity without metastases treated between Jan 2017 to June 2020 were identified and included in the present study. Pre- and post-operative inflammatory biomarkers and other prognostic markers were evaluated and their impact on disease-free survival (DFS) and overall survival (OS) was studied. Seventeen patients (16 males and one female) were included in the present study with a median age of 42 years (IQR: 26–76 years). With the median follow-up of 15 months, nine of 17 patients had developed recurrence and were succumbed to either locoregional recurrence or distant progression. One-year Kaplan–Meier estimates of DFS and OS were 57% and 58.3% respectively. On univariate analysis, baseline NLR, PLR, and pathological bone/skin involvement were identified to be significant prognostic factors affecting the patient’s DFS and OS. On multi-variate analysis, baseline NLR > 3 and pathological bone or skin involvement by tumour were emerged as some independent significant predictors. For the first time, the predictive role of inflammatory markers is studied and proven significant affecting patients’ survival outcomes. Hence, these inflammatory biomarkers may be considered for routine clinical use as reliable and low-cost prognostic markers to tailor the management of SC of oral cavity.

Unpredictable stock price forecasting is a difficult task due to the markets' flexible and unconditionally volatile nature. views into the machine learning meadow with the impending emotive and quantitative strategy. Increasing computational capabilities, software-based statistical medium of prognosis, and inventive method of prognosticating the model are all combined. In this study, the next due day-closing prices of Indian equities SBIN and Tatamotors are used to compare the long short term memory, Random Forest, and linear regression algorithms. Utilizing the RMSE standard layout indication, the prototypes are assessed. The low value of this indicator results in the most accurate closing price prediction model when compared to others.

Thyroid hormones have a crucial role in adapting the metabolic functions during stress and critical illness. Patients who are critically ill may have profound changes in thyroid hormone metabolism. Non-thyroidal Illness Syndrome (NTIS) is one among them, in which there is marked abnormality seen in the thyroid hormone levels. Hence this study is to understand the alterations of the thyroid function tests (TFTs) encountered in critically ill patients admitted in medical intensive care unit (MICU) without primary thyroid disease and to correlate with the severity of Acute Physiology and Chronic Health Evaluation (APACHE III) scoring.The study was conducted on 100 critically ill patients with no previous thyroid disorders, admitted in MICU in the Department of General Medicine in a tertiary care hospital between September 2017 and August 2019 who fulfilled the inclusion and exclusion criteria.Out of 100 critically ill patients the abnormal thyroid function prevalence was seen in 78% patients. The most common abnormality seen in our study was low total triiodothyronine (TT3) (61%) followed by low free triiodothyronine (FT3) (36%), low total thyroxine (TT4) (29%), high thyroid-stimulating hormone (TSH) (18%), and low free thyroxine (FT4) (12%). Low TT3, TT4, and FT3 values had a significant correlation with increasing critical severity score of APACHE III with a p value which was statistically significant (plt;0.05).With increase in severity of critical illness assessed by APACHE III, TFT, that is, TT3, TT4, and FT3 levels were decreasing, suggestive of increasing non-thyroidal illness in critically ill patients.

In the society one side women is getting highest success in life and second side she suffers by many problems. Much time they are culturally, socially, economically and politically excluded from the mainstream of the society. In the process of globalisation societal structure has changed but traditional rules could not be changed. This has created very worst position of widows in her family. This research is basically focused on global scenario of widows and widow’s life in different countries. Awidowis a woman whose spouse has died. The state of having lost one's spouseto death is termedWidowhood. In 2015, the global affected population was 258,481,056 million widows with 584,574,358 children. The number of children of widows grew by 5.7 percent. Over the same period, the number of widows grew by 9.0 percent. A minimum estimate of 38,261,345 million widows 14.8 percent of the total live in extreme poverty where basic needs go unmet.

Nasopharyngeal carcinoma (NPC) is rare in the UK. The aim of the current study was to investigate survival outcomes for patients with NPC treated with (chemo)radiotherapy using 65 Gy in 30 fractions in a non-endemic region.All consecutive 62 patients with histology proven non-metastatic nasopharyngeal carcinoma diagnosed between January 2009 to June 2019 were included in this retrospective analysis.Median age was 59 years (range:19-81). The majority of patients had stage III disease (66.1%). Induction chemotherapy was given in 21% of patients and 82.3% of patients received concomitant systemic therapy. All patients were treated with 65 Gy in 30 fractions. There was disease recurrence in 17.4% patients. The 5-year disease-free, disease-specific and overall survival were 81.9%, 79.2% and 76.4%, respectively. On univariate analysis, disease recurrence was associated with N-stage (p = 0.047) and overall stage group (p = 0.023).To the best of authors' knowledge, this is the first report of the use of 65 Gy in 30 fractions of radiotherapy ± weekly cisplatin chemotherapy in NPC in a real-world setting. Our results are comparable to that from other non-endemic regions of the world using different dose fractionation of (chemo)radiotherapy. Future randomised control trials are warranted to compare various dose fractionations in these settings.

Graphene oxide (GO) nanosheet suspension is not stable in physiological ionic fluids. To improve stability, surfactants such as Pluronic 103 (P103) have been tested. Going further, this work investigated whether conferring positive surface charge to the surfactant may improve the adsorption ability of P103 micelles on GO sheets. Positive charge on the surfactant was induced by adding dodecyltrimethylammonium bromide (DTAB, a cationic surfactant) in P103 micelles. Subsequent changes in aggregation parameters were investigated through dynamic light scattering and small-angle neutron scattering studies. DTAB incorporation was accompanied by a steady increase in the ζ potential and mixed micelle formation. At high surface charge density, the interaction between adjacent head groups was distorted, which led to dissociation of mixed micelles. Structural developments during the adsorption of mixed micelles on the sheet surface (mass fractal formation) were monitored in terms of changes in the scattering features of aggregates. These fractals emerged as a result of electrostatic interactions. Our observations point toward the existence of small-sized building blocks at low DTAB concentration (≤4 mM). With a superior adsorption, mixed micelles are expected to occupy the intersheet space and maintain a hydration layer. However, at a higher DTAB concentration (≥10 mM), micelles dissociate to produce DTAB-rich unimers and P103-rich loose aggregates. At this point, sheets tend to aggregate in the solvent, regardless of fractal formation.

Purpose The purpose of this work was to develop a new trispiperazido phosphate-based reactive diluent (diphosphate-piperazine hydroxyl acrylate [DPHA]) and used as a flame retardant with an epoxy acrylate (EA) in ultraviolet (UV)-curable wood coating. Design/methodology/approach The concentration of reactive diluent was varied from 0% to 20% in the UV-curable formulation with constant photoinitiator concentration. The effect of DPHA concentration on film properties was studied by differential scanning calorimetry and thermogravimetric analysis, gel content, water absorption and limiting oxygen index. Findings The results showed that the viscosity of the prepared formulation decreased by increasing reactive diluent (DPHA) concentration which leads to improving the coating efficiency. A high concentration of reactive diluent (DPHA) of the cured films shows good resistance against stain, mechanical and thermal properties, which results in an increased glass transition temperature (Tg) and cross-linking density of the films. Originality/value The new trispiperazido phosphate-based reactive diluent was used in wood coating formulation, which resulted in excellent flame-retardant properties with higher cross-linked density with good stain resistance. This material can provide a wide range of application for coating industries to produce a glossy finish.

Aims To study the risk factors, clinical and angiographic profile of Indian rural youth (under 35yrs) presenting with Premature Coronary Artery Disease (PCAD). Subjects and Methods: The PCAD registry had 1628 patients who were aged below 35 years, of which 681 patients satisfied the entry criteria. The data was analysed by statistical software R version 3.5.0. Results The study enrolled 681 patients after satisfying the entry criteria. The mean age of patients was 30.85 years. There were 405 (59.5%) aged between 30 and 35 yrs, 205 (30.1%) between 25 and 30 yrs, 64 (9.4%) between 20 and 25 yrs and 7 (1.0%) were aged less than 20 yrs. Majority of them were males, 617 (90.6%). Nearly 411 (60.4%) were smokers, 56patients (8.2%) were diabetics and 97 (14.2%) were hypertensives. Around 441 (64.8%) patients had low HDL cholesterol levels and 218 (32.0%) had elevated triglyceride levels. Abdominal obesity was seen in 443 (65.1%) patients. Most common clinical presentation was ST elevation myocardial infarction (STEMI) seen in 536 (78.7%) patients. Around 40% patients had recanalized/non obstructive/thrombotic/normal coronaries on coronary angiogram. Conclusions Conventional risk factors such as smoking, low HDL levels and abdominal obesity play a major role in the causation of premature coronary artery disease among the rural youth. Thrombotic milieu in the coronaries was commonly noted in coronary angiograms. Lack of awareness, combined with urbanisation of rural lifestyle could be responsible for increasing incidence of premature coronary artery disease in rural youth.

BACKGROUND We wanted to study clinical, social, biochemical and angiographic profile of Indian youth in their teens (13 to 19 yrs. age) with Premature Coronary Artery Disease (PCAD). METHODS This is a prospective ongoing descriptive observational study of Indians aged below 40 years with Coronary Artery Disease which was started on 1st April, 2017. Of 3450 patients registered in PCAD registry till date, 17 satisfied entry criteria. Entire clinical and angiographic profile of these patients was documented. Conventional lipids were estimated using commercially available kits. The distribution of different lipid profile parameters was visualised by nonparametric density plot. The data was analysed by statistical software R version 3.5.0. RESULTS 17 out of total of 3450 patients (0.6%) registered under PCAD registry belonged to study age group for this particular study. The mean age of all patients under PCAD registry was 18.34 years. 1 patient each was 15 and 16 years old, two and four seventeen-year olds and majority (9) of them were 19 years. Average age of this study group was 18.345 yrs. A majority of 16 (94%) of the patients were males. 8 (47.10%) were smokers. 1 patient (5.8%) was diabetic and 1 patient (5.8%) was hypertensive. 2 (11.7%) had strong family history of premature coronary artery disease. Most common index presentation of coronary artery disease in teenage Indians was with ST elevation myocardial infarction (10 patients – 58.9%), and unstable angina / Non-ST elevation MI (2 patients – 11.7%). 3 patients (17.6%) presented with evolved myocardial infarction, 2 patients (11.6%) presented with spontaneous myocardial infarction. Mean total cholesterol of entire study population was 171.95 ± 47.11, LDL was 116.39 ± 84.81 mg/dL, HDL was 34.50 ± 9.64, TG was 165.18 ± 87.11, non-HDL was 138.09 ± 46.18. CONCLUSIONS Previous Studies have shown that atherosclerotic plaques or their precursors can be seen in children younger than 10 years (2 – 5). During later life, effect of sedentary lifestyle, coupled with unhealthy nutrition, smoking, alcohol consumption, obesity and family history of cardiovascular disease accelerates atherosclerotic disease. The problem in India is the incomplete detection, treatment, and control of CAD risk factors. Larger sample population studies are needed to draw population specific cut-off values for risk factors and to discover novel risk factors.

The eye is a challenging organ for ophthalmic drug delivery due to the barriers associated with the anterior and posterior segments like nasolacrimal drainage, blinking, induced lacrimation, impermeability of corneal epithelial membrane, and blood-ocular barrier. Although there are conventional approaches, such as eye drop, ointment, suspension, implants, and injection, they suffer from limitations of low bioavailability, poor patient compliance (due to invasive approach and repeated dosing), and potential for several side effects. This review explored the various mucoadhesive polymers, derivatized polymers, and different modification methods for such polymer derivatization (via carboxymethylation, thiolation, and quaternization) for their effective drug delivery toward ophthalmic application. Various types of micro and nanoparticulate systems of such derivatized mucoadhesive polymer-based carriers have been also exemplified and discussed here for their improved medicinal efficacy. To address the issues associated with conventional ophthalmic formulations, mucoadhesive drug delivery has been proposed. The emerging technologies play an important role in the development of more efficient mucoadhesive carriers obtained by derivatization or modification of core polymers with various functional groups such as carboxymethyl, amine, and new generation thiols. Mucoadhesive polymers form bonding with mucin (hydrogen, covalent, electrostatic bonding, etc.) and enhance corneal residence time and cellular uptake of the drug. Mucoadhesive carriers are designed to associate with the micro and nanoparticulate systems to overcome the ocular barriers with improved therapeutic efficacy.

Highlights • Noonan syndrome is the second most common syndromic cause of CHD. • We present a rare case of Noonan syndrome having a combination of ASD, PS and HCM. • Patient underwent balloon valvotomy for pulmonary stenosis. • The patient is under regular follow-up and awaiting heart transplant., Introduction Noonan syndrome is the second most common syndromic cause of congenital heart disease. Most patients have an autosomal dominant inheritance, but some cases may be sporadic. Pulmonary stenosis is the most common cardiac manifestation in Noonan syndrome, associated with the atrial septal defect and hypertrophic cardiomyopathy. A combination of these three is present only in 5% of patients. Presentation of case We report a case of a 21-year-old female who presented to our hospital concomitant cardiac lesions associated with pulmonary stenosis, atrial septal defect, and hypertrophic cardiomyopathy. This combination of cardiac defects is an infrequent manifestation of Noonan syndrome. The patient presented with complaints of exertion syncope over the past two years. 2D-Echocardiography showed biventricular hypertrophy, dysplastic pulmonary valve, severe pulmonary stenosis, asymmetric septal hypertrophy and large atrial septal defect. The genetic analysis report showed autosomal dominant inheritance with Ras/MAPK (mitogen-activated protein kinase) Positive. Discussion Due to the wide spectrum of symptoms and presentations in Noonan cases, accurate clinical and genetic diagnosis, and comprehensive management of the disorder are strongly recommended. Conclusion We have described a case of rare combination of cardiovascular defects in Noonan Syndrome with a view to achieve better insight into the disease course and advantages of timely treatment and follow up. Our patient is currently in follow-up after treatment with percutaneous balloon pulmonary valvuloplasty, has improved symptoms, and is awaiting heart transplant.

This paper provides a computational fluid dynamics (CFD) study of the wedge-duct over turbine blade for flow and heat transfer coefficient characteristics. The influence of flow parameters on drop in pressure and heat transfer is investigated using Reynold's numbers of 10000, 20000, and 30000. Two cases of air coolant at 65ºC (Case 1) and 100ºC (Case 2) are considered. Case 1 delivers a low friction coefficient and a better thermal performance parameter, which improves heat transfer of the disturbed pin-fin layout within the wedge duct. Combustion chamber internal walls experience exceptionally high temperatures and heat flux. As a result, arrayed pin fins can be used to improve the heat transfer and cooling efficiency.

Coronavirus disease 2019 (COVID-19) is a highly hypercoagulable viral infection complicated as COVID-inflicted coagulopathy (CIC), that is associated with increased risk of morbidity and mortality. International guidelines recommend low molecular weight heparin (LMWH) to treat CIC in both in-hospital and in-home settings. However, in India, using subcutaneous LMWH may not be a feasible option for a vast majority of patients under home management. Additionally, while some evidence advocates the use of novel oral anticoagulants (NOACs), in hospitalized settings, most guidelines find no role of NOACs in hospital settings. On the other hand, the resource crunch faced in recent COVID-19 pandemic in India forced physicians to treat many patients in home settings. These patients had been usually prescribed NOACs for ease of administration and adherence. Therefore, there is a need to form a consensus on the use of NOACs to manage CIC in India.

Data stream mining is an emerging field of data science. It is a process of extraction of knowledge from streaming data using incremental algorithms. Mining streaming data comes with different challenges [3] like concept drift, handling incomplete and delayed information, skewness of data, and privacy preservation. Privacy of streaming data should be maintained during the process of its mining and processing to protect sensitive information from attackers and also to preserve user-sensitive personal data that is vulnerable to malicious purposes. In this paper, we proposed a system for mining crime news data streams along with privacy preservation of sensitive data using K-anonymization and Apache Spark. The knowledge gained through the process of mining streaming data is visualized in the form of real-time updating charts which provides the end-user with useful insights about current crime rates and statistics in the popular cities of India.