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An insight into the global hydrological cycle which is an important controlling factor of ecological system, requires the microphysical properties of rain to be understood very clearly. To estimate rain fall rate, Radar reflectivity (Z) and rainfall rate (R) relationship is a preferred choice. Therefore it is necessary to study the microphysical property of rain with a special focus in hills besides the plane land in tropical region as topography has a major impact on local weather. Here the place under investigation, Majhitar, Sikkim is having 200 metres of altitude and surrounded by hills. Rain events are separated into convective and stratiform type using Gamache-Houze method. Radar reflectivity is extracted from LASER Precipitation Monitor (LPM) data at Sikkim Manipal Institute of Technology (SMIT) site for one whole month (August, 2019) rain events. The Z–R relation for Sikkim is established and a clear deviation from Marshall—Palmer and Rosenfeld proposed model is reported. The variation in the pattern of convective and stratiform rain presented in the work is clear evidence of high altitude effect and the terrain of hill is introducing signature of orographic rain with the conventional rain also.

We present an EOM-CCSD-based quantum mechanical/molecular mechanical (QM/MM) study on the electron attachment process to solvated cytosine. The electron attachment in the bulk solvated cytosine occurs through a doorway mechanism, where the initial electron is localized on water. The electron is subsequently transferred to cytosine by the mixing of electronic and nuclear degrees of freedom, which occurs on an ultrafast time scale. The bulk water environment stabilizes the cytosine-bound anion by an extensive hydrogen-bond network and drastically enhances the electron transfer rate from that observed in the gas phase. Microhydration studies cannot reproduce the effect of the bulk water environment on the electron attachment process, and one needs to include a large number of water molecules in the calculation to obtain converged results. The predicted adiabatic electron affinity and electron transfer rate obtained from our QM/MM calculations are consistent with the available experimental results.

The article attempts to develop regression based model for the prediction of stochastic—deterministic phenomena like orographic rain in North East Indian hills and valleys using historical thirty eight years data of rainfall over the three hill stations Majhitar, Silchar and Shillong. Considering the randomness, non-stationarity within the time series, the suitable model for prediction of rainfall has been determined. The performance of the prediction model is also calculated in terms of deviation from actual data. Results shows that for long term prediction of rainfall for the autoregressive integrated moving average ARIMA model (3, 1, 2) is suitable for obtaining the prediction of orographic rainfall of North eastern India.

This article investigates the performance of a collar-stay-shaped rigid wearable dual-band antenna for the purpose of wireless communications. The collar position of formal shirt has been chosen for placing the antenna. Because of its rigid structure, it can overcome the problem of frequency resonance shifting and downfall of signal strength associated with a flexible antenna due to body bending and cloth crumpling. It finds applications in 4.34 and 5.96 GHz with bandwidths 120 MHz and 84 MHz, respectively. This antenna yields a maximum gain of 4.51 and 5.37 dBi at 4.34 GHz and 5.96 GHz, respectively.

Flavonoids are plant-specific dietary components with their promising health-promoting effects in human cell which has been well proven with plethora of experimental and human clinical studies. They own a variety of biological activities and properties as antioxidant, anti-inflammatory, anti-cancerous, anti-allergic and many more which can modulate cell signaling and gene expression-related disease development. Poor bioavailability of flavonoids is a great concern as it can put a check or even can hinder their health effects. Therefore, efforts to improve their bioavailability with the aim of improving the efficacy of flavonoids are subject of current research in this area. This chapter highlights the overall picture of flavonoids, including their beneficial roles, contributing toward improving the human health.

In this research outcome, a C-shaped microstrip antenna is developed for the applications of Worldwide Interoperability for Microwave Access (WiMAX) and Wireless Local Area Network (WLAN). The proposed C-shaped patch antenna exhibits two operating frequencies at 3.7 and 5.2 GHz with bandwidths 110 MHz (3.62–3.73 GHz) and 160 MHz (5.06–5.22 GHz), respectively. The antenna structure provides a peak gain of 5.53 dBi and 5.39 dBi at 3.7 GHz and 5.2 GHz, respectively. Antenna efficiency obtained at 3.7 GHz and 5.2 GHz are 34.5% and 31.5%, respectively. Key performance metrics of the antenna are evaluated by two different software.

This study reports the synthesis and antibacterial evaluation of two novel complexes, [Cd (Q) (Bpy) (CH3COO)2, complex 1] and [Cd (Q) (Phen) (CH3COO)2, complex 2], based on quercetin ligand. The method of synthesis was by reacting natural flavonoid quercetin (Q) with a good chelator (Bpy = 2,2’-bipyridine, Phen= 1,10-phenanthroline and Q = quercetin) and metal ions. The produced metal complexes were studied in the solid state by Fourier-transform infrared (FTIR) spectroscopy and in solution by UV-Vis absorption. Further analysis included high resolution mass spectrometry (HRMS) for confirmation. To understand the nature and coordination of quercetin and its metal complexes, density functional theory (DFT) calculation was performed. The scavenging (DPPH radical), antibacterial, MTT, enzymatic and non-enzymatic antioxidant activity assay, cytotoxicity assay (fluorescence study) were done and quercetin was used for comparison. Both complex 1 and complex 2 induced loss of cell viability via impairment of metabolic activity, leakage of intracellular proteins, and increased oxidative stress. The free-radical scavenging activity of complex 2 (IC50 340.175 µg/mL) was statistically significantly more potent than that of complex 1. The MIC values of complex 2 (7.80 µg/mL Escherichia coli, 15.62 µg/mL Staphylococcus aureus) were higher as compared to complex 1 and quercetin in both test microorganisms. There was inhibition of cell proliferation in Escherichia coli treated with 2 µg/mL of complex 2, whereas Staphylococcus aureus did not show inhibition at this concentration. The cytotoxicity screening on MG 63 cell line showed that the compounds were safe up to 500 mg/L.

Stressful environments accelerate the formation of isoaspartyl (isoAsp) residues in proteins, which detrimentally affect protein structure and function. The enzyme PROTEINl-ISOASPARTYL METHYLTRANSFERASE (PIMT) repairs other proteins by reverting deleterious isoAsp residues to functional aspartyl residues. PIMT function previously has been elucidated in seeds, but its role in plant survival under stress conditions remains undefined. Herein, we used molecular, biochemical, and genetic approaches, including protein overexpression and knockdown experiments, inArabidopsisto investigate the role of PIMTs in plant growth and survival during heat and oxidative stresses. We demonstrate that these stresses increase isoAsp accumulation in plant proteins, that PIMT activity is essential for restricting isoAsp accumulation, and that both PIMT1 and PIMT2 play an important role in this restriction andArabidopsisgrowth and survival. Moreover, we show that PIMT improves stress tolerance by facilitating efficient reactive oxygen species (ROS) scavenging by protecting the functionality of antioxidant enzymes from isoAsp-mediated damage during stress. Specifically, biochemical and MS/MS analyses revealed that antioxidant enzymes acquire deleterious isoAsp residues during stress, which adversely affect their catalytic activities, and that PIMT repairs the isoAsp residues and thereby restores antioxidant enzyme function. Collectively, our results suggest that the PIMT-mediated protein repair system is an integral part of the stress-tolerance mechanism in plants, in which PIMTs protect antioxidant enzymes that maintain proper ROS homeostasis against isoAsp-mediated damage in stressful environments.

Objectives To examine the association between local health departments' (LHDs') engagement in accreditation and their staffs' perceptions of workplace environment and the overall satisfaction with their jobs. Design Data from the 2014 Public Health Workforce Interests and Needs Survey (PH WINS) (local data only) and the 2014 Forces of Change survey were linked using LHDs' unique ID documented by the National Association of County & City Health Officials. The Forces of Change survey assessed LHDs' accreditation status. Local health departments were classified as "formally engaged" in the Public Health Accreditation Board accreditation process if they had achieved accreditation, submitted an application, or submitted a statement of intent. The PH WINS survey measured employees' perception of 3 aspects of workplace environment, including supervisory support, organizational support, and employee engagement. The overall satisfaction was measured using the Job in General Scale (abridged). There are 1884 LHD employees who completed PH WINS and whose agencies responded to the question on the accreditation status of the Forces of Change survey. Results When compared with employees from LHDs less engaged in accreditation, employees from LHDs that were formally engaged in accreditation gave higher ratings to all 3 aspects of workplace environment and overall job satisfaction. Controlling for employee demographic characteristics and LHD jurisdiction size, the agency's formal engagement in accreditation remained related to a higher score in perceived workplace environment and job satisfaction. After controlling for perceived workplace environment, accreditation status was marginally associated with job satisfaction. Conclusion The findings provide support for previous reports by LHD leaders on the benefits of accreditation related to employee morale and job satisfaction. The results from this study allow us to further catalog the benefits of accreditation in workforce development and identify factors that may moderate the extent of the benefits. Findings from this study show that engagement in public health accreditation is associated with overall job satisfaction. This link may be explained by the hypotheses that meeting accreditation standards could increase staff satisfaction or that having higher job satisfaction could lead to a higher likelihood that a health department would apply for accreditation. Further research to explore this relationship is critical as many health departments are weighing the value of accreditation as they face constrained financial resources.

Mumps is an acute communicable self-limiting swelling of the parotid or other salivary glands. Various organs can be involved including the testes, central nervous system, mammary glands, ovary, pancreas, kidneys, and heart. We hereby present a rare case of an 18-year-old unvaccinated male with acute disseminated encephalomyelitis following mumps without parotitis.

miRNAs are 21–24 nt non-coding RNAs involved in negative regulation of the target gene expression in response to stress and developmental cues. Wheat, the major staple food crop, is highly sensitive to heat stress (HS). Even moderate high temperatures during critical stages causes reduction in yield and quality of the grains. Here, we identified a novel miRNA (candidate miR430) from wheat using de novo assembly, and cloned it from wheat cv. HD2985 using universal adaptor. The identified miRNA was mapped on to the Chromosome 3B and predicted to have more than 30 target genes. Most of the targets identified were associated with heat shock proteins. Expression analysis of miR430 in contrasting wheat cultivars by quantitative real-time PCR revealed significant genotypic variations under HS. Tissue specific expression analysis showed relatively low expression in leaves, as compared with stem and root under HS. A negative correlation was found between the expression of miR430 and their respective target genes under HS. MiR430 can be used to manipulate the expression of target genes under HS towards enhancing HS tolerance for the development of ‘climate-smart’ wheat crop.

3-Oxetanone is a strained cyclic molecule which plays an important role in synthetic chemistry. A few studies exist in the literature about the equilibrium properties of this molecule and the dissociation patterns of substituted 3-oxetanones. For the unsubstituted 3-oxetanone, formation of ketene (CH2CO) and formaldehyde (HCHO) was considered to be the major dissociation pathway. In a recent work, pyrolysis products of 3-oxetanone molecule in the gas phase were investigated by Fourier transform infrared spectroscopy and photoionization mass spectrometry. In this study, an additional dissociation channel forming ethylene oxide (c-C2H4O) and carbon monoxide CO was reported. In the present work, gas phase dissociation chemistry of 3-oxetanone was investigated by electronic structure theory, ab initio classical chemical dynamics simulations, and Rice–Ramsperger–Kassel–Marcus (RRKM) rate constant calculations. The barrier height for the ethylene oxide channel was found to be much higher than the ketene pathway...

Vagal paragangliomas are rare benign tumors accounting for only 3% of head and neck paragangliomas and arise from vagal ganglions, predominately the nodose ganglion in the carotid sheath. Imaging plays an important role in their diagnosis, differentiation from more common lesions presenting in the carotid space, and management. MRI is the method of choice for investigation when paragangliomas are clinically suspected. The typical salt-and-pepper appearance in T1-weighted images is well known but not specific to paragangliomas. Demonstration of the continuity of the lesion with the vagus nerve on magnetic resonance imaging (MRI) further asserts the diagnosis of glomus vagale. Although this tumor can be diagnosed on a contrast-enhanced computed tomography (CECT) examination, it is limited by the non-demonstration of its neural origin. Sonography is considered only a preliminary investigation in patients, and a CECT and/or MRI study of the neck is conducted before treatment planning. This case is unique as a confident diagnosis of glomus vagale was made on high-resolution sonography of the neck. A middle-aged male patient presenting with a neck swelling was diagnosed with a glomus vagale tumor on USG by the direct demonstration of its continuity with the vagus nerve, and Doppler examination confirmed its vascularity. The diagnosis was confirmed on histopathology after surgical excision. The sonographic appearance, Doppler characteristics, and imaging differential diagnosis of glomus vagale are discussed in detail.I paragangliomi vagali sono rari tumori benigni e rappresentano solo il 3% dei paragangliomi del distretto testa-collo; originano dai gangli vagali e più frequentemente dal ganglio nodoso localizzato all’interno della guaina carotidea. L’imaging svolge un ruolo importante nella sua diagnosi, nella differenziazione dalle lesioni più comuni che possono trovarsi nello spazio carotideo e, nella sua gestione, una volta identificato. La RM è tuttavia l’indagine di scelta; tuttavia il tipico aspetto “sale e pepe” in T1 pesate pur essendo ben noto non è specifico per i paragangliomi. Pertanto la dimostrazione della continuità della lesione con il nervo vago con la RM è fondamentale per la diagnosi di glomo carotideo. La TC con mdc, può suggerirne la diagnosi, ma è limitata nel dimostrarne la sua origine neurale. Pertanto l’ecografia è considerata solo come un’indagine preliminare in questi pazienti e TC con mdc e/o RM del collo vengono effettuate prima di pianificare il trattamento. In questo caso viene mostrato come la diagnosi di Tumore del glomo carotideo sia stata effettuata con esame ecografico. Un pz maschio di mezza età presentatosi con tumefazione del collo, grazie all’esame ecografico che dimostrava la presenza di una massa riccamente vascolarizzata al color-Doppler e in continuità con il nervo vago veniva inviato col sospetto di tumore glomivo, a esame di II livello e quindi a intervento chirurgico che ne confermavano, grazie all’esame istologico, la diagnosi. L’aspetto ecografico, le caratteristiche Doppler e di imaging del tumore del glomo vagale è di seguito discusso nei dettagli.I paragangliomi vagali sono rari tumori benigni e rappresentano solo il 3% dei paragangliomi del distretto testa-collo; originano dai gangli vagali e più frequentemente dal ganglio nodoso localizzato all’interno della guaina carotidea. L’imaging svolge un ruolo importante nella sua diagnosi, nella differenziazione dalle lesioni più comuni che possono trovarsi nello spazio carotideo e, nella sua gestione, una volta identificato. La RM è tuttavia l’indagine di scelta; tuttavia il tipico aspetto “sale e pepe” in T1 pesate pur essendo ben noto non è specifico per i paragangliomi. Pertanto la dimostrazione della continuità della lesione con il nervo vago con la RM è fondamentale per la diagnosi di glomo carotideo. La TC con mdc, può suggerirne la diagnosi, ma è limitata nel dimostrarne la sua origine neurale. Pertanto l’ecografia è considerata solo come un’indagine preliminare in questi pazienti e TC con mdc e/o RM del collo vengono effettuate prima di pianificare il trattamento. In questo caso viene mostrato come la diagnosi di Tumore del glomo carotideo sia stata effettuata con esame ecografico. Un pz maschio di mezza età presentatosi con tumefazione del collo, grazie all’esame ecografico che dimostrava la presenza di una massa riccamente vascolarizzata al color-Doppler e in continuità con il nervo vago veniva inviato col sospetto di tumore glomivo, a esame di II livello e quindi a intervento chirurgico che ne confermavano, grazie all’esame istologico, la diagnosi. L’aspetto ecografico, le caratteristiche Doppler e di imaging del tumore del glomo vagale è di seguito discusso nei dettagli.

Brain-Computer Interfaces (BCI) have proved to be a promising tool for neurorehabilitation. However, BCIs based on conventional methods are not highly accurate and reliable, different brain activity patterns are not optimal for all the users of BCIs and has low information transfer rate. Several studies have shown that the combination of different brain signal acquisition methods can lead to higher performance of BCIs. In this paper, we aim to investigate whether the performance of BCI increases if we combine Electroencephalography (EEG) and functional Near Infrared Spectroscopy (fNIRS) simultaneously for classifying Motor Imagery (MI) tasks of right- versus left-hand grasping movement. The results show enhancement in classification accuracy using a multimodal approach of an EEG + fNIRS BCI with an average increase of approximately 8-10% compared to only EEG-based BCI. This indicates that the hybrid approach in Brain-Computer Interface is capable of enhancing the BCI performance.

Pubic symphysis diastasis following childbirth via vaginal delivery is a rare but debilitating condition. It is an uncommon and under diagnosed condition resulting in acute pelvic pain and deformity. Since postpartum pain is frequently dismissed as attributable to labor and childbirth, the diagnosis of pubic diastasis is often delayed and sometimes missed altogether. In this article we report a case of 35 years old multigravida with pubic symphysis diastasis presenting on second day post partum . Management consisted of simple conservative treatment with binders and analgesics, which were sufficient in achieving a complete reversal of the condition. A multi-disciplinary approach is essential in both early detection and treatment for satisfactory patient outcomes.

A reliable and accurate glacial monitoring system is being developed with the help of a UAV and high-resolution camera on board. GPS is another major part of system which will help to collect information on glacier melting using reflectrometry principle and complement the information of aerial view of the lake formed due to glacier melting. The information gathered in that way helps the existing human habitat in the vicinity of the glacial lake from Glacial lake Outburst Flood (GLOF), a serious event of North East Indian Himalayan region. The information gathered in that way and generated warning signal are then transmitted to android application which exploits the data for the real time monitoring of the glacier melting as well as increase of area of the lake formed due to glacier melting.

Reliable method of high accuracy and time efficient monitoring of lake formation due to glacier melting is a serious challenge of alpine Himalaya. The development of model for the Glacial Lake Outburst Flood (GLOF) requires the database which is not available so far. A few surveys are already carried out in this regard based on satellite imagery which are comparatively less accurate. Hence, there is an urgent need for proper information which can be originated from real time monitoring of glacier melting as well as lake formation as a result of that. Wherever there is a human habitat in close proximity of such lake, the development of a method to gather such information is a further crucial. An approach has been demonstrated in this paper to develop an end-to-end solution for real time monitoring of glacial lake using unmanned aerial vehicle (UAV) and providing the warning as well the continuous monitoring via android application to the appropriate authority.

Drug delivery is defined as administration of drug component inside the body, and the system adopted for the same is known as drug delivery system. Advancements in the drug delivery system are gaining more attention and popularity due to the use of nanoformulations that enables efficient, effective and specific targeting of the drug. Several drug carriers such as liposomes, aptamers, quantum dots, peptide, polymers, metals and magnetic nanoparticle-based delivery are categorised as advanced generation drug delivery systems. The structural complexity of nano-based drug delivery system, e.g. nanocapsules, dendrimers, nanosponges, nanocrystals, nanogels and nanocapsules, provides high surface area for precise targeting in the field of cancer management and several other life-threatening diseases.

Integration procedures are employed to increase and enhance computing networks and their application domain. Extensive studies towards the integration of MANET with the internet have been studied and worked towards addressing various challenges for such integration. Some idyllic mechanisms always fail due to the presence of some nasty node or other problems such as face alteration and eavesdropping. The focus of this chapter is on the design and discovery of secure gateway scheme in MANET employing trust-based security factors such as route trust and load ability. Over these, the elliptic curve cryptography is applied to achieve confidentiality, integrity, and authentication while selecting optimum gateway node that has less bandwidth, key storage space, and faster computational time. Simulation results of the security protocol through SPAN for AVISPA tool have shown encouraging results over two model checkers namely OFMC and CL-AtSe.

There is a long demand for light-weight, high-strength, and wear-resistance aluminium alloys, particularly in automotive and aerospace industries. This demand is somewhat fulfilled by aluminium metal matrix composites. However, aluminium nano-metal matrix composite because of its superior properties is increasingly popular to replace aluminium metal matrix composites. The SiC (grit size is

In Combination logic there are some patterns which commonly occur and it is convenient to represent these in their own separate units often they are also available as separate integrated circuits. This research paper covers the two of these, the decoder and the multiplexer. In this work, designing of 2:1 MUX and MUX Based Decoder using SCL (Source Coupled Logic) is done. Power and value of current spike (Rail–to-Rail current) is found for the circuits. The Simulation is done using 180nm technology using TANNER (Version 9.2) tool.

Extensive developments in the area of industrial biotechnology over past few years have signified the importance of citric acid as one of the most known organic acid, applied mainly as flavoring, emulsifying, cleaning, and chelating agent. It also plays a major role in pharmaceutical and cosmetic industries. Citric acid is produced by various microorganisms such as Aspergillus niger, Penicillium restrictum, Trichoderma viride, Mucor piriformis, A. awamori. A. niger is one of the most commonly used source for citric acid production under submerged fermentation conditions. A.niger was isolated from rotten onion, coconut, and lemon and was grown in supplemented Potato Dextrose Broth (PDB) at 30°C for 7 days. Best source for isolation of A.niger amongst these sources was analyzed by observation of optical density. Subsequently, production of citric acid using A.Niger on variable sugar sources was carried under Nitrogen and phosphorus limitation. Three different production media for citric acid production were used,Cane Molasses, Czapek Dox and Orange peel media. Effect of variation of pH in the range of 1-5 and temperature in the range of 200 to 500C over production of citric acid in cane molasses, Czapek Dox and Orange peel was estimated. Quantitative estimation of citric acid produced under varying environmental parameters in submerged culture condition was done using titration method and it was observed the best production media for citric acid production using A.nigerwas Cane molasses media at the pH 1 and temperature 20 ° C. K e y w o r d s Citric acid, Aspergillusniger, Submerged fermentation, Czapek dox, Cane molasses, Orange peel, titration, Optical density, pH and temperature.

Background: To study the place of Maternal Serum Alfa Feto Protein (MSAFP) as a biomarker of placental adherence in low lying placenta, and to study maternal outcome in the study group. Methods: This is a prospective observational study analyzing the conditions and the data of 90 cases with low lying placenta in a tertiary care hospital. The analysis was done for the association of MSAFP with MRI, perinatal and maternal outcome. Results: The level of MSAFP was found higher in 14 out of 15 cases (93.3%) of placenta previa with placental adherence. There was significant surgical intervention (80%) and increased maternal morbidity (68.8%) in the study group with placental adherence and raised MSAFP respectively. Conclusions: MSAFP is an important biomarker for prognostication of placental adherence in low lying placenta.

Weed management in cotton is a major challenge because of the slow initial crop growth. Further, noxious weeds (purple nutsedge: Cyperus rotundus L.) and invasive weeds (smooth joyweed: Alternanthera paronychioides A. St.-Hil.) are difficult to control. Thus, the small and poor farmers of the Indian sub-continent are in need of effective integrated weed management strategies. Intercropping in the wide row space Bt-transgenic cotton hybrids is a possible option to the readily available expensive technologies such as herbicides and polythene mulch. We evaluated 12 different intercrops and its mulching, over 5-years (2014–15 to 2018–19), on weed control, species diversity, seedcotton yield and economics. Intercrops were compared with newspaper or polythene mulch, farmers’ practice (FP) and a control. Number of monocot and dicot weeds were the least in the polythene mulched plots and the greatest in the control treatment. Intercrops significantly reduced weed density by 43–71% compared to the control treatment. Intercrops varied in their weed suppression over years, with a consistent weed suppression observed in the sunnhemp plots. Weed biomass was, on an average, reduced by 43% in the sunnhemp plots compared to the FP. High total phenolics and terpenoid content in the above ground parts of sunnhemp possibly contributed to the inhibition of weed seed germination and growth. The top five weeds, in the study area, were Echinochloa colona L., C. rotundus, Urochloa plantaginea (Link.) Hitch., Corchorus trilocularis L. and A. paronychioides. Polythene mulched plots had the highest seedcotton yield but net benefits were the most with sunnhemp intercrop (USD 295.2 ha-1 vs. 176.2 ha-1 for the polythene and 67.2 ha-1 for newspaper mulch) due to reduced input costs. Sunnhemp grown as an intercrop and later mulched can be used as a tool to filter out noxious weeds and provide an effective strategy for integrated weed management.

Background: Recurrent pregnancy loss (RPL) is one of the most frustrating and difficult areas in reproductive medicine because the aetiology is often unknown and there are only few evidence-based diagnostic and treatment strategies. Objective of this study was to compare the role of trans vaginal sonography with hysteroscopy in detection of uterine causes of abortions.Methods: This prospective cohort study was conducted in the department of obstetrics and gynaecology, Kasturba Hospital, Daryaganj, Delhi. The study was conducted from January 2016 to December 2016.Results: On transvaginal sonography majority of women i.e. 39(78%) patients had normal ultra-sonographic findings. 11(22%) showed various abnormal findings. Most commonly diagnosed abnormal finding on TVS was polyp, seen in 5(10%) patients. It was seen as a well-defined, uniformly hyperechoic mass within the endometrial cavity. normal hysteroscopic findings were seen in 27(54%) patients. Rest 23(46%) patients had abnormal uterine factors as diagnosed by hysteroscopy.Synechiae was detected in 9(18%) patients. It was the most common abnormality detected on hysteroscopy. Out of 9 patients who had synechiae, 2 had severe dense adhesions. In 6 patients, the adhesions were mild and flimsy. While minimal adhesions were noted in 1 patient, seen near the cornua.Conclusions: hysteroscopy is still the gold standard for diagnosis and most definitive procedure of choice if any kind of operative intervention is required.

Background Community-acquired pneumonia (CAP) is a common cause of hospitalization. While there are single-center studies on acute kidney injury requiring dialysis (AKI-D) and CAP, data on national trends and outcomes regarding AKI-D in CAP hospitalizations is lacking. Methods We utilized the Nationwide Inpatient Sample to analyze trends overall and within subgroups. We also utilized multivariate regression to adjust for potential confounders of annual trends and to generate adjusted odds ratios (aOR) for predictors and outcomes, including mortality and adverse discharge. Results There were 11,500,456 pneumonia hospitalizations between 2002 and 2013, of which 3675 (0.3%) were complicated by AKI-D. The AKI-D rate increased from 2.7/1000 hospitalizations in 2002 to 4.3/1000 hospitalizations in 2013. The rate of increase was higher in males and African Americans. Although temporal changes in demographics and comorbidities explained a substantial proportion, they could not explain the entire trend. The predictor with the highest odds of AKI-D required mechanical ventilation during hospitalization (aOR 12.47; 95% CI 11.66-13.34). Other significant predictors included sepsis (aOR 4.37; 95% CI 4.09-4.66), heart failure (aOR 2.40; 95% CI 2.25-2.55), and chronic kidney disease (CKD) (aOR 2.00; 95% CI 1.86-2.16). AKI-D was associated with increased in-hospital mortality (aOR 3.08; 95% CI 2.88-3.30) and adverse discharge (aOR 2.09; 95% CI 1.92-2.26). Although adjusted mortality decreased per year, attributable mortality remained stable. Conclusion Pneumonia hospitalizations complicated by AKI-D have increased with a differential increase by demographic groups. AKI-D is associated with significant morbidity and mortality. In the absence of effective AKI-D therapies, the focus should be on early risk stratification and prevention to avoid this devastating complication.

How to cite this article: Mahto SK, Sheoran A, et al. A Rare and Lethal Complication of Oral Warfarin Therapy. Indian J Crit Care Med 2019;23(4):197-198.

Heat stress adversely affects growth, development, and yield of winter wheat (Triticum aestivum). Plants have, however, evolved mechanisms to adapt to such conditions mainly by the expression of stress-associated chaperones, the heat shock proteins (HSPs), for modulating the tolerance level. Here, we report cloning of cytosolic putative HSP70 of 1678 bp from a thermotolerant cultivar (C306) of wheat (T. aestivum). A BLASTn search showed maximum homology with the predicted HSP70 protein reported from Hordeum vulgare (accession no AK354795.1). In silico characterization showed the presence of a nucleotide-binding domain of the sugar kinase/HSP70/actin superfamily in the sequence. Putative HSP70 showed temporal and spatial variations in the expression under heat stress (HS). We observed the abundance of HSP70 protein, H2O2, proline, and guaiacol peroxidase activity during the seed-hardening stage under HS; accumulation was, however, higher in the thermotolerant C306 than in thermosusceptible HD2329 cultivar. A gradual decrease in cell membrane stability (CMS) and an increase in total antioxidant capacity (TAC) were observed in both the cultivars at the different stages of growth. The expression of HSP70 showed a negative correlation with CMS and a positive correlation with TAC under HS; changes were less pronounced in C306 than in HD2329 at all the stages of growth studied. HSP70 seems to play diverse roles associated with thermotolerance, and partially protect wheat from terminal HS. Being the important member of family of the HSPs, HSP70 needs to be studied in detail, to be used for developing climate-smart wheat crops, through genetic engineering/breeding approaches.

Background: Uterine Fibroid Embolization (UFE) is a new modality which has appeared in the horizon for non-surgical management of many conditions including fibroids. Moderate to severe anemia with fibroids is one of the reasons for delay in definitive treatment. Need for blood transfusion and its consequent risk of adverse reactions and diseases became a necessity to consider alternative treatment. Objective: To evaluate the efficacy and safety of UFE as an alternative to major surgery. Methods: Seventeen women with symptomatic uterine fibroids who declined surgery or were at poor risk for surgery were treated by Uterine Artery Embolization (UAE). The uterine arteries were catheterised and embolized with polyvinyl alcohol particles. The patients were followed up at regular interval clinically and with transabdominal ultrasonography. Results: UAE performed on all 17 patients had no major complications. Clinical follow-up showed a significant reduction in symptoms within six months of the procedure, with 79% improvement in menorrhagia and 86% improvement in pain. Follow-up imaging showed reduction in fibroid sizes ranging from 9-60%. The mean procedural time was 150 minutes. The mean hospital stay was 5 days (range, 3 to 10). Conclusions: Mid-term results of UAE for the treatment of symptomatic fibroids in our hospital indicate this to be a safe and effective therapeutic option.

Introduction Percutaneous nephrostomy PCN is a palliative procedure required to drain malignant ureteral obstruction to provide reasonable benefit to the patient The study was conducted with the objective to assess the success effectiveness and safety of combined USG and Fluoroscopy guided percutaneous nephrostomy in malignant ureteral obstruction Method obstructed ureters due to malignant cause in patients were drained by PCN using combined ultrasound USG and fluoroscopic guidance Post procedural renal function tests were compared to pre procedural values using paired t test Percentage of correct placement of tube and complications were studied Result PCN was successful in units Significant improvement in renal function occurred in patients Mean urea dropped from mg dl plusmn to plusmn mg d and mean S creatinine decreased from plusmn to plusmn between days No statistically significant increase was seen in renal parenchymal thickness Major complications developed in while minor in PCN rsquo s with pain being the most common complication in cases Conclusion PCN was successfully performed under combined image guidance and it effectively drained the obstructed kidney It is a safe procedure but has a high minor complication rate leading to patient morbidity

A wireless sensor network contains various nodes having certain sensing, processing and communication capabilities. Actually they are multifunctional battery operated nodes called motes. These motes are small in size and battery constrained. They are operated by a power source. A wireless sensor network consists of a huge number of tiny sensor nodes which are deployed either randomly or according to some predefined distribution. The sensors nodes in a sensor network are cooperative among themselves having self-organizing ability. This ensures that a wireless network serves a wide variety of applications. Few of them are weather monitoring, health, security and military etc. As their applications are wide, this requires that sensors in a sensor network must play their role very efficiently. But, as discussed above, the sensor nodes have energy limitation. This limitation leads failure of nodes after certain round of communication. So, a sensor network suffers with sensors having energy limitations. Beside this, sensor nodes in a sensor network must fulfill connectivity and coverage requirements. In this paper, we have discussed various issues affecting the design of a wireless sensor network. This provides the readers various research issues in designing a wireless sensor network.

A postmenopausal 50yrs old para3 presented with abdominal pain and distension; decreased appetite and breathlessness. She was provisionally diagnosed as malignant ovarian tumor with secondaries. On USG 16x14 cm size well defined heterogeneous mass lesion was seen in left adnexa with internal vascularity; mild ascitis; right sided pleural effusion. MRI abdomen and pelvis showed large 19.1 x 12.7 cm mass with multiple septations and peripheral nodules. USG guided FNAC showed scanty inflammatory cells with proteinaceous fluid background, malignant cells were not seen. Pleural and ascitic fluid tap showed inflammatory and mesothelial cell but no malignant cell. Clinical and investigation profile suggest the Meigs's syndrome. Left side salpingo-ovariectomy done and the desired section were sent for histomorphological evaluation. Histology reported ovarian fibroma and thus confirm the diagnosis.

Context This article focuses on local health departments (LHDs) that are advanced in accreditation and quality improvement (QI) efforts and the barriers and facilitators associated with sustaining improvements and building an organizational culture of QI. Objective To understand the barriers and facilitators associated with building and sustaining progress toward a QI culture in LHDs. Design Quantitative data from a self-reporting survey and qualitative data from telephone interviews. Setting Twenty-two LHDs across the United States responded to the survey. Ten of the 22 LHD respondents participated in telephone interviews. Participants QI lead staff at LHDs that are advanced in accreditation preparation and QI. Main outcome measures Self-reported LHD survey ratings against indicators for a QI culture, and the identified barriers and facilitators around sustaining QI initiatives. Results Of the 6 domains of a QI culture measured in the survey, the percentages of respondents that scored themselves highly to at least 1 indicator in each domain are as follows: leadership commitment (100%); employee empowerment (100%); teamwork and collaboration (100%); continuous process improvement (86%); customer focus (72%); and QI infrastructure (64%). Qualitative data from 10 telephone interviews revealed that key barriers to sustaining progress around QI included staff turnover, budget cuts, and major crises or events that arise as priority. Key facilitators included leadership commitment, accreditation, and dedication of resources and staff time to QI. Conclusions When engaging in QI, LHDs should consider investing efforts in gaining leadership support and dedicating staff time early in the QI journey to ensure that QI efforts and initiatives are sustained. Local health departments interested in developing a QI culture should also consider pursuing accreditation, as it provides a structured framework for continuous improvement. They should also actively develop QI knowledge and skills among all staff members to minimize the negative impact of staff turnover.

Context Recent years have seen rising interest in initiatives that focus on public health improvement. This includes support for accreditation of public health departments-administered by the Public Health Accreditation Board (PHAB)-and increasing expectations that health departments should use evidence-based programs, services, and policies (interventions) such as those described in The Guide to Community Preventive Services (The Community Guide). Objective This project was initiated to explore the potential connections between Community Guide interventions and PHAB domains, standards, and measures. Design The project team focused on developing a Crosswalk tool to assist health departments in identifying evidence-based interventions from The Community Guide whose implementation could help document conformity with PHAB domains, standards, and measures. All Community Preventive Services Task Force-recommended interventions were reviewed to determine whether they reflect the intent and requirements of the PHAB standards and measures. Main outcome measures Three types of connections were defined through which Community Guide interventions could be relevant to the required documentation for a PHAB measure. All instances of these connections were identified and included in the Crosswalk. Results The Crosswalk tool consists of 2 tables. The first table cross-references individual PHAB domains, standards, and measures with interventions from The Community Guide that could help provide documentation for accreditation. The second table can help accreditation preparation staff to engage with program staff. It is searchable by Community Guide topic, identifying the PHAB measures that relate to each Community Guide intervention within that topic. The type, location, and extent of connections between Community Guide interventions and PHAB domains, standards, and measures are presented and discussed. Conclusions Tools such as the Crosswalk can be instrumental in advancing the use of evidence-based interventions in public health practice.

Globally Helicoverpa armigera, a polyphagous pest of many economic crops, has developed resistance to almost all groups of insecticides presently in used for its control. In cotton, its larvae cause severe damage and feeds on all plant parts including young leaves, square, flowers and bolls which in turn cause economic damage. Recent reports on development of its resistance to transgenic cotton which has Cry1Ac and Cry2Ab (Bt cotton) has given an indication of future threat to cotton growers. Therefore, use of semiochemicals as management strategy for these insects would be a great alternative as ethological pest management within insect pest management (IPM) to control this menace. These semiochemicals/volatile organic compounds can be present in insect (egg, larva, female) as well as in the host plant. In the present study, a total of seven volatiles have been identified from methanol extract of eggs and faecal pellets, out of which two volatiles; methyl ester of octadecanoic acid (methyl stearate) and methyl ester of hexadecanoic acid (methyl palmatate), were detected in egg samples. From faecal pellets five volatiles were identified namely octadecanoic acid (stearic acid) and its methyl ester, hexadecanoic acid (palmitic acid) and its methyl ester, tetradecanoic acid (myristic acid), caryophyllene and its oxide, phytol. Interestingly, methyl ester of octadecanoic acid and methyl ester of hexadecanoic acid were detected in both the samples. Volatiles observed in common may be used as effective semiochemicals in ethological pest management of Helicoverpa armigera. However, further study is needed to validate the competency of these fatty acids under field conditions.