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Weld seam identification with industrial robots is a difficult task since it requires manual edge recognition and traditional image processing approaches, which take time. Furthermore, noises such as arc light, weld fumes, and different backgrounds have a significant impact on traditional weld seam identification. To solve these issues, deep learning-based object detection is used to distinguish distinct weld seam shapes in the presence of weld fumes, simulating real-world industrial welding settings. Genetic algorithm-based state-of-the-art object detection models such as Scaled YOLOv4 (You Only Look Once), YOLO DarkNet, and YOLOv5 are used in this work. To support actual welding, the aforementioned architecture is trained with 2286 real weld pieces made of mild steel and aluminum plates. To improve weld detection, the welding fumes are denoised using the generative adversarial network (GAN) and compared with dark channel prior (DCP) approach. Then, to discover the distinct weld seams, a contour detection method was applied, and an artificial neural network (ANN) was used to convert the pixel values into robot coordinates. Finally, distinct weld shape coordinates are provided to the TAL BRABO manipulator for tracing the shapes recognized using an eye-to-hand robotic camera setup. Peak signal-to-noise ratio, the structural similarity index, mean square error, and the naturalness image quality evaluator score are the dehazing metrics utilized for evaluation. For each test scenario, detection parameters such as precision, recall, mean average precision (mAP), loss, and inference speed values are compared. Weld shapes are recognized with 95% accuracy using YOLOv5 in both normal and post-fume removal settings. It was observed that the robot is able to trace the weld seam more precisely.

In Wireless Sensor Networks (WSNs), routing algorithms can provide energy efficiency. However, due to unbalanced energy consumption for all nodes, the network lifetime is still prone to degradation. Hence, energy efficient routing was developed in this article by selecting cluster heads (CH) with the help of adaptive whale optimization (AWOA) which was used to reduce time-consumption delays. The multi-objective function was developed for CH selection. The clusters were then created using the distance function. After establishing groupings, the supercluster head (SCH) was selected using the benefit of a fuzzy inference system (FIS) which was used to collect data for all CHs and send them to the base station (BS). Finally, for the data-transfer procedure, hop count routing was used. An Oppositional-based Whale optimization algorithm (OWOA) was developed for multi-constrained QoS routing with the help of AWOA. The performance of the proposed OWOA methodology was analyzed according to the following metrics: delay, delivery ratio, energy, NLT, and throughput and compared with conventional techniques such as particle swarm optimization, genetic algorithm, and Whale optimization algorithm.

Drought is the most prevalent unfavorable condition that impairs plant growth and development by altering morphological, physiological, and biochemical functions, thereby impeding plant biomass production. To survive the adverse effects, water limiting condition triggers a sophisticated adjustment mechanism orchestrated mainly by hormones that directly protect plants via the stimulation of several signaling cascades. Predominantly, water deficit signals cause the increase in the level of endogenous ABA, which elicits signaling pathways involving transcription factors that enhance resistance mechanisms to combat drought-stimulated damage in plants. These responses mainly include stomatal closure, seed dormancy, cuticular wax deposition, leaf senescence, and alteration of the shoot and root growth. Unraveling how plants adjust to drought could provide valuable information, and a comprehensive understanding of the resistance mechanisms will help researchers design ways to improve crop performance under water limiting conditions. This review deals with the past and recent updates of ABA-mediated molecular mechanisms that plants can implement to cope with the challenges of drought stress.

ObjectiveDetermine the impact of long-term non-surgical weight loss maintenance on clinical relevance for osteoarthritis, cancer, opioid use, and depression/anxiety and healthcare resource utilization.MethodsA cohort of adults receiving primary care within Geisinger Health System between 2001-2017 was retrospectively studied. Patients with ≥3 weight measurements in the two-year index period and obesity at baseline (BMI ≥30 kg/m2) were categorized: Obesity Maintainers (reference group) maintained weight within +/-3%; Weight Loss Rebounders lost ≥5% body weight in year one, regaining ≥20% of weight loss in year two; Weight Loss Maintainers lost ≥5% body weight in year one, maintaining ≥80% of weight loss. Association with development of osteoarthritis, cancer, opioid use, and depression/anxiety, was assessed; healthcare resource utilization was quantified. Magnitude of weight loss among maintainers was evaluated for impact on health outcomes.ResultsIn total, 63,567 patients were analyzed including 67% Obesity Maintainers, 19% Weight Loss Rebounders, and 14% Weight Loss Maintainers; median follow-up was 9.7 years. Time until osteoarthritis onset was delayed for Weight Loss Maintainers compared to Obesity Maintainers (Logrank test p 15% weight loss was associated with the greatest decrease in incident osteoarthritis. Healthcare resource utilization was significantly higher for Weight Loss Rebounders and Maintainers compared to Obesity Maintainers. Increased weight loss among Weight Loss Maintainers trended with lower overall healthcare resource utilization, except for hospitalizations.ConclusionsIn people with obesity, sustained weight loss was associated with greater clinical benefits than regained short-term weight loss and obesity maintenance. Higher weight loss magnitudes were associated with delayed onset of osteoarthritis and led to decreased healthcare utilization.

Epidemiologic data regarding health care acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) from Nepal are negligible. We conducted a prospective observational cohort study in the intensive care unit (ICU) of a major tertiary hospital in Nepal between April 2016 and March 2018, to calculate the incidence of VAP, and to describe clinical variables, microbiological etiology, and outcomes. Four hundred and thirty-eight patients were enrolled in the study. Demographic data, medical history, antimicrobial administration record, chest X-ray, biochemical, microbiological and haematological results, acute physiology and chronic health evaluation II score and the sequential organ failure assessment scores were recorded. Categorical variables were expressed as count and percentage and analyzed using the Fisher's exact test. Continuous variables were expressed as median and interquartile range and analyzed using Kruskal-Wallis rank sum test and the pairwise Wilcoxon rank-sum test. 46.8% (205/438) of the patients required intubation. Pneumonia was common in both intubated (94.14%; 193/205) and non-intubated (52.36%; 122/233) patients. Pneumonia developed among intubated patients in the ICU had longer days of stay in the ICU (median of 10, IQR 5-15, P< 0.001) when compared to non-intubated patients with pneumonia (median of 4, IQR 3-6, P< 0.001). The incidence rate of VAP was 20% (41/205) and incidence density was 16.45 cases per 1,000ventilator days. Mortality was significantly higher in patients with pneumonia requiring intubation (44.6%, 86/193) than patients with pneumonia not requiring intubation (10.7%, 13/122, p

While substantial public health investment in anti-smoking initiatives has had demonstrated benefits on health and fiscal outcomes, similar investment in reducing obesity has not been undertaken, despite the substantial burden obesity places on society. Anti-obesity medications (AOMs) are poorly prescribed despite evidence that weight loss is not sustained using other strategies alone. We used a simulation model to estimate the potential impact of 100% uptake of AOMs on Medicare and Medicaid spending, disability payments, and taxes collected relative to status quo with negligible AOM use. Relative to status quo, AOM use simulation would result in Medicare and Medicaid savings of $231.5 billion and $188.8 billion respectively over 75 years. Government tax revenues would increase by $452.8 billion. Overall, the net benefit would be $746.6 billion. Anti-smoking efforts have had substantial benefits for society. A similar investment in obesity reduction, including broad use of AOMs, should be considered.

Leukocyte adhesion deficiency (LAD) syndrome is a group of inborn errors of immunity characterized by a defect in the cascade of the activation and adhesion leading to the failure of leukocyte to migrate to the site of tissue injury. Three different types of LAD have been described. The most common subtype is LAD type 1 (LAD1) caused due to defects in the ITGβ2 gene. LAD type 2 (LAD2) is caused by mutations in the SLC35C1 gene leading to a generalized loss of expression of fucosylated glycans on the cell surface and LAD type 3 (LAD3) is caused by mutations in the FERMT3 gene resulting in platelet function defects along with immunodeficiency. There is a paucity of data available from India on LAD syndromes. The present study is a retrospective analysis of patients with LAD collated from 28 different centers across India. For LAD1, the diagnosis was based on clinical features and flow cytometric expression of CD18 on peripheral blood leukocytes and molecular confirmation by Sanger sequencing. For patients with LAD3 diagnosis was largely based on clinical manifestations and identification of the pathogenic mutation in the FERMT3 gene by next-generation Sequencing. Of the total 132 cases diagnosed with LAD, 127 were LAD1 and 5 were LAD3. The majority of our patients (83%) had CD18 expression less than 2% on neutrophils (LAD1°) and presented within the first three months of life with omphalitis, skin and soft tissue infections, delayed umbilical cord detachment, otitis media, and sepsis. The patients with CD18 expression of more than 30% (LAD1+) presented later in life with skin ulcers being the commonest manifestation. Bleeding manifestations were common in patients with LAD3. Persistent neutrophilic leukocytosis was the characteristic finding in all patients. 35 novel mutations were detected in the ITGβ2 gene, and 4 novel mutations were detected in the FERMT3 gene. The study thus presents one of the largest cohorts of patients from India with LAD, focusing on clinical features, immunological characteristics, and molecular spectrum.

Despite recent advances in typhoid fever control, asymptomatic carriage of Salmonella Typhi in the gallbladder remains poorly understood. Aiming to understand if S. Typhi becomes genetically adapted for long-term colonisation in the gallbladder, we performed whole genome sequencing on a collection of S. Typhi isolated from the gallbladders of typhoid carriers. These sequences were compared to contemporaneously sampled sequences from organisms isolated from the blood of acute patients within the same population. We found that S. Typhi carriage was not restricted to any particular genotype or conformation of antimicrobial resistance genes, but was largely reflective of S. Typhi circulating in the general population. However, gallbladder isolates showed a higher genetic variability than acute isolates, with median pairwise SNP distances of 21 and 13 SNPs (p = 2.8x10-9), respectively. Within gallbladder isolates of the predominant H58 genotype, variation was associated with a higher prevalence of nonsense mutations. Notably, gallbladder isolates displayed a higher frequency of non-synonymous mutations in genes encoding hypothetical proteins, membrane lipoproteins, transport/binding proteins, surface antigens, and carbohydrate degradation. Specifically, we identified several gallbladder-specific non-synonymous mutations involved in LPS synthesis and modification, with some isolates lacking the Vi capsular polysaccharide vaccine target due to the 134Kb deletion of SPI-7. S. Typhi is under strong selective pressure in the human gallbladder, which may be reflected phylogenetically by long terminal branches that may distinguish organisms from chronic and acute infections. Our work shows that selective pressures asserted by the hostile environment of the human gallbladder generate new antigenic variants and raises questions regarding the role of carriage in the epidemiology of typhoid fever.

At the end of December 2019, Wuhan City became the epicenter of the highly contagious virus known as the novel coronavirus. Now that mid-2020 has already passed, almost every country is adversely affected by Corona Virus Disease (COVID-19). The routine activities of people of all ages are overturned, which has led to a shift in the trends of waste created by households, streets, and most importantly, medical facilities and quarantine centers. Compulsive use of personal protection equipment such as masks, gloves, sanitizers, etcetera by the frontline workers from the medical sector, banks, daily need stores, waste collection industries, etc. and the use of masks by every common man stepping out has skewed the trend of waste generation to a different direction. Recently, the replacement of single-use plastic was accepted by the masses, and the pandemic suddenly rebounded to the previous situation, it is expected to be worse in the long run. Another secondary outcome is reduced waste collection and recycling due to lockdown, leading to a pile-up of wastes. But several nations are adopting strategies to break the transmission chain of the virus by trying to minimize human contact. The study discusses the effect of COVID-19 on the generation, recycling, and disposal of solid waste. A brief collection of different countries’ efforts to restrict the transmission of virus through solid waste is also discussed.

Background and aims: Biologic therapy has emerged as an effective modality amongst the medical treatment options available for ulcerative colitis (UC). However, its impact on post-operative care in patients with UC is still debatable. This review evaluates the risk of post-operative complications following biologic treatment in patients with UC. Methods: A systematic search of the relevant databases was conducted with the aim of identifying studies that compared the post-operative complication rates of UC patients who were either exposed or not exposed to a biologic therapy prior to their surgery. Outcomes of interest included both infection-related complications and overall surgical morbidity. Pooled odds-ratio (OR) and 95% confidence intervals (CI) were calculated using Review Manager 5.3. Results: In all, 20 studies, reviewing a total of 12,494 patients with UC, were included in the meta-analysis. Of these, 2254 patients were exposed to a biologic therapy prior to surgery. The pooled ORs for infection-related complications ( n = 8067) and overall complications ( n = 11,869) were 0.98 (95% CI 0.66–1.45) and 1.14 (95% CI 1.04–1.28), respectively, which suggested that there was no significant association between the use of pre-operative biologic therapy and post-operative complications. Interestingly, the interval between the last dose of biologic therapy and surgery did not influence the risk of having a post-operative infection. Conclusions: This meta-analysis suggests that pre-operative biologic therapy does not increase the overall risk of having post-operative infection-related or other complications. PROSPERO registration id-CRD42019141827.

Background: Chronic periodontitis might be associated with oral premalignant lesions, tongue cancers, and other oral neoplasms, which is a foremost public health problem throughout the world. The nutritional status of the patient with cancer becomes very important for tolerating the treatment course as most of the newly diagnosed patients with head and neck cancer are malnourished before treatment begins. Antimicrobial proteins are also essential contributors to maintaining the balance between health and disease in this complex environment. Therefore the aim of this study was to determine whether an association exists between the measures of nutritional status and the levels of antimicrobial proteins with the periodontal condition in newly diagnosed, untreated head and neck cancer patients. Materials and Methods: A total of 50 patients newly diagnosed with head and neck carcinoma were included. Saliva and plasma samples were collected, together with clinical periodontal recordings. Nutritional status parameters consisted of body mass index, serum albumin, hemoglobin, and total lymphocyte count. Cystatin C and lysozyme were the antimicrobial proteins. Results: A logistic regression model showed that periodontal parameters were inversely related to their nutritional status; however, antimicrobial protein levels showed to be directly related to periodontal condition. Conclusion: This study suggests an association between periodontal disease, nutritional status parameters, and antimicrobial protein levels.

The research study aimed to study the effect of short term exposure to light basically red, blue and white on the autonomic tone of essential hypertensive individuals. The objective was to find out the baseline cardiac autonomic function along with the effect of these lights on the cardiac autonomic function among them. Till date few if any study have been conducted upon the individuals with certain disorder as common as essential hypertension. This was a cross sectional observational study conducted in the institute itself that included 77 newly diagnosed hypertensive subjects who willingly participated in the study. After written informed consent, brief history taking with the help of self-made questionnaire and clinical examination, they were randomized to different intervention groups (IG) namely IG I (red) IG II (blue) and IG III (white). HRV analysis of the last 5-6 minutes of both the baseline and color exposure was finally analyzed using MS Excel version 13 and Graph Pad Prism version 7.05. Different HRV parameters have been found to be affected differently on different color exposures. Red has shown to have an impact, mainly on the sympathetic system whereas white showed a dominant vagal component thus acting as a parasympathetic regulator. On one hand, where no conclusive result was found on blue light exposure, white light showed the most prominent results affecting various time and frequency components of HRV like SDRR, TP, LF etc. The present study, both, contradicts as well as supports various other works done on the similar area of interest. One reason of such high variation in different results is because HRV is itself a very dynamic function affected by even a slight change in both the internal and external environment of the subject. As artificial lights of various colors are part and parcel of the aesthetics and designing of most of the work environment all over world, it is very pertinent to study its impact upon human health status. The outcome of the study may play a decisive role in the diagnostics and therapeutics of essential hypertension in days to come. Furthermore, on the basis of the present findings, a future study could be undertaken with bigger data base addressing the limitations of the present study to find some conclusive evidence in the area highlighted.

Background: A new elastomeric impression material which is a combination of vinyl polysiloxane (VPS) and polyether (PE) elastomers called “polyvinyl ether silicone” (PVES) has been introduced with predictable accuracy and high-quality impressions. There is insufficient data on mechanical properties of this material. Materials and Methods: A comparative study of mechanical properties of VPS, PE, and PVES was carried out using light- and heavy-body consistencies of the three materials. Three standardized stainless steel molds were made to fabricate study specimens (n = 96). The specimens were tested for elastic recovery, strain under compression, tear energy, and tensile strength (TS) using the universal testing machine. Statistical analysis was done using two-way analysis of variance test. Results: Elastic recovery was higher in VPS as compared to other two materials. Strain under compression was higher for PE followed by PVES. Tensile energy was significantly higher in PVS while TS was higher in VPS, followed by PVES and PE. Conclusion: PVES tested was found to be more flexible with high tensile energy. This material can be preferred in cases with undercut areas favoring the removal of impressions without tear and distortion.

An ovarian cyst is the most common gynecological presentation. Majority are benign, with only a few being malignant. Epithelial ovarian tumors account for majority of ovarian neoplasm which usually present with vague symptoms of abdominal pain or asymptomatic and are detected incidentally. Spontaneous rupture of cystic tumors is an unusual presentation. We report here a case of ruptured serous borderline tumor in a young female.

Background: Pathogenesis of most of the inflammatory process are associated with reactive oxygen species (ROS), derived from various metabolic sources and which may lead to direct or indirect tissue damage due to oxidative stress, resulting in periodontal diseases. Usually antioxidant systems are capable of removing free radicals, thereby preventing tissue damage from free radical. ROS can result in tissue damage, involving lipid peroxidation. The aim of this study was to evaluate and compare the levels of superoxide dismutase (SOD), glutathione peroxidase (GPx), malondialdehyde (MDA), and sialic acid (SA) in periodontally healthy and chronic periodontitis among nonsmokers and smokers and to determine their value as diagnostic markers for chronic periodontitis. Materials and Methods: A total of 90 male patients aged 20--60 years were recruited and grouped as Group 1: 30 Healthy nonsmokers, who had never smoked. Group 2: 30 nonsmokers with chronic periodontitis. Group 3: 30 smokers with chronic periodontitis. Unstimulated saliva was collected for at least 5 min and clinical measurements; SOD, GPx, MDA and SA were assessed using a spectrophotometric method. Results: Data showed a significant correlation between salivary SOD, GPx, MDA, and SA in group 1, group 2, and group 3. SOD and GPx were found to be lower and MDA and SA levels were found to be higher among smokers with chronic periodontitis. Conclusion: Reduced levels of antioxidant enzymes SOD and GPx and elevated levels of lipid peroxidation product MDA as well as increased levels of SA could be used as diagnostic markers to measure oxidative stress in periodontal disease associated with risk factor such as smoking.

Abstract Background Pancreatic cancer (PC) is a highly aggressive disease, and the lethality of this disease stems from early metastatic dissemination where surgical removal cannot provide a cure. Improvement of the therapeutic outcome and overall survival of PC patients requires to understand the fundamental processes that lead to metastasis such as the gain of cellular migration ability. One such family of proteins, which are essential players of cellular migration, is Semaphorin. Previously, we have identified one of the Semaphorin family member, Semaphorin-5A (SEMA5A) to be involved in organ-specific homing during PC metastasis. We have also demonstrated that SEMA5A has a constitutive expression in PC cell lines derived from metastatic sites in comparison with low endogenous expression in the primary tumor-derived cell line. In this study, we examined whether constitutive SEMA5A expression in metastatic PC cells regulates tumor growth and metastatic potential. Methods We generated SEMA5A knockdown in T3M-4 and CD18/HPAF cells and assessed their phenotypes on in vitro motility, tumor growth, and metastatic progression. Results In contrary to our initial expectations, orthotopic injection of SEMA5A knockdown cells into nude mice resulted in a significant increase in both tumor burden and liver metastases in comparison with the Control cells. Similarly, we observed higher in vitro migratory potential with pronounced morphological changes associated with epithelial-mesenchymal transition (EMT), a decrease in the expression of epithelial marker E-cadherin (E-Cad), increase in the expression of mesenchymal markers N-cadherin (N-Cad) and Snail and the activation of the Wnt-signaling pathway in SEMA5A knockdown cells. Furthermore, re-establishing SEMA5A expression with a knockdown resistant mouse Sema5A in SEMA5A knockdown cells resulted in a reversion to the epithelial state (mesenchymal-epithelial transition; MET), as indicated by the rescue of E-Cad expression and a decrease in N-Cad and Snail expression. Conclusions Collectively, our data suggest that SEMA5A expression maintains epithelial phenotype in the metastatic microenvironment.

Abstract Background Oncogenic Human papillomavirus (HPV) infections are closely associated with anal cancer which is high among human immunodeficiency virus (HIV) infected males. There are no data regarding anal HPV infection and cytological abnormalities in HIV positive males receiving free therapy in the national program. Thus, this cross-sectional study was performed to assess the prevalence and risk factors of anal HPV infection and cytological abnormalities in HIV positive males. Methods We screened 126 HIV-positive male patients attending the antiretroviral treatment center (ART) between 2014 and 2015 with anal papanicolaou smear cytology and HPV-DNA testing. HPV-DNA was detected by using polymerase chain reaction (PCR) method with two consensus primer sets E6 and MY09/11 and further analyzed for the presence of various HPV genotype by Sanger sequencing. Risk factors associated with anal cytological abnormalities and HPV infection was analyzed by using univariate and multivariate logistic regression models. Results Out of 126, 52 were on antiretroviral therapy. 91% were married to female partners but during the study 48 (38%) gave positive history of anal intercourse with other men. Anal cytology was done in 95 patients, out of which 60 (63.15%) had cytological abnormalities. LSIL (low-grade squamous intraepithelial lesions) was present in 27 (45%), ASCUS (atypical squamous cells of undetermined significance) in 31 (52%) and ASC-H (atypical squamous cells cannot exclude a high-grade squamous intraepithelial lesion) in 2 (3.33%). In multivariate analysis, the risk factors for cytological abnormality were presence of history of anal intercourse (OR, 6.1; 95% CI, 2.0–18.7) and WHO stage III & IV (OR, 2.7; 95% CI, 1.1–7.5). HPV-DNA was detected in 33/119 (27.73%) patients. The most prevalent HPV type in the study was HPV-16 (10.08%), other HPV types detected were 18,31,35,17,66,72,52,68 and 107 (17.65%). Conclusions High prevalence of anal cytological abnormalities in our study suggests that regular anal Pap smear screening should be done in HIV positive males in the ART center.

Abstract Background Infections caused by multi-drug resistant gram-negative bacterial infections are the principle threats to the critically ill patients of intensive care units. Increasing reports of these infections from the Nepalese intensive care unit underline the clinical importance of these pathogens. However, the impact of these infections on the patient’s clinical outcome has not yet been clearly evaluated. The objective of our study was to determine the incidence and associated clinical outcome of multi-drug resistant gram-negative bacterial infections in intensive care unit from a tertiary care center of Nepal. Methods A prospective cohort study was conducted among adult patients admitted in intensive care unit of B. P Koirala Institute of Health Sciences from July to December 2017. Patients infected with multi-drug resistant gram-negative bacteria, non-multi-drug resistant gram-negative bacteria and those without infection were included. Identification of gram-negative bacteria and their antibiotic susceptibility pattern was performed with standard microbiological methods. Demographic, clinical profiles and outcomes (in-hospital-mortality, intensive care unit and hospital length of stay) were documented. Results The incidence rate of multi-drug resistant gram-negative bacteria infections was 47 per 100 admitted patients (64/137) with 128 episodes. Acinetobacter species (41%, 52/128) was the commonest followed by Klebsiella pneumoniae (28%, 36/128) and Pseudomonas spp (21%, 27/128). Patients with multi-drug resistant gram-negative bacteria in comparison to non-multi-drug resistant gram-negative bacteria had high healthcare-associated infections (95%, 61/64 versus 20%, 2/10; p =

Background: Laparoscopic cholecystectomy is commonly performed operation for symptomatic gall stone disease. The presence of stones within the biliary system is associated with the bacterial colonization of the bile. The aim of this study is to evaluate the bacteriological profile of the bile and to determine appropriate antibiotics for preoperative prophylaxis in laparoscopic cholecystectomy patients. Material & Methods: A prospective study was carried out in NMCTH, Biratnagar from June2017- May 2018. A total of 100 patients admitted through OPD of our hospital for laparoscopic cholecystectomy were studied. About 5ml of bile aspirated from gall bladder was transported to laboratory in sterile syringe for culture and sensitivity. All age groups and both sex were included. Results: Bile culture was positive in 16 patients. The most common organisms isolated from bile was Escherichia coli (50%) followed by Klebsiella species (25%). Histopathological report of all 16 cases revealed chronic cholecystitis. Wound infection was seen in 5% cases and all were bile culture positive. Most sensitive drug was found to be aminoglycoside group followed by piperacilin and tazobactam. Conclusion: Most common organism isolated from bile culture was Escherichia coli. Aminoglycoside group of drugs was found to be more promising compared to other group of drugs. It can be considered as a first line drug for preoperative prophylaxis for patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis. Journal of Nobel Medical College Volume 7, Number 1, Issue 12, January-June 2018, Page: 41-44

Background: The study was carried out to assess the genetic variability present in ashwagandha and to examine the nature of associations of various traits to the root yield of the plant. Methods: Fifty-three diverse genetic stocks of ashwagandha (Withania somnifera) were evaluated for 14 quantitative characteristics. Analysis of variance, correlation, and path coefficient analysis were performed using the mean data of 2 years. Results: Analysis of variance revealed that the genotypes differed significantly for all characteristics studied. High heritability in conjunction with high genetic advance was observed for fresh root weight, 12 deoxywithastramonolide in roots, and plant height, which indicated that selection could be effective for these traits. Dry root weight has a tight linkage with plant height and fresh root weight. Further, in path coefficient analysis, fresh root weight, total alkaloid (%) in leaves, and 12 deoxywithastramonolide (%) in roots had the highest positive direct effect on dry root weight. Conclusion: Therefore, these characteristics can be exploited to improve dry root weight in ashwagandha genotypes and there is also scope for the selection of promising and specific chemotypes (based on the alkaloid content) from the present germplasm. Keywords: ashwagandha, direct effect, genetic advance, heritability, path coefficient

BACKGROUND: Eating disorders (EDs) can lead to life-threatening nutritional deficiencies whereas self-esteem influences interpersonal relationships and academic performance. Excessive concerns about body image resulting in body dissatisfaction not only affect psychological well-being but also predisposes to disordered eating behaviors. The objective of this study is to assess the eating behavior and level of self-esteem, their relationship with body image perception and also identify factors associated with them among undergraduate female college students. MATERIALS AND METHODS: This cross-sectional study was conducted among 180 female undergraduate students of University of Delhi. Sociodemographic characteristics and anthropometric measurements were recorded. Eating Attitude Test-26, Rosenberg Self-esteem Scale, Contour Drawing Rating Scale and Body Shape Questionnaire 34 were used to assess eating behavior, self-esteem, body image dissatisfaction and body shape concerns, respectively. Both descriptive and inferential statistics were used and binary logistic regression was applied to identify the factors determining high risk eating behavior and low self-esteem. RESULTS: In this study, 27.8% of the study participants were overweight or obese, 30.6% had body shape concerns and 76.7% had body image dissatisfaction. Significant proportion (13.9%) of the participants was identified as high risk for the development of EDs and having low self-esteem (12.8%). Body shape concern and family influences were significant predictors of high risk eating behavior whereas type of college and family influences significantly predicted low self-esteem. CONCLUSIONS: The study concluded that factors such as nutritional status, family influences, type of college and body shape concerns lead to high risk eating behavior and low self-esteem. These findings will help in creating awareness on importance of concept of positive body image, healthy weight control behaviors and in developing future interventions.

We proposed the extraction of necessary electrical parameters of graphene (Gr) on Si/SiO _2 /Gr and Si/SiO _2 /Al _2 O _3 /Gr heterostructure THz modulators using the THz measurement technique. The obtained average THz absorption is 24.5% more on Si/SiO _2 /Al _2 O _3 /Gr as compared to the Gr on Si/SiO _2 . The calculated value of the carrier mobility of graphene on Si/SiO _2 /Al _2 O _3 is 2.33 times more than that on Si/SiO _2 . The presence of Al _2 O _3 may play a role of a barrier for diffusion of trap and impurity charges from Si/SiO _2 to graphene which may lead to higher mobility and higher THz absorption. THz modulation measurements by optical pumping were also performed. Maximum modulation depth was 18.54% on Si/SiO _2 /Al _2 O _3 /Gr modulator at 2W pumping power which is 16.54% higher as compared to Gr on Si/SiO _2 . This shows that graphene on Si/SiO _2 /Al _2 O _3 heterostructure exhibits great potential for the development of an efficient electro-optical THz modulator as compared to Si/SiO _2 /Gr modulator.

Nowadays, the world is experiencing an energy crisis due to extensive globalization and industrialization. Most of the sources of renewable energy are getting depleted, and thus, there is an urge to locate alternative routes to produce energy efficiently. Microbial fuel cell (MFC) is a favorable technology that utilizes electroactive microorganisms acting as a biocatalyst at the anode compartment converting organic matter present in sewage water for bioelectricity production and simultaneously treating wastewater. However, there are certain limitations with a typical stand-alone MFC for efficient energy recovery and its practical implementation, including low power output and high cost associated with treatment. There are various modifications carried out on MFC for eliminating the limitations of a stand-alone MFC. Examples of such modification include integration of microbial fuel cell with capacitive deionization technology, forward osmosis technology, anaerobic digester, and constructed wetland technology. This review describes various integrated MFC systems along with their potential application on an industrial scale for wastewater treatment, biofuel generation, and energy production. As a result, such integration of MFCs with existing systems is urgently needed to address the cost, fouling, durability, and sustainability-related issues of MFCs while also improving the grade of treatment received by effluent.

Background: Good adhesive bonding of restorative materials to cavity walls minimizing microleakage is an important criterion for the performance and longevity of a restoration in the oral cavity. The present study is aimed to compare the microleakage among newer composite materials. Materials and Methods: Forty-five extracted healthy premolars were collected; standard Class II cavities were prepared. They were randomly divided into three groups of 15 teeth each. The groups were made based on the different composite restorative materials used for restoration. Group A consisted of conventional microfilled composite resin restorations, and Group B was posterior nanocomposite resin. Group C was restored using ORMOCER – Admira. After completion of restorations, all teeth were subjected to thermocycling at 5° C, 37° C, and 55° C for 250 cycles. Later, all samples were immersed into 50% silver nitrate dye group wise for for 4 hours (h), and teeth were sectioned buccolingually. Sectioned teeth were observed under a stereomicroscope for the evaluation of microleakage. ANOVA and unpaired t-tests were used for statistical analysis. The significance level was at set P < 0.001. Results: The results of this study showed that Group C (ORMOCER – Admira) presented with the least microleakage followed by Group B (Tetric N-Ceram) followed by Group A (Tetric Ceram). Conclusions: Overall ORMOCER – Admira performed better than the other two composite materials with the least microleakage.

In recent years, there has been a significant accumulation of waste in the environment, and it is expected that this accumulation may increase in the years to come. Waste disposal has massive effects on the environment and can cause serious environmental problems. Thus, the development of a waste treatment system is of major importance. Agro-industrial wastewater and waste residues are mainly rich in organic substances, lignocellulose, hemicellulose, lignin, and they have a relatively high amount of energy. As a result, an effective agro-waste treatment system has several benefits, including energy recovery and waste stabilization. To reduce the impact of the consumption of fossil energy sources on our planet, the exploitation of renewable sources has been relaunched. All over the world, efforts have been made to recover energy from agricultural waste, considering global energy security as the final goal. To attain this objective, several technologies and recovery methods have been developed in recent years. The microbial fuel cell (MFC) is one of them. This review describes the power generation using various types of agro-industrial wastewaters and agricultural residues utilizing MFC. It also highlights the techno-economics and lifecycle assessment of MFC, its commercialization, along with challenges.

Abstract Background Undifferentiated febrile illness (UFI) includes typhoid and typhus fevers and generally designates fever without any localizing signs. UFI is a great therapeutic challenge in countries like Nepal because of the lack of available point-of-care, rapid diagnostic tests. Often patients are empirically treated as presumed enteric fever. Due to the development of high-level resistance to traditionally used fluoroquinolones against enteric fever, azithromycin is now commonly used to treat enteric fever/UFI. The re-emergence of susceptibility of Salmonella typhi to co-trimoxazole makes it a promising oral treatment for UFIs in general. We present a protocol of a randomized controlled trial of azithromycin versus co-trimoxazole for the treatment of UFI. Methods/design This is a parallel-group, double-blind, 1:1, randomized controlled trial of co-trimoxazole versus azithromycin for the treatment of UFI in Nepal. Participants will be patients aged 2 to 65 years, presenting with fever without clear focus for at least 4 days, complying with other study criteria and willing to provide written informed consent. Patients will be randomized either to azithromycin 20 mg/kg/day (maximum 1000 mg/day) in a single daily dose and an identical placebo or co-trimoxazole 60 mg/kg/day (maximum 3000 mg/day) in two divided doses for 7 days. Patients will be followed up with twice-daily telephone calls for 7 days or for at least 48 h after they become afebrile, whichever is later; by home visits on days 2 and 4 of treatment; and by hospital visits on days 7, 14, 28 and 63. The endpoints will be fever clearance time, treatment failure, time to treatment failure, and adverse events. The estimated sample size is 330. The primary analysis population will be all the randomized population and subanalysis will be repeated on patients with blood culture-confirmed enteric fever and culture-negative patients. Discussion Both azithromycin and co-trimoxazole are available in Nepal and are extensively used in the treatment of UFI. Therefore, it is important to know the better orally administered antimicrobial to treat enteric fever and other UFIs especially against the background of fluoroquinolone-resistant enteric fever. Trial registration ClinicalTrials.gov, ID: NCT02773407 . Registered on 5 May 2016.

Background :Laparoscopic cholecystectomy (LC) is a treatment of choice for symptomatic gall stone disease and is commonly done all over the country in general surgical practice. The aim of this study is to show the results of LC in our medical college. Material and Methods: A retrospective analysis of the patients underwent laparoscopic cholecystectomy from July 2015 to September 2016 was carried out in NMCTH, Biratnagar. A total of 391 patients admitted through OPD of our Hospital underwent laparoscopic cholecystectomy were studied. All age groups and both sex were included. Results: Out of 391 patients with symptomatic cholelithiasis, 385(98.46%) patients underwent successful laparoscopic cholecystectomy. Age range of patients in the study varied between 12-84 years and maximum patients (30.69%) were found in the age group of 31-40 years. There were 333(82.58%) female and 58(17.41%)male patients. Mean age of the patients was 39.61 years. Indication for surgery was symptomatic cholelithiasis. Conversion was done in 6(1.53%) cases due to unclear anatomy. A rare congenital anomaly, Accessory right hepatic duct with cystic duct continuous with it was encountered in 12-yearboy; LC was done safely without injuring biliary tree. As postoperative complications, one patient developed biliary peritonitis which was managed by drainage tube. Conclusion: Laparoscopic cholecystectomy is successfully being done for last 5 years in our institute. The results are comparable with those of published series. Anatomical variations and complications may present, for which care must be taken. Journal of Nobel Medical College Volume 6, Number 1, Issue 10 (January-June, 2017), page: 1-5

Abstract Hepatitis C virus (HCV) is a global pathogen and infects more than 185 million individuals worldwide. Although recent development of direct acting antivirals (DAA) has shown promise in HCV therapy, there is an urgent need for the development of more affordable treatment options. We initiated this study to identify novel inhibitors of HCV through screening of compounds from the National Cancer Institute (NCI) diversity dataset. Using cell-based assays, we identified NSC-320218 as a potent inhibitor against HCV with an EC50 of 2.5 μM and CC50 of 75 μM. The compound inhibited RNA dependent RNA polymerase (RdRp) activity of all six major HCV genotypes indicating a pan-genotypic effect. Limited structure-function analysis suggested that the entire molecule is necessary for the observed antiviral activity. However, the compound failed to inhibit HCV NS5B activity in vitro, suggesting that it may not be directly acting on the NS5B protein but could be interacting with a host protein. Importantly, the antiviral compound also inhibited dengue virus and hepatitis E virus replication in hepatocytes. Thus, our study has identified a broad-spectrum antiviral therapeutic agent against multiple viral infections.

Abstract Background The United States Environmental Protection Agency has established methods for testing beach water using the rapid quantitative polymerase chain reaction (qPCR) method, as well as “beach action values” so that the results of such testing can be used to make same-day beach management decisions. Despite its numerous advantages over culture-based monitoring approaches, qPCR monitoring has yet to become widely used in the US or elsewhere. Considering qPCR results obtained on a given day as the best available measure of that day’s water quality, we evaluated the frequency of correct vs. incorrect beach management decisions that are driven by culture testing. Methods Beaches in Chicago, USA, were monitored using E. coli culture and enterococci qPCR methods over 894 beach-days in the summers of 2015 and 2016. Agreement in beach management using the two methods, after taking into account agreement due to chance, was summarized using Cohen’s kappa statistic. Results No meaningful agreement (beyond that expected by chance) was observed between beach management actions driven by the two pieces of information available to beach managers on a given day: enterococci qPCR results ofsamples collected that morning and E. coli culture results of samples collected the previous day. The E. coli culture beach action value was exceeded 3.4 times more frequently than the enterococci qPCR beach action value (22.6 vs. 6.6% of beach-days). Conclusions The largest evaluation of qPCR-based beach monitoring to date provides little scientific rationale for continued E. coli culture testing of beach water in our setting. The observation that the E. coli culture beach action value was exceeded three times as frequently as the enterococci qPCR beach action value suggests that, although the beach action values for bacteria using different measurement methods are thought to provide comparable information about health risk, this does not appear to be the case in all settings.

Background. Poor sleep quality is common in the intensive care unit (ICU), where several factors including environmental factors contribute to sleep deprivation. Objective. This study aims to assess and compare the effectiveness of earplugs and eye mask versus ocean sound on sleep quality among ICU patients. Design. A true experimental crossover design was used. Setting. Medical ICU of the Maharishi Markandeshwar Institute of Medical Sciences and Research Hospital, Mullana, India. Participants. Sixty-eight patients admitted in the medical ICU were randomly allocated by lottery methods into group 1 and group 2. Methods. Nocturnal nine-hour (10 : 00 pm to 7 : 00 am) for a four-night period were measured. Earplugs and eye mask versus ocean sound were crossed over between two groups. Subjective sleep quality of four nights was assessed using a structured sleep quality scale. Scores for each question range from 0 to 3, with a higher score indicating poor sleep quality. Results. Repeated measures ANOVA showed that there was a significant change in the sleep quality score (p=0.001), which showed that sleep quality score was improved after the administration of earplugs and eye mask and ocean sound. Fisher’s LSD post hoc comparison showed a significant difference (p=0.001). Conclusion. Earplugs and eye mask were better than ocean sound in improving sleep quality. Earplugs, eye mask, and ocean sound are safe and cost effective, which could be used as an adjuvant to pharmacological interventions to improve sleep quality among ICU patients. However, further research in this area needs to be conducted. This trial is registered with NCT03215212.

In the rapidly changing and modernizing era, human population is becoming vulnerable to many disorders related with altered lifestyle and food habits. Vatarakta is one such metabolic disorder. It is disease caused due to margavarana of aggravated Vata by vitiated Rakta or morbid Kapha and Medas. Etiological factors of Vatarakta are responsible for aggravation of Vata dosha and Rakta dushti. It also has rasayana, pain relieving and anti inflammatory properties which renders it quite effective for those suffering from the disease. The presentation of Vatarakta along with its etiopathogenesis is quite similar to gouty arthritis in modern medicine. Patoladi kwath is a combination of tridosha shamak, Raktasodhak (blood purifier) and also Vatashamak drugs. This decoction helps in Vatarakta to alleviate the features of aggravated doshas and remove blockage in srotas thereby causing Vayu shaman. The management of Vatarakta is a challenge as it is a disease of severe morbidity, chronicity and incurable to certain extent with associated complications . With certain lifestyle modifications alongwith pathya ahara(right diet) and certain Ayurvedic modalities it can be cured and prevented.

Introduction Extracorporeal membrane oxygenation (ECMO) provides cardiac and/or respiratory support when other therapies fail. Nosocomial infection is reported in up to 64% of patients receiving ECMO and increases morbidity and mortality. These patients are at high risk of infection due, in part, to the multiple invasive devices required in their management, the largest being the cannulae through which ECMO is delivered. Prevalence of nosocomial infection in ECMO patients, including ECMO cannula-related infection, is not well described across Australia and New Zealand.Methods and analysis This is a prospective, observational point prevalence study of 12 months duration conducted at 11 ECMO centres across Australia and New Zealand. Data will be collected for every patient receiving ECMO during 12 predetermined data collection weeks. The primary outcome is the prevalence of laboratory-confirmed bloodstream infection, and suspected or probable nosocomial infections; and the secondary outcomes include describing ECMO cannula dressing and securement practices, and adherence to local dressing and securement guidelines. Data collection will be finalised by March 2019.Ethics and dissemination Relevant ethical and governance approvals have been received. Study results will describe the prevalence of suspected and confirmed nosocomial infection in adult, paediatric and neonatal patients receiving ECMO across Australia and New Zealand. It is expected that the results will be hypothesis generating and lead to interventional trials aimed at reducing the high infection rates seen in this cohort. Results will be published in peer-reviewed journals and presented at relevant conferences.Trial registration number ANZCTRN12618001109291; Pre-results.

Background and objective: The lack of human and intellectual resources and capital has affected the survival of different industries and organizations in this globally competitive world. Universities have failed to provide necessary human resources to these organizations. The coordination between industries and universities is not optimal. Such challenges are being faced in the United Arab Emirates (UAE); therefore, there is a need to investigate the reasons behind these challenges to develop an ideal university-industry relationship in UAE. The present study aims to evaluate the missing links in the relationships between universities and industries of UAE. Methods: A quantitative research design has been used to recruit 100 department heads and senior professors from 20 public and private universities in the UAE. Descriptive statistics, regression analysis and factor analysis have been used to analyze the data collected through SPSS v.20. Results: The results have shown a significant and positive impact of intellectual property (IP) policies (p = 0.045) and scientific knowledge (p = 0.023) on knowledge transfer; IP policies (p = 0.067), shared governance (p = 0.018) and scientific knowledge (p = 0.017) on trust; IP policies (p = 0.069), shared governance (p = 0.034) and scientific knowledge (p = 0.018) on innovation performance. Conclusion: The findings have suggested that the role of interorganizational governance mechanisms is important in university industry collaborations to increase trust, innovation, and shared governance.