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Background and Aims: Multimodal analgesia regimens for optimizing the postoperative pain following abdominal surgeries are a crucial component of enhanced recovery after surgery (ERAS), as it reduces postoperative opioid consumption along with their adverse effects. We compared the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block (QLB) versus posterior transversus abdominis plane block (TAPB) with respect to duration of analgesia, modified Defense and Veterans Pain Rating Scale (DVPRS) scores for pain, activity, sleep, stress, and mood, respectively, the total amount of rescue analgesic consumption, hemodynamics parameters and side effects, in patients undergoing total abdominal hysterectomy under general anesthesia. Materials and Methods: In this study, which was prospective, randomized, and double-blind, 60 patients of the American Society of Anesthesiologists Physical Status I and II, aged 18–65 years, undergoing abdominal hysterectomy, were randomized into two groups. Group QLB (n = 30) and Group TAPB (n = 30) received bilateral QLB and TAPB with 40 ml of 0.375% ropivacaine, respectively. The data were compared using standard qualitative and quantitative tests. Results: The duration of pain relief was longer in Group QLB compared to Group TAPB (981.83 ± 138.62 min vs. 637 ± 127.02 min, P < 0.0001). The DVPRS score for pain, activity, sleep, stress, and mood, respectively, were significantly lower in Group QLB (P < 0.05). The total rescue analgesic consumption was significantly lesser in Group QLB (103.33 ± 18.26 mg) compared to Group TAPB (150.00 ± 50.85 mg) (P < 0.0001). No significant hemodynamic changes or side effects were observed (P > 0.05). Conclusion: Bilateral QLB significantly prolonged the duration of analgesia with reduced rescue analgesic requirement compared with bilateral TAPB in patients undergoing total abdominal hysterectomy.

Nanotechnology has been progressively developed recently and used extensively in all disciplines. These nanoscale particles overpower the use of conventional technological metal particles. Applications of Cu nanoparticles in agriculture enhance production and soil fertility, albeit their usage in excess amounts causes toxicity for soil fauna. So, we studied and collated the toxicity research trends of copper nanoparticles in the worm’s species (earthworms and enchytraeids) and their activities to assess the consequences of copper nanoparticles in varied sizes and oxidation states. Various Cu NPs have a high capacity for adsorbing biomolecules and interacting with biological receptors. Cu NPs can interact with the host organism’s inherent immunity and impair the host’s immune system when confronted with different dose concentrations. These artificially induced nanoparticles interpret the biological cell system and manipulate cell receptors in situ. Nations all across the world are currently attempting to establish a global policy on the regulation of nanomaterials as per their ecological safety. In some cases, they have been reported to be more hazardous than the comparable ions and micromaterials in some cases. As a result, nanoparticle safety research has far-reaching ramifications for national economies. These studies will be extremely significant in regulating the environmental outcome of nanoparticles.

Spinal tumors extending up to two levels can be removed using minimally invasive techniques. A microscope is traditionally used as a visualization tool with the tubular-retractor system. An exoscope is a newer optical tool with improved digital resolution, panoramic view, and better ergonomics for surgery. A 36-year-old who presented with paraparesis was diagnosed with intradural extramedullary tumor in the T7-T8 region. A complete tumor resection was possible using tubular retractors and exoscope. The patient recovered clinically. We document our surgical experience and present an edited video of the surgery. The key steps and nuances are described in the audio timeline. The authors acknowledge the feasibility of performing this surgery via a minimally invasive method using an exoscope.

Background: Shift work implementation is essential for providing continuous patient care in hospitals. However, working in shifts on a routine basis may disrupt the circadian pattern and alter the sleep-wakefulness cycle in nurses. Stress due to shift work can influence the adaptability of the cardiovascular system, produce psychophysiological strain and deteriorate work performance in female nurses. Objective: This study investigated the effect of morning and night shift work on sleep quality and circadian patterns governing heart rate variability (HRV) in female nurses working in a tertiary care hospital. Methods: Thirty-eight healthy female nurses were recruited. Frequency and time domain parameters of HRV were recorded as markers of cardiac autonomic function. A student t-test was used to investigate differences in HRV between morning and night shift workers. Mann-Whitney non-parametric test was applied for the difference between Pittsburgh Sleep Quality Index (PSQI) scores in the two groups Results: Standard deviation of the normal-to-normal interval (SDNN) (msec), total power (ms2) and high-frequency (HF) band power (ms2) were significantly reduced in night shift nurses than in morning shift nurses. The low-frequency (LF)/HF ratio was significantly increased in night shift nurses. The differences in standard deviation of the averages of NN intervals (SDaNN) (msec), root mean square of successive differences between adjacent NN intervals (RMSSD), mean NN, very low-frequency (VLF) band power (ms2) and LF band power (ms2) were not statistically significant. The global PSQI score was significantly higher among night shift workers than in morning shifts. Conclusion: Inadequate sleep can disrupt the body’s ability to regulate heart rhythm and increase the risk of cardiovascular diseases and mortality. The research suggests a propensity for autonomic imbalance in night shift workers when compared to their counterparts on morning shifts.

Background: Metabolic surgery, which results in significant weight loss and the improvement, prevention, or remission of multiple related conditions including type 2 diabetes, heart disease, hypertension, sleep apnea, and various malignancies, is the most effective and long-lasting therapy for excessive obesity. Aims and Objectives: To examine the results of metabolic operations with an emphasis on thyroid function, weight reduction, diabetes mellitus, and hypertension. Material and Methods: From June 2021 to June 2022, thirty-two (15 men and 17 women) patients were selected from the outpatient division of state-run Government Medical College. It is a case series analysis on patients who underwent bariatric surgeries which were conducted after clinical history and clinical examination with appropriate investigations on those patients who were admitted. The study only covered those who had no significant organ involvement and those who met the inclusion criteria were invited to take part in the study. Results: About 32 individuals underwent metabolic surgeries in the General Surgery department, at SVBP Hospital affiliated with LLRM Medical College Meerut. The difference between various parameters, such as pre-op and post-op, is compared using the various statistical analysis between the single group that differs from a known mean value. Conclusion: Metabolic surgery is presently the most effective treatment for attaining long-term weight loss and has been demonstrated to benefit T2DM thyroid and Hypertensive patients. Our study supports the statistical significance of variables including hemoglobin, BMI, HbA1c, serum creatinine, total cholesterol, LDL, SBP, and TSH.

Rationale: Dengue fever is capable of inciting the formation of transient polyclonal antibodies directed at red blood cell antigens, resulting in complement-mediated hemolysis, leading to intravascular hemolysis and hemoglobinuria. Patient’s concern: A 12-year-old male patient who recovered from dengue fever a week ago had red blood cell agglutination, spherocytes, and engulfment of red blood cells (erythrophagocytosis) by monocytes and neutrophils on routine hematological peripheral blood smear. The unexpected blood smear results prompted the lab physicians to investigate autoimmune hemolytic anemia, which revealed a monospecific positive direct antiglobulin test for complement (C3d, C3b) and the presence of Donath-Landsteiner antibody. Diagnosis: Paroxysmal cold hemoglobinuria (PCH), secondary to dengue fever. Interventions: Oxygen supplements, antibiotics, intravenous immunoglobulins, steroid therapy, and packed cell transfusions were administered. Outcomes: The patient’s condition was improved following the therapy. Lessons: Post-dengue PCH is a rare complication that requires a thorough peripheral smear examination for erythrophagocytosis, as advanced hematology analyzers fail to detect such findings.

Aim: The aim of the study was to assess the association of nutritional status and dental caries in children at an orphanage in Raichur city, Karnataka. Materials and Methods: A specially designed structured questionnaire was administered to a total of 101 children of the orphanage to gather demographic details, dietary habits, sugar exposure, and oral hygiene practices. The sweet score was recorded as given by Nizel and Papas, body mass index (BMI) was assessed using the Centers for Disease Control 2000, growth charts, dental caries, and odontogenic infections were recorded using decayed missing filled teeth in deciduous dentition (dmft)/Decayed Missing Filled Teeth in permanent dentition (DMFT) and pufa/PUFA (Pulpal involvement, Ulceration, Fistula, and Abscess) index (Monse et al., 2010), respectively. Results: A total of 101 participants were enrolled in the study including children aged 6–15 years old with a mean age of 10.67 ± 2.74 years. A statistically significant relation was found between the duration of stay in an orphanage and the prevalence of dental caries (P < 0.05). A statistically significant positive correlation was found between the duration of stay in the orphanage and BMI (0.382) dmft/DMFT (0.203). In addition, a statistically significant positive correlation was also observed between dmft/DMFT and pufa/PUFA. Conclusion: The study showed caries to be primarily associated with the sugar exposure and dietary habits, whereas untreated dental decay was the main cause of odontogenic infections. The untreated caries PUFA ratio was 13.98% with only one filled component, indicating the unmet needs for decayed teeth and lack of awareness and access to preventive and curative dental care facilities by the children of the orphanage.

Abstract The draft genome sequence of an agriculturally important actinobacterial species Amycolatopsis sp. BCA-696 was developed and characterized in this study. Amycolatopsis BCA-696 is known for its biocontrol properties against charcoal rot and also for plant growth-promotion (PGP) in several crop species. The next-generation sequencing (NGS)-based draft genome of Amycolatopsis sp. BCA-696 comprised of ~ 9.05 Mb linear chromosome with 68.75% GC content. In total, 8716 protein-coding sequences and 61 RNA-coding sequences were predicted in the genome. This newly developed genome sequence has been also characterized for biosynthetic gene clusters (BGCs) and biosynthetic pathways. Furthermore, we have also reported that the Amycolatopsis sp. BCA-696 produces the glycopeptide antibiotic vancomycin that inhibits the growth of pathogenic gram-positive bacteria. A comparative analysis of the BCA-696 genome with publicly available closely related genomes of 14 strains of Amycolatopsis has also been conducted. The comparative analysis has identified a total of 4733 core and 466 unique orthologous genes present in the BCA-696 genome The unique genes present in BCA-696 was enriched with antibiotic biosynthesis and resistance functions. Genome assembly of the BCA-696 has also provided genes involved in key pathways related to PGP and biocontrol traits such as siderophores, chitinase, and cellulase production.

Traffic management is a critical activity, the population is increasing day by day and so the traffic on the road is also increasing. Traffic jams and long waiting queues of vehicles at the road crossing are now part of everyone's life. The traffic lights used at the crossing to regulate the traffic play a vital role in the smooth functioning of traffic movement. At a crossing of four roads, it has been observed that giving an equal amount of green light to all roads is meaningless since the arrival of traffic on different paths is different. Importantly, the arrival rate is responsible for all traffic jams, long queues, and increased waiting time. Therefore, this paper suggests a green light allocation scheme for all paths i depending on the arrival rate of the vehicles. Thus, the allocation of green light will be dynamic. Further, weight is also computed, where more arrival rate means more weight, thereby assigning more time to the green signal. This will help in reducing the long queue length, residual traffic, and long waiting times. On simulating the traffic with the traffic data, the proposed optimized green light allocation scheme to path i reduces the residue traffic to negligible, allowing smooth traffic flow even during peak hours. The work also provides a proficient optimization of the waiting time of vehicles accumulated during the red light. According to the simulation, the maximum time assigned for the green signal during the peak hour of 9:30 AM to 10:00 AM for paths i, where 1≤i≤4 is 39.96, 33.36, 26.64, and 20.04 seconds respectively. Similarly, during the second rush hour of 5:00 PM to 6:00 PM, the simulation assigns a green signal time of 41.4, 37.2, 24.84, and 16.56 seconds for corresponding paths 1–4. Thus, the proposed work suggests an effective traffic management scheme at the four-road crossing.

Abstract The sole treatment for snakebite envenomation (SBE), the anti-snake venom (ASV), suffers from considerable drawbacks, including side effects and limited species specificity. Additionally, despite its existence for more than a century, uniform availability of good quality ASV does not yet exist. The present review describes the journey of a SBE victim and highlights the global crisis of SBE management. A detailed analysis of the current ASV market has also been presented along with the worldwide snake distribution. The current production of country specific licensed ASV throughout the globe along with their manufacturers has been examined at the snake species level. Furthermore, a detailed analysis of on-ground situation of SBE management in antivenom manufacturing countries has been done using the most recent literature. Additionally, the export and import of different ASVs have been discussed in terms of procurement policies of individual countries, their shortcomings, along with the possible solution at the species level. It is interesting to note that in most countries, the existence of ASV is really either neglected or overstated, implying that it is there but unsuitable for use, or that it is not present but can be obtained from other countries. This highlights the urgent need of significant reassessment and international collaborations not just for development and production, but also for procurement, distribution, availability, and awareness. A PROMISE (Practical ROutes for Managing Indigenous Snakebite Envenoming) approach has also been introduced, offering simple, economical, and easy to adopt steps to efficiently alleviate the worldwide SBE burden.

Background: Toothbrushes that are used regularly can accumulate a high amount of microorganisms, which have the potential to cause infections or reinfections. There is a need for toothbrush disinfection methods which are effective and can be easily implemented. The present study assessed the antimicrobial efficacy of different disinfectants on contaminated toothbrushes in healthy and chronic periodontitis patients. Materials and Methods: Sixty patients were taken who were divided into two Groups A and B: Group A consisted of 30 healthy patients who were further subgrouped as Group A1 (control group), Group A2 (1% sodium hypochlorite), Group A3 (1% vinegar), and Group A4 (ultraviolet [UV] sanitizer) and Group B consisted of 30 patients with mild-to-moderate generalized chronic periodontitis who were further subgrouped as B1, B2, B3, and B4 based on the different disinfection processes. Microbial counts were assessed and compared. A paired sample t-test was used for statistical analysis, and the level of significance was set at P < 0.001. Results: All disinfectants showed a statistically significant reduction in microbial load on contaminated toothbrushes in both the groups (P < 0.001). There was no statistical difference between the efficacies of vinegar and sodium hypochlorite when compared with UV sanitizer in both the groups (P = 0.115 and P = 0.205). Conclusion: The study concluded that UV sanitizer can be used as a preferable toothbrush disinfection method.

Introduction:The study was performed to analyze the effect of Yagya therapy on pulmonary functions among healthy college students.Methods:A total of 40 male participants were randomly selected and divided into two groups, i.e., the experimental group (n = 20) and the control group (n = 20). Participant’s age was ranged between 18 and 30 years (group age mean ± standard deviation = 22.20 ± 2.14 years). The experimental group performed Yagya in two sessions (morning and evening) every day for 34 days. Each session was for 30 min. The outcome measured assessed was (i) forced vital capacity (FVC), (ii) forced expiratory volume in the first second (FEV1), (iii) peak expiratory flow rate (PEFR), and (iv) maximum voluntary ventilation (MVV) at baseline and post.Results:The paired sample t-test showed that there was a significant increase in FVC, FEV1, and MVV for both experimental group and control group. The magnitude of change in FEV1 and MVV was little higher in the experimental group. The PEFR showed no significant changes in both groups. Independent sample t-test also showed no significant effect in favor of any assessed variables of both groups.Conclusions:The findings of the study indicate that the practice of Yagya shows slight or almost the same effect on pulmonary functions of the experimental as well as in the control groups. Hence, we can conclude that Yagya has no such specific improvement in pulmonary functions compared to usual care. Furthermore, larger-scale and well-designed randomized controlled trials should be highly encouraged to analyze the effect.

Abstract Tumor-Infiltrating Lymphocytes (TILs) have strong prognostic and predictive value in breast cancer, but their visual assessment is subjective. To improve reproducibility, the International Immuno-oncology Working Group recently released recommendations for the computational assessment of TILs that build on visual scoring guidelines. However, existing resources do not adequately address these recommendations due to the lack of annotation datasets that enable joint, panoptic segmentation of tissue regions and cells. Moreover, existing deep-learning methods focus entirely on either tissue segmentation or cell nuclei detection, which complicates the process of TILs assessment by necessitating the use of multiple models and reconciling inconsistent predictions. We introduce PanopTILs, a region and cell-level annotation dataset containing 814,886 nuclei from 151 patients, openly accessible at: sites.google.com/view/panoptils . Using PanopTILs we developed MuTILs, a neural network optimized for assessing TILs in accordance with clinical recommendations. MuTILs is a concept bottleneck model designed to be interpretable and to encourage sensible predictions at multiple resolutions. Using a rigorous internal-external cross-validation procedure, MuTILs achieves an AUROC of 0.93 for lymphocyte detection and a DICE coefficient of 0.81 for tumor-associated stroma segmentation. Our computational score closely matched visual scores from 2 pathologists (Spearman R = 0.58–0.61, p

Abstract Vehicle identification systems are vital components that enable many aspects of contemporary life, such as safety, trade, transit, and law enforcement. They improve community and individual well-being by increasing vehicle management, security, and transparency. These tasks entail locating and extracting license plates from images or video frames using computer vision and machine learning techniques, followed by recognizing the letters or digits on the plates. This paper proposes a new license plate detection and recognition method based on the deep learning YOLO v8 method, image processing techniques, and the OCR technique for text recognition. For this, the first step was the dataset creation, when gathering 270 images from the internet. Afterward, CVAT (Computer Vision Annotation Tool) was used to annotate the dataset, which is an open-source software platform made to make computer vision tasks easier to annotate and label images and videos. Subsequently, the newly released Yolo version, the Yolo v8, has been employed to detect the number plate area in the input image. Subsequently, after extracting the plate the k-means clustering algorithm, the thresholding techniques, and the opening morphological operation were used to enhance the image and make the characters in the license plate clearer before using OCR. The next step in this process is using the OCR technique to extract the characters. Eventually, a text file containing only the character reflecting the vehicle's country is generated. To ameliorate the efficiency of the proposed approach, several metrics were employed, namely precision, recall, F1-Score, and CLA. In addition, a comparison of the proposed method with existing techniques in the literature has been given. The suggested method obtained convincing results in both detection as well as recognition by obtaining an accuracy of 99% in detection and 98% in character recognition.

Abstract Medical image segmentation has made a significant contribution towards delivering affordable healthcare by facilitating the automatic identification of anatomical structures and other regions of interest. Although convolution neural networks have become prominent in the field of medical image segmentation, they suffer from certain limitations. In this study, we present a reliable framework for producing performant outcomes for the segmentation of pathological structures of 2D medical images. Our framework consists of a novel deep learning architecture, called deep multi-level attention dilated residual neural network (MADR-Net), designed to improve the performance of medical image segmentation. MADR-Net uses a U-Net encoder/decoder backbone in combination with multi-level residual blocks and atrous pyramid scene parsing pooling. To improve the segmentation results, channel-spatial attention blocks were added in the skip connection to capture both the global and local features and superseded the bottleneck layer with an ASPP block. Furthermore, we introduce a hybrid loss function that has an excellent convergence property and enhances the performance of the medical image segmentation task. We extensively validated the proposed MADR-Net on four typical yet challenging medical image segmentation tasks: (1) Left ventricle, left atrium, and myocardial wall segmentation from Echocardiogram images in the CAMUS dataset, (2) Skin cancer segmentation from dermoscopy images in ISIC 2017 dataset, (3) Electron microscopy in FIB-SEM dataset, and (4) Fluid attenuated inversion recovery abnormality from MR images in LGG segmentation dataset. The proposed algorithm yielded significant results when compared to state-of-the-art architectures such as U-Net, Residual U-Net, and Attention U-Net. The proposed MADR-Net consistently outperformed the classical U-Net by 5.43%, 3.43%, and 3.92% relative improvement in terms of dice coefficient, respectively, for electron microscopy, dermoscopy, and MRI. The experimental results demonstrate superior performance on single and multi-class datasets and that the proposed MADR-Net can be utilized as a baseline for the assessment of cross-dataset and segmentation tasks.

Abstract Wireless charging of Electric Vehicles (EVs) has been extensively researched in the realm of electric cars, offering a convenient method. Nonetheless, there has been a scarcity of experiments conducted on low-power electric vehicles. To establish a wireless power transfer system for an electric vehicle, optimal power and transmission efficiency necessitate arranging the coils coaxially. In wireless charging systems, coils often experience angular and lateral misalignments. In this paper, a new alignment strategy is introduced to tackle the misalignment problem between the transmitter and receiver coils in the wireless charging of Electric Vehicles (EVs). The study involves the design and analysis of a coil, considering factors such as mutual inductance and efficiency. Wireless coils with angular misalignment are modelled in Ansys Maxwell simulation software. The proposed practical EV system aims to align the coils using angular motion, effectively reducing misalignment during the parking of two-wheelers. This is achieved by tilting the transmitter coil in the desired direction. Furthermore, micro sensing coils are employed to identify misalignment and facilitate automatic alignment. Additionally, adopting a power control technique becomes essential to achieve both constant current (CC) and constant voltage (CV) modes during battery charging. Integrating CC and CV modes is crucial for efficiently charging lithium-ion batteries, ensuring prolonged lifespan and optimal capacity utilization. The developed system can improve the efficiency of the wireless charging system to 90.3% with a 24 V, 16 Ah Lithium Ion Phosphate (LiFePO4) battery at a 160 mm distance between the coils.

NKT cells are innate-like T cells, recruited to the skin during viral infection, yet their contributions to long- term immune memory to viruses are unclear. We identified granzyme K, a product made by cytotoxic cells including NKT cells, as linked to induction of Th1-associated antibodies during primary dengue virus (DENV) infection in humans. We examined the role of NKT cells in vivo using DENV-infected mice lacking CD1d-dependent ([CD1d.sup.dep]) NKT cells. In CD1d-KO mice, Th1- polarized immunity and infection resolution were impaired, which was dependent on intrinsic NKT cell production of IFN- [gamma], since it was restored by adoptive transfer of WT but not IFN-[gamma]-KO NKT cells. Furthermore, NKT cell deficiency triggered immune bias, resulting in higher levels of Th2-associated IgG1 than Th1-associated IgG2a, which failed to protect against a homologous DENV rechallenge and promoted antibody-dependent enhanced disease during secondary heterologous infections. Similarly, Th2 immunity, typified by a higher IgG4/IgG3 ratio, was associated with worsened human disease severity during secondary infections. Thus, [CD1d.sup.dep] NKT cells establish Th1 polarity during the early innate response to DENV, which promotes infection resolution, memory formation, and long-term protection from secondary homologous and heterologous infections in mice, with consistent associations observed in humans. These observations illustrate how early innate immune responses during primary infections can influence secondary infection outcomes., Introduction Viral pathogens such as flaviviruses, coronaviruses, and influenza viruses pose unique challenges for adaptive immune responses because of the existence of many serotypes and/or the frequent emergence of new [...]

An increasingly multicultural Aotearoa early childhood education (ECE) landscape forms the context for my doctoral study in progress. My research explores the culturally embedded and negotiated environmental identities of a growing number of migrant Indian teachers. This article documents my experiences of confronting and navigating the unexpected while planning and conducting the data collection for my research. The primary challenges were access to participants as well as participant dropouts. I discuss how I mitigated these challenges by employing an alternate sampling method as well as accounting for participant attrition and trustworthiness of data. The modification strategies highlight flexibility and responsiveness as critical research tools. This article has implications for early career researchers intending to plan or begin their research in the light of any future disruptions, such as the current COVID-19 climate.

Soil salinity and alkalinity seriously threaten rice production in south Asia. Improving screening methodologies to identify sources of tolerance for improved breeding for salt tolerant rice is of continuing importance. Rice genotypes of varying salt tolerance, such as tolerant (T), semi-tolerant (ST), and sensitive (S), were grown in field lysimeters in saline soil of ECe 4 and 8 mS cm-1 and alkali soil of pH 9.5 and 9.8 in North India and analyzed for chlorophyll (Chl), sugar, starch and proline in leaves. Chlorophyll a and b decreased due to salinity in all the tolerance groups. However, Chl a was not much affected but chl b increased with alkalinity. Under high stress both at ECe 8 and pH 9.8 Chl a and b were more in tolerant than in sensitive genotypes. The ratio of Chl a/b was similar in T, ST and S genotypes under salinity stress. Sugar accumulation was higher in T compared to S under normal conditions but under salinity or alkalinity stress the differences were not significant. Leaf starch was highest in T, intermediate in ST and lowest in S genotypes in normal as well as under salinity and alkalinity stress. There was decrease in starch with salinity and alkalinity stress only in T group but not in ST and S group. Proline increased significantly in all the tolerance groups even at low salinity of ECe 4 mS cm -1 or pH 9.5. The salt tolerant genotypes of rice maintained higher levels of Chl a and b, starch and proline under high salinity and alkalinity stress and are the robust criteria for tolerating high salinity and alkalinity.