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Aim Anaemia (particularly iron deficiency) is of important concern in patients with chronic kidney disease (CKD) as it reflects the outcome of the disease. Current recommendations for the use of intravenous iron (IV) therapy in the management of anaemia in such patients are limited. This study highlights the comparison of oral to intravenous iron in patients with chronic kidney disease. Materials and methods This is a prospective case-control study comparing intravenous iron to oral iron in chronic kidney disease patients admitted to the Medicine Department of Acharya Vinoba Bhave Rural Hospital, in central India from October 2018 to October 2020. A total of 150 patients were divided into two groups of 75 each, one receiving oral iron (ferrous sulfate 325 mg tablets) and the other intravenous iron (IV iron sucrose). Results Serum iron, serum ferritin, and transferrin saturation (TS) showed increased levels in the IV iron group than in the oral iron group. In the IV group, a statistically significant increase was found in haemoglobin levels after therapy among all stages of kidney disease (p0.05) while the same was not reported in the oral iron group. Conclusion IV iron sucrose therapy had been found to be effective, well-tolerated, and more successful than oral iron treatment in chronic kidney disease patients as far as the parameter of iron deficiency anaemia is concerned.

Introduction Individuals with pre-diabetes and metabolic-associated fatty liver disease (MAFLD) have an increased risk of developing diabetes mellitus (type-2) when compared with individuals with pre-diabetes without MAFLD. Patients with any of the components of metabolic syndrome should be screened for the risk of MAFLD, as all its components are well correlated with the degree of liver fat content. In this research article, we have highlighted the association of MAFLD with various anthropometric parameters in pre-diabetes as compared to diabetes and normal individual. Methods In this cross-sectional study a total of 356 patients more than 18 years of age who meet the criteria for diabetes and pre-diabetes according to WHO, were enrolled. Anthropometric indices like body mass index (BMI), waist-hip ratio, waist to height ratio, and neck circumference were recorded. Patients underwent ultrasonography of liver and blood investigations like lipid profile, and liver function tests. Results The prevalence of MAFLD observed in this study was 44.1% in diabetics and 22% in pre-diabetics, compared to 9.2% in healthy controls. The ROC analyses showed that MAFLD predict pre-diabetes using the waist-hip ratio was higher in women compared to men (0.750 and 0.693 respectively). In men, the waist-hip ratio was followed by 0.648 for Neck Circumference, 0.646 for BMI, and 0.635 for waist-to-height ratio respectively, whereas the ROC analyses in women showed that other than waist-hip ratio, no other anthropometric index that had consistently higher AUC value. Conclusion Though there was an association between high BMI, waist-hip ratio, waist to height ratio, and neck circumference with MAFLD in pre-diabetes, it was not strongly associated as in the diabetic group.

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

Aim To assess knowledge of our neonatal intensive care unit clinical staff regarding preterm neurodevelopmental outcomes using the 33-item Preterm Birth Knowledge Scale (PB-KS). Methods An anonymous convenience sampling survey of clinical staff in the Neonatal Directorate was conducted between July and December 2019. PB-KS, demographic information and prior staff education on long-term outcomes in very preterm infants were collected. Results There were 56 responses (five neonatologists, eight paediatric trainees, 41 neonatal nurses and two allied health staff). Responses were scored as correct or incorrect. The mean score on the PB-KS was 19.5 (range: 4-29 out of 40) with 50% correct answers. Accuracy was highest (96%) for rates of cerebral palsy and lowest (11%) for estimation of quality of life among preterm survivors. Staff reported training in long-term outcomes of preterm infants through attending a conference/seminar (20%) or a combination of formal training and seminars (41.1%). Over half of our clinical staff reported a lack of formal training. Formally trained clinical staff scored significantly better in this survey. Didactic seminars were indicated as preferred choice for staff education. Conclusions Results of our survey will assist in developing a customised educational programme to address identified gaps in the knowledge of clinical staff as our survey also showed significantly better scores among staff who were formally trained about long-term outcomes in very preterm infants. Staff responses indicated that knowledge on long-term outcomes was variable but more accurate with regard to more severe disabilities and shorter-term developmental outcomes.

Knee joint is the largest and complex joint of the body and also most frequently injured joint in sportsmen due to the lack of bony support. The stability of the joint is highly dependent on its supporting ligamentous structures; therefore, injuries of ligaments and menisci are extremely common. MRI has virtually replaced conventional arthrography and other modalities for the evaluation of menisci and cruciate ligaments [3]. Compared with CT scans, MRI provides superior anatomic and pathological status of soft tissues, ligaments, fibro cartilage and articular cartilage. Since the 1980’s, diagnostic arthroscopy has been used frequently to show intra-articular abnormalities with more than 95% accuracy depending on the expertise of the arthroscopist [6]. During arthroscopy, all the internal structures are visualized, the abnormality detected and treated as well. MRI has enormous impact on musculoskeletal imaging and knee is the most frequently imaged joint. It is non- invasive and does not require ionizing radiation. Advantages of MRI include excellent inherent soft tissue contrast, multiplanar imaging capability, lack of patient exposure to radiation, ability to visualize ligaments, tendons, articular cartilages, menisci, para-articular soft tissues and the bone marrow.

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

Background: Patient factors associated with urinary tract cancer can be used to risk stratify patients referred with haematuria, prioritising those with a higher risk of cancer for prompt investigation. Objective: To develop a prediction model for urinary tract cancer in patients referred with haematuria. Design, setting, and participants: A prospective observational study was conducted in 10 282 patients from 110 hospitals across 26 countries, aged ≥16 yr and referred to secondary care with haematuria. Patients with a known or previous urological malignancy were excluded. Outcome measurements and statistical analysis: The primary outcomes were the presence or absence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC], and renal cancer). Mixed-effect multivariable logistic regression was performed with site and country as random effects and clinically important patient-level candidate predictors, chosen a priori, as fixed effects. Predictors were selected primarily using clinical reasoning, in addition to backward stepwise selection. Calibration and discrimination were calculated, and bootstrap validation was performed to calculate optimism. Results and limitations: The unadjusted prevalence was 17.2% (n = 1763) for bladder cancer, 1.20% (n = 123) for UTUC, and 1.00% (n = 103) for renal cancer. The final model included predictors of increased risk (visible haematuria, age, smoking history, male sex, and family history) and reduced risk (previous haematuria investigations, urinary tract infection, dysuria/suprapubic pain, anticoagulation, catheter use, and previous pelvic radiotherapy). The area under the receiver operating characteristic curve of the final model was 0.86 (95% confidence interval 0.85-0.87). The model is limited to patients without previous urological malignancy. Conclusions: This cancer prediction model is the first to consider established and novel urinary tract cancer diagnostic markers. It can be used in secondary care for risk stratifying patients and aid the clinician's decision-making process in prioritising patients for investigation. Patient summary: We have developed a tool that uses a person's characteristics to determine the risk of cancer if that person develops blood in the urine (haematuria). This can be used to help prioritise patients for further investigation.

Introduction: Frailty phenotype represents weight loss, decreased functional and physical capacity and activity, falls, slow gait, and memory impairment. Sarcopenia is a generalized and progressive loss of skeletal muscle mass, strength, and function, which occurs due to primary effects of aging and secondary effects of other causes including diseases, malnutrition, and inactivity. Materials and Methods: This prospective cross-sectional study was performed on 70 critically ill geriatric patients (of age > 60 years) admitted in Medicine ICU (MICU) from December 2020 to May 2021 at a rural medical school at Wardha in central rural India. We assessed sarcopenia in all the patients by the European Working Group on Sarcopenia in Older People (EWGSOP) criteria and compared it with the modified frailty index. All the patients were divided in sarcopenic and non-sarcopenic groups; frailty index was applied, and outcomes were measured in terms of mortality, the need for ventilation, and length of ICU stay. Results: In this study, the mean age of the patients was 68.61 ± 5.88 years in the sarcopenic group and 69.10 ± 6.31 years in the non-sarcopenic group. Eighteen (42.86%) patients in the sarcopenic group were severely frail, whereas eight (28.57%) patients in the non-sarcopenic group (p = 0.532) were not. In the sarcopenic severely frail group, mortality was six (14.29%), and eight (19.05%) required ventilation (p = 0.001), whereas in the non-sarcopenic severely frail group, mortality as well as the need for ventilation were four (14.29%) (p = 0.0001). Total duration of ICU stays was 4.30 ± 1.07 days in the sarcopenic group (n = 42), whereas it was 3.85 ± 1.23 days in the non-sarcopenic group (n = 28) (p = 0.10). Conclusion: Our study found that critically ill patients with sarcopenia had more tendency to become frail, thereby increased risk of mortality. A timely routine assessment for sarcopenia upon ICU admission may provide an important prognostic factor in patient outcomes.

Introduction: Pre-diabetes is a state of intermediate hyperglycemia. Although it looks benign, pre-diabetes is known to be associated with low-grade inflammation. High sensitivity C-reactive protein (hsCRP) is a sensitive marker to detect low-grade inflammation. Here, we studied whether hsCRP can be used as a biomarker in the early diagnosis of pre-diabetes in a rural population. Methods: A total of 200 participants, including 100 cases and 100 controls who were age- and gender-matched, were enrolled according to the World Health Organisation criteria for pre-diabetes in this study. All the cases and controls underwent a detailed history, physical examination, anthropometric measurements, and biochemical analysis. The biochemical analysis included blood glucose levels, lipid profile, and hsCRP Results: The mean hsCRP in pre-diabetics 2.17 ± 0.72 mg/L was significantly higher than controls (0.66 ± 0.22 mg/L; p < 0.0001). High sensitivity CRP was significantly and positively correlated to age, body mass index (BMI), total cholesterol, low-density lipoprotein, cholesterol, and waist-hip ratio. Conclusion: Raised level of hsCRP was associated with pre-diabetes and also correlated with age, higher BMI, higher cholesterol, higher low-density lipoprotein, and higher waist-hip ratio.

Obesity, defined on the basis of anthropometric measures is a global epidemic and threatening to healthy population worldwide. A research from China among young adults (20--44 years) recorded six and two times the risk of hypertension (HTN) in individuals who were obese and overweight, respectively, relative to normal weight individuals. This study highlights about anthropometric indices and its association with HTN among young medical students at rural medical college.In this cross-sectional study, 1,000 medical students had been enrolled. Anthropometric indices like body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), neck circumference (NC) as per South East Asian guidelines were measured in all students.Among young medical students, the prevalence of obesity defined by BMI, WC, WHR, and NC was 46.5%, 32.4%, 57.3%, and 8.4%. Among males, there was significant positive correlation of BMI with SBP (The prevalence of HTN in this study was 9.8% in young medical students overall and varies according to anthropometric indices. The prevalence rate varies in males and females depending on the anthropometric measures.

Background: Aim of the study was to study the correlation between clinical, ultrasonographical and hormonal features in women diagnosed as polycystic ovary syndrome (PCOS) and association with vitamin D levels.Methods: This prospective study was conducted among women attending gynecological outpatient department (OPD) of Subharti Medical College, Meerut over a period of two years among 100 patients with clinical diagnosis of PCOS/PCOD according to Rotterdam criteria (2013) were included in this study. All biochemical investigations to be carried out for levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), vitamin D levels, lipid profile to understand the endocrinal and metabolic derangements if any in the patient. Ultrasound pelvis for ovarian study was conducted to know the ovarian morphology, no of follicles if any and their size, which were helpful in the diagnosis of PCOS.Results: Nulliparity and multiparity was reported among 32% and 68% of the subjects respectively. Most common complaint was hirsuitism (43%). According to ultrasonography (USG), PCOS was found to be positive and negative among 87% and 13% of the subjects respectively. Most of the subjects had vitamin D level of 20-50 while

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

This study presents two compact high-efficiency active integrated antennas (AIAs) working at 2.15 GHz. Both AIAs are realised by integrating the planar inverted-F antenna (PIFA) at the back side of the class-E power amplifier. In the first design, the antenna input impedance is transformed into an optimum impedance of the power amplifier. It achieves the maximum power added efficiency (PAE) of 68.6% with a total dimension of 0.36 λ 0 × 0.32 λ 0 × 0.03 λ 0 ( λ 0 is calculated at 2.15 GHz). In the second design, the antenna directly connected to the drain terminal of the power amplifier and offers a maximum PAE of 74% with a compact size of 0.21 λ 0 × 0.17 λ 0 × 0.04 λ 0 , results in the size reduction of 59%. The novelty of the second design is it offers frequency reconfigurable nature by moving the shorting plate of PIFA without scaling the power amplifier and antenna, which can support Universal Mobile Telecommunications System (UMTS) (1920-2170 MHz), long term evolution (LTE)-40 (2300-2400), and Worldwide Interoperability for Microwave Access (WiMAX) (2500-2690 MHz) frequency bands. The measured results demonstrate that the proposed reconfigurable AIA yields the maximum PAE of 64% at both frequencies 2.3 and 2.6 GHz.

In this paper, a compact planar CPW-fed antenna operating over the four frequency bands is proposed for RF energy harvesting applications. The proposed antenna includes five radiating elements and a stepped ground plane, occupies a total area of 48 × 42 mm2. By virtue of stepped ground plane, the antenna exhibits a better impedance match compared to the antenna with the full ground plane. The measured | S 11 | better than −10 dB is obtained at the frequency bands GSM-900, GSM-1800, Wi-Fi 2.1 GHz and Bluetooth (2.4 GHz), showing its suitability for RF energy harvesting application. For this to be feasible, the developed antenna is matched with the rectifier at four desired frequencies using a compact quad-band matching network. The merit of the proposed rectifier circuit is it can be extended for n number of frequency the band by using only 3n-1 number of lumped elements. To validate the design method experimentally, a prototype of a dual-band rectifier is also fabricated. The measured result demonstrates that the proposed dual-band rectifier circuit achieved the peak efficiency of 42 % and 38 % for 0.9 and 2.1 GHz, respectively at a load impedance of 4.7 k Ω .

This paper presents a compact active integrated antenna (AIA) comprising of class-A power amplifier (PA) and stepped impedance planar inverted-F antenna (PIFA). In the proposed design, a common ground is used for both PA and PIFA, resulting a compact antenna of size 0.14λ 0 × 0.11λ 0 × 0.01λ 0 (λ 0 is free space wavelength at 0.85 GHz). Moreover, it is demonstrated that by using the stepped impedance radiator the operating frequency of the active PIFA is shifted down from its natural resonant frequency of 1.36 GHz to 0.85 GHz, offering an extensive size reduction of 80%. This active integration increases the passive antenna gain through the effective loading of the antenna to the power amplifier. The measured result indicates that the active and passive antennas achieved the gain of 15.7 dB and 3.81 dBi, respectively after the integration. In addition, the maximum SAR value of antenna is found to be 0.64 W/kg.

This paper presents a broadband hybrid slot-dielectric resonator antenna for radiofrequency (RF) energy-harvesting application. The antenna geometry consists of a simple pentagon-shaped dielectric resonator antenna (PDRA) excited by a microstrip feed underlying rectangular slot with narrow notch. It is investigated that the bandwidth of the proposed PDRA is improved significantly owing to electromagnetic coupling between feeding slot and the dielectric resonator. The measured results demonstrate that the proposed PDRA achieves an impedance bandwidth of 110.8%, covering the frequency range from 0.86 to 3 GHz in addition of stable radiation pattern with peak gain of 6.8 dBi and more than 90% radiation efficiency throughout the band, showing its suitability for RF energy harvesting application. For this to be feasible, the developed antenna is matched with the rectifier at two public telecommunication bands of GSM-900 and GSM-1800 using a compact dual-band hybrid matching network. The measured result demonstrates that the proposed dual-band rectenna system provides the peak efficiency of 63 and 59% for a load impedance of 4.7 kΩ at 0.9 and 1.8 GHz, respectively.

In cancer patients, syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the leading cause of hyponatremia. 1 Hyponatremia is a serious disorder of dyselectrolytemia, linked with neurological symptoms that are life-threatening and it is the most common aetiology of tumour-related electrolyte imbalance.2 The tumours commonly causing hyponatremia of SIADH variety are lung, head-neck and breast tumours. SIADH has been documented in various malignancy types with numerous possible aetiologies apart from active malignancy.2,3 The aetiology distribution of SIADH in tumour patients are not completely known. Secondly, clinically, it is not clear which malignancy is most commonly associated with SIADH.3 Calcified meningioma presenting as SIADH had not been reported so far in the literature. Here a case of an elderly female with clinical features and brain imaging suggestive of meningioma associated with hyponatremia due to SIADH had been highlighted.

Background: Extra hepatic biliary obstruction (EHBO) is not a rare surgical problem; our experience in managing 36 patients over a period of two years at a tertiary care hospital in a rural setting in India. The objective was to study the etiology and clinical presentation of patients with EHBO, role of various investigative modalities and management strategies in these patients and their outcome.Methods: This was a prospective study conducted between September 2018 to August 2020 in the department of surgery in tertiary care center Subharti medical college (SMC) Meerut. Data was taken in a pre-formed performa and the results were tabulated and analyzed (descriptive analysis).Results: Out of 36 patients, 2 (5.5%) patients underwent choledochoduodenostomy, 1 (2.7%) exploratory laparotomy with CBD exploration with t tube drainage, 1 (2.7%) ERCP with pigtail drainage; 17(47.2%) ERCP (endoscopic retrograde cholangiopancreatography) followed by cholecystectomy, 1 (2.7%) open cholecystectomy with t tube drainage, 4 (11.1%) ERCP alone, 2 (5.5%) hepaticojejunostomy, 1 (2.7%) ERCP followed by diverticulectomy, 2 (5.5%) PTBD (percutaneous transhepatic biliary drainage) followed by a triple bypass surgery, 2 (5.5%) PTBD, 1 (2.7%) pylorus preserving pancreaticoduodenectomy, 1 (2.7%) ERCP with sphincterotomy, 1 (2.7%) PTBD followed by whipples procedure. Patients were followed up and 5 (13.8%) patients had recurrence of the disease.Conclusions: EHBO is a hepatobiliary surgical condition caused by both neoplastic and non-neoplastic etiology. Benign pathologies common in younger patients whereas neoplastic conditions in older age. Ultrasonography is the most common investigative modality followed by ERCP with PTBD/ENBD playing an important role in decompression of biliary obstruction as a palliative measure in advanced malignancies.

This paper focuses on various design constraints of radio frequency energy harvesting circuit (RFEHC). Matching networks such as L- and Π-type are used to investigate the RFEHC performance. The sim...

A novel high gain and broadband hybrid dielectric resonator antenna (DRA) is designed and experimentally validated. To obtain the wide impedance bandwidth, the proposed antenna geometry combines the dielectric resonator antenna and an underlying slot with a narrow rectangular notch, which effectively broadens the impedance bandwidth by merging the resonances of the slot and DRA. An inverted T-shaped feed line is used to excite both antennas, simultaneously. It supports amalgamation of different resonant modes of the both, DRA and slot antenna. The measured results show that the proposed antenna offers an impedance bandwidth of 120% from 1.67 to 6.7 GHz. The antenna gain is next enhanced by a reflector placed below the antenna at an optimum distance. On engineering the height and dimension of this reflector the antenna gain is improved from 2.2 dBi to 8.7 dBi at 1.7 GHz. Finally, antenna operation is attested experimentally with a rectifier circuit in the frequency range of 1.8–3.6 GHz, where various strong radio signals are freely available for RF energy harvesting. The measured maximum efficiency of the rectifier and rectenna circuit were found to be 74.4% and 61.4%, respectively.

The management of non-muscle-invasive bladder cancer (NMIBC) has evolved from the first reports on bladder endoscopy and transurethral resection to the introduction of adjuvant intravesical treatment. However, disease recurrence and progression remain an ongoing risk, placing a heavy burden on healthcare resources and on patients' quality of life. Deeper understanding of the molecular basis of the disease and developments in optics, lasers and computer science are already offering opportunities to revolutionize care and improve long-term prognosis. This article discusses developments likely to cause a paradigm shift towards the delivery of personalized care and reduced burden of disease in NMIBC.

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

Background/Purpose Magnesium deficiency has been a common, but easily ignored, electrolyte abnormality. Studies on magnesium deficiency are lacking in India, especially in a rural setting. Here, we have correlated serum magnesium levels with outcomes in elderly patients admitted to the medical intensive care unit with respect to the length of intensive care unit stay, need for mechanical ventilatory support and its duration, and outcome (discharge/death). Methods A prospective, observational study was conducted in patients aged 60 years and older, who had been admitted to the intensive care unit of the medicine department for over a year. The chi-square test was applied to correlate hypomagnesemia with the outcome. Results In our study, 59.30% of the elderly patients had hypomagnesemia. Compared with patients with a normal magnesium level, hypomagnesemic patients had no correlation with the duration of medical intensive care unit stay (5.57 ± 6.10 days vs. 5.61 ± 5.55 days), but the need for mechanical ventilation (57.84% vs. 45.71%), rate of discharge from the intensive care unit or cure (60.28% vs. 71.42% ), rate of death (39.21% vs. 28.57%), and mean duration of ventilation (3.07 ± 5.05 days vs. 2.15 ± 3.46 days) were higher. However, no significant statistical difference was found between these groups. Conclusion Hypomagnesemia was associated with a slightly higher mortality rate. Requirement and duration of ventilatory support were also higher, although not statistically significant. Hypomagnesemia was not found to have any impact on the duration of medical intensive care unit stay. Monitoring of serum magnesium levels may have prognostic and perhaps therapeutic implications in the elderly.

Atypical femoral fracture is a known complication of patients receiving long-term bisphosphonates for osteoporosis. Recognizing early radiographic features is important to provide timely care and management before the development of a more debilitating complete fracture with its associated morbidity and mortality. We report a case of a 72-year-old lady on long-term treatment with alendronate, who presented initially with groin pain and subsequently with a femoral fracture, without any major trauma. The initial radiographic finding of focal thickening along the lateral cortex of the proximal femur was missed.

CONTEXT:Evidence is emerging that preterm infants are at risk for autism spectrum disorder (ASD).OBJECTIVES:To conduct a systematic review and meta-analysis to estimate the prevalence of ASD in preterm infants.DATA SOURCES:Medline (via PubMed and Ovid), Embase, PsycINFO, and relevant conference proceedings were searched in May 2017.STUDY SELECTION:Original studies in which researchers report on the prevalence of ASD using diagnostic tests in children born preterm were included. Studies in which researchers used only ASD screening tools were excluded.DATA EXTRACTION:Relevant data were extracted independently by 3 authors.RESULTS:Researchers in a total of 18 studies (3366 preterm infants) used ASD diagnostic tools. The median gestation, birth weight, and age at assessment were 28.0 weeks (range: 25.1–31.3 weeks), 1055 g (range: 719–1565 g), and 5.7 years (range: 1.5–21 years), respectively. Meta-analysis revealed that the overall prevalence rate for ASD was 7% (95% confidence interval: 4% to 9%). The funnel plot and Egger’s test revealed that there was probably no evidence of publication bias.LIMITATIONS:The limitations were significant heterogeneity and a lack of studies from middle- and low-income countries.CONCLUSIONS:The prevalence of ASD is significantly high in the preterm population. Adequate resources are needed to improve the outcomes of these children.

BACKGROUND Excessive inflammation is associated with adverse outcomes in preterm infants. C- reactive protein (CRP) is a marker of inflammation/infection. Probiotics have anti-inflammatory properties. Randomized controlled trials (RCTs) in preterm infants have not reported effect of probiotics on CRP. AIM To evaluate effect of probiotics on CRP in preterm infants who had participated in a RCT of Bifidobacterium breve (B. breve) m-16v. METHODS Data on all infants (GA

A class-E power amplifier integrated with a rectangular ring planar inverted-F antenna (PIFA) is presented in this paper. The proposed PIFA is very compact and occupying less volume 16 × 10 × 5.5 mm3. The measured result shows that the proposed PIFA offers an impedance bandwidth of 250 MHz from 2.3–2.55 GHz, which is useful for LTE band 40 and WLAN (2.4–2.48 GHz). The maximum power-added efficiency (PAE) of class-E power amplifier is found to be 70% at 2.3 GHz. Further, the proposed PIFA is integrated with the class-E power amplifier to design an active-integrated antenna. The simulated results of the active-integrated antenna are presented. It is found that the gain of the active-integrated antenna system is increased from 2.4 dBi (passive) to 17.2 dBi (active).

Wirsungorrhage is a rare cause of hematochezia caused by a bleeding source in the pancreas, pancreatic duct or structures adjacent to it, such as the splenic artery that bleed into the pancreatic duct and thence to duodenum. We report a case of 38 year old male presenting with hypovolemic shock and fresh bleeding per rectum (hematochezia) secondary to splenic artery aneurysm diagnosed on the basis of computed tomography (CT) Angiography. In this case report we have highlighted the importance of angiography, when cause of gastrointestinal bleeding is not detectable by endoscopy.