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Background and Aims: Optimal patient positioning and operating table height are essential for an ergonomic posture of an anesthesiologist in which there is minimal or no strain on thewrist during mask ventilation. It also avoids flexion of the neck, lower back, and knee bending at the time of laryngoscopy and intubation. Material and Methods: One hundred eighty patients were randomly allocated to three groups based on different table heights. The height of the table is kept at the mid-sternum level of an anesthesiologist in group 1, at the xiphoid process in group 2, and at the level of umbilicus in group 3. Laryngoscopic view with or without postural changes (exertion at wrist joint, flexion of the neck, lower back, or knee bending) was graded as per Cormack Lehane’s (CL) grading. The degree of discomfort experienced by the anesthesiologist during mask ventilation or tracheal intubation was graded subjectively (1 = no discomfort, 2 = mild discomfort, 3 = moderate discomfort, and 4 = severe discomfort) at different table heights. Postural changes required to obtain the best glottic view and quality of endotracheal (ET) intubation (intubation time and attempts required) were also noted. For analysis, quantitative variables were expressed as mean ± SD and compared using unpaired t or analysis of variance test. Qualitative variables were expressed as frequencies/percentages and compared using the Chi-square test. Results with P value

Abstract Microplastics are one of the concerning environmental pollutants because of their ubiquity. Their capability to adsorb other environmental pollutants increases the risk even further. Existing identification approaches for microplastic characterization for polymer class and their surface-adsorbed heavy metal detection require the utilization of multiple resources and expertise. The article discusses the applicability of a custom-made hyphenated Laser Induced Breakdown Spectroscopy (LIBS)—Raman spectroscopic system in characterizing microplastics by comparing the analytical performance with conventional methods such as Attenuated Total Reflectance- Fourier Transform Infrared (ATR-FTIR) spectroscopy, confocal Raman spectroscopy, and Scanning Electron Microscopy–Energy Dispersive X-ray Spectroscopy (SEM–EDS). Raman analysis identified polyethylene (PE), polypropylene (PP), and polyethylene terephthalate (PET) plastics, which is confirmed by confocal Raman and FTIR study of the same. LIBS study of microplastics detected heavy metals such as Al, Ni, Co, and Zn, along with Ca and Mg trace elements. The cross-examination with EDS validates these trace elements' presence on the microplastics' surface. The results of the reported LIBS-Raman analysis and its validity evaluated using conventional gold-standard methods show the applicability of the proposed methodology in characterizing microplastics from environmental resources with less or no sample preparation in short time.

Background and Aims: Caudal block is more frequently used in children for postoperative analgesia. However, its disadvantage is its short duration. Erector spinae plane block (ESPB) at the sacral level can potentially block the pudendal nerve. It may prove an alternative to caudal block for hypospadias repair regarding time to first rescue analgesia. Methods: Fifty children of 2–7 years of age were included. After induction of general anaesthesia, Group I (n = 25) was given ultrasound-guided sacral ESPB with 1 ml/kg of 0.25% bupivacaine and Group II (n = 25) was given caudal block with 0.5 ml/kg of 0.25% bupivacaine. Postoperatively at face, leg, activity, cry, consolability (FLACC) score ≥4, rescue analgesia was given using intravenous 15 mg/kg paracetamol. The primary outcome was to compare time to first rescue analgesia, and secondary outcomes were intraoperative haemodynamic parameters, fentanyl consumption, postoperative FLACC score and analgesic consumption in 24 h. Continuous variables were compared using the independent sample t-test or Mann–Whitney test, and categorical variables were compared using the Chi-square test. Results: The mean time to first rescue analgesia was 21.30 (standard deviation [SD]: 3.06) h in Group I and 9.36 (SD: 1.71) h in Group II (P < 0.001) (mean difference −11.94 [95% CI: −13.39, −10.48]). The FLACC score was significantly higher (P < 0.05) postoperatively at 8, 10, 12 and 18 h in Group II. Mean postoperative analgesic consumption was 310.5 (SD: 72.69) mg in Group I and 615.6 (SD: 137.51) mg in Group II (P < 0.001) (mean difference 30.5 [95% CI: 236.41, 373.78]). Conclusion: Sacral ESPB is better regarding time to first rescue analgesia than caudal block in paediatric patients undergoing hypospadias repair.

The experiment was conducted during winter (rabi) seasons of 2021–22 and 2022–23 at ICAR-Indian Institute of Vegetable Research, Varanasi, Uttar Pradesh to study the improvement in yield and quality parameters in tomato (Solanum lycopersicum L.) cultivar using brinjal (Solanum melongena L.) rootstock. Three improved cultivars of tomatoes i.e. Kashi Aman, Kashi Adarsh and Kashi Chayan were grafted over three brinjal rootstocks, IC-111056, IC- 354557, and Surya. Experimental findings revealed that brinjal rootstocks significantly affected photosynthetic traits, root architectures, fruit yields and quality traits of tomatoes. Maximum photosynthetic rate (23.8 µmol/m2/s) and stomatal conductance (492.74 mmol/m2/s) were recorded in Kashi Chayan grafted over Surya rootstock, whereas chlorophyll fluorescence yields (Fv/Fm) was significantly higher in Kashi Aman self-rooted plants (0.452–0.457). Grafting tomato onto brinjal rootstocks significantly enhanced most of the yield traits, such as fruit number, weight, size and yields. Surya + Kashi Chayan graft combination registered an enhancement in number of fruits and yields by 8.65% and 8.4%, respectively over self-rooted Kashi Chayan. Significantly higher root volumes were noticed in two graft combinations i.e. IC-354557 + Kashi Aman (28.53 cm2) and Surya + Kashi Chayan (27.98 cm2), while 63% and 44.5% higher root length density (RLD) were registered in graft combinations IC-354557 + Kashi Chayan and Surya + Kashi Chayan, respectively over self-rooted Kashi Chayan. Fruit quality such as lycopene and ascorbic acid contents were significantly affected in different rootstocks and scions, whereas fruit acidity was unaffected. From the present study it may be conclude that use of brinjal rootstock Surya significantly improved most of the physiological, yield, root architecture and fruit quality in Kashi Chayan tomato cultivars.

The existence of over-damped nonlinear differential equations results from a variety of engineering conundrums and physical natural occurrences. Non-oscillatory dynamics with forced over-damping are used in the simulation of nonlinear differential systems. For non-oscillatory nonlinear differential systems, it is possible to derive approximations of solutions using a variety of analytical methods, both with and without external forcing. This paper introduces a novel method for estimating solutions for highly nonlinear damped vibration systems subject to parameterized external forcing. The extended Krylov-Bogoliubov-Mitropolsky (KBM) technique and harmonic equilibrium (HM), which have both been previously developed in the literature, are the foundation of the suggested method. This method was initially created by Krylov-Bogoliubov to discover periodic details in second-order nonlinear differential equations. Several examples are provided to show how the suggested technique is applied. The process is fairly simple and straightforward, and using this formula, the result can be found with very marginal errors from the previous citations. The primary significance of this approach is in its ability to provide approximate analytical solutions of the first order that closely align with the findings obtained by numerical methods. These solutions are applicable to a variety of beginning scenarios and are distinct from those presented in earlier literature. Also, we illustrated the two-dimensional graph of all the solutions that we got in this article by using the data from the mentioned table. The results that we obtained from this method are effective and reliable for better measurements of strong nonlinearities.

Abstract Introduction The current research investigates into the application of various thunderstorm indices to predict severe thunderstorm occurrences during the monsoon season across four distinct regions in India. Methods: The study assesses the prediction model’s efficacy using various skill scores and the Weather Research and Forecasting (WRF) model has been integrated for 30 h with double moment microphysics scheme NSSL-17 which accurately reproduces vertical and meteorological measures. Objective Furthermore, it investigates fifteen thunderstorm indices derived from the ERA5 dataset to identify the most effective index for forecasting severe thunderstorms. Results The results indicate that combining thunderstorm indices with skill scores, such as the Heidke Skill Score and True Skill Statistic, enhances the accuracy of severe thunderstorm predictions in the Indian monsoon season. The accurate predictions rely on determining optimal thresholds for each index. The study emphasizes the importance of using multiple indices rather relying solely on single measure for predicting severe thunderstorms. Advanced indices like the Energy Helicity Index (EHI) and Supercell Composite Parameter (SCP) perform well in forecasting extreme severe thunderstorms due to their strong reliance on wind shears. The EHI (> 1), and SCP (≥ 3.5), STP (≥ 1.2) along with low SRH at 3 km (100 m2/s2), indicated no evidence of helicity or tornado activity during the event. On the other hand, the CAPE, K Index, and VT Index demonstrate robust predictive capabilities for non-severe category thunderstorms. Conclusions Integrating numerous thunderstorm indices improves meteorologists’ forecasts, ensuring public safety. Based on this work, future research can improve severe weather forecasting models’ accuracy and reliability.

Mangroves are crucial ecosystems that play a role in carbon sequestration, shoreline fortification, and provide habitats for diverse species. In developing nations like India, there is a need for more knowledge on the occurrence and distribution of MPs in mangrove forests under changing seasons. Our investigation aimed to fulfil this research gap by studying the seasonal patterns of microplastic distribution within the sediments of the Kota mangroves in south-western India. The mean (± standard deviation) microplastic abundance was 1418.52 (±1404.34) MPs/kg during the wet season and 1414.32 (±1368.65) MPs/kg during the dry season. A consistent pattern in microplastic categories was observed, with fibres being the predominant shape followed by film, fragment, and foam. Microplastics of size 0.1–0.3mm were dominant in all seasons. Fourier Transformed Infrared Spectroscopy (FTIR-ATR) and Raman Spectroscopy analyses revealed the presence of polypropylene, polyethylene, polyethylene terephthalate, and polystyrene. Energy Dispersive Spectroscopy between control and extracted samples revealed adsorption of Cd, Zn, Pb, Fe, and Ni onto the extracted microplastics. The primary contributors to the MP pollution were attributed to fishing related activities, fish meal processing industry, tourism, and local households. This study established a baseline information on the seasonal dynamics governing the distribution of microplastics in sediment of Kota mangroves.

Accurate diagnosis and treatment of cardiovascular diseases require the integration of cardiac imaging, which provides crucial information about the structure and function of the heart to improve overall patient care. This review explores the role of Artificial Intelligence (AI) in advancing cardiac imaging analysis, with a focus on unsupervised learning methods. Unlike supervised AI systems, which rely on annotated datasets, the use of unsupervised learning proves to be a game-changer. It effectively tackles issues related to limited datasets and sets the stage for scalable and adaptive solutions in cardiac imaging. This paper gives a comprehensive overview of the limitations of traditional methods and the potential of unsupervised AI in overcoming challenges related to dataset scarcity through an extensive literature review and analysis of unsupervised algorithms, including clustering techniques, dimensionality reduction, and generative models. This review study highlights the contributions of unsupervised techniques for enhancing diagnostic accuracy and efficiency in cardiac imaging. By comparing unsupervised and supervised methods, the paper aims to explain the benefits and limitations of each approach, offering valuable insights for advancing AI integration in cardiac healthcare. The findings are expected to guide future research and development, leading to innovative advancements in cardiovascular diagnostics.

Background: Mallampati grading (MPG) classification in a sitting position is the most commonly used method for airway assessment. The study aimed to compare the predictive value of MPG in the sitting and supine positions to predict difficult tracheal intubation (DTI). Patients and Methods: The present study was a prospective, blinded, and observational study. Three hundred nine patients aged 18–60 years, scheduled for surgery requiring orotracheal intubation, were included. Airway assessment was performed preoperatively, including sitting MPG with and without phonation. Supine MPG with and without phonation was noted in the operation theater. The ease of bag-mask ventilation (BMV) and laryngoscopy view were graded according to the Han scale and the Cormack and Lehane scores, respectively. A receiver operating characteristic curve was used to assess the cutoff point, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of MPG, and body mass index for predicting DTI. Results: Difficult BMV, DTI, and both (difficult BMV and DTI) were observed in 22.7%, 12.9%, and 5.2% of patients, respectively. MPG in the sitting position without phonation yielded the highest diagnostic accuracy (76.38%), specificity (79.55%), and PPV (28.6%), with good sensitivity (55%) and NPV (92.2%). Supine MPG without phonation showed comparable results. Conclusion: Sitting position MPG without phonation is the best predictor of DTI, followed by supine MPG without phonation. Therefore, supine MPG without phonation is equivalent to sitting without phonation MPG and can be used for predicting DTI whenever the patient cannot be made upright.

In the 21st century, climate change, which is predominantly caused by human activities, has emerged as a major global concern. This paper examines in depth the profound and multifarious effects of climate change on ecosystems and the ecosystem services they provide. It further investigates the complex connections between climate change and ecosystems, focusing on terrestrial, aquatic, and marine habitats. Notably, we emphasize the unique challenges confronting ecosystems in Southeast Asia, a region of ecological significance where the ocean economy is fundamental to human livelihoods. Climate change threatens ecosystem services in numerous ways, including the provision of food and water, climate regulation, nutrient cycling, and cultural importance. We emphasize the potential transformation of ecosystems from carbon sinks to carbon sources, which has implications for climate control. Moreover, changes in disease vectors and altered landscapes raise concerns for human health and cultural traditions. We emphasize the importance of international cooperation, as exemplified by the Paris Agreement, in mitigating climate change collectively. In addition, we advocate for the inclusion of indigenous communities and traditional ecological knowledge in conservation and restoration initiatives. This paper concludes by emphasizing the profound interdependence between ecosystems and human well-being and the urgency of taking action. HIGHLIGHTS Climate change impacts on aquatic ecosystems, terrestrial ecosystems, ecosystem services.; Future management.;

The construction industry plays a significant role in global resource consumption and environmental degradation. To mitigate these negative impacts, researchers and engineers have been exploring sustainable building materials and practices. This research paper focuses on the development of Eco Bricks, a sustainable alternative to conventional clay bricks, using a combination of cement, sand, Fly ash Ground Granulated Blast Furnace Slag (GGBS), PET bottles, aggregates, shredded plastic waste, and water. This study aims to investigate the mechanical properties, environmental benefits, and feasibility of producing Eco Bricks for construction applications. Furthermore, this research explores the environmental advantages of using Eco Bricks. By diverting plastic waste from landfills and reducing the demand for traditional building materials like clay bricks or concrete blocks, Eco Bricks contribute to reduced carbon emissions and resource conservation. This paper also addresses potential challenges associated with Eco Bricks, including quality control, durability, and long-term performance in different climatic conditions.

BackgroundTraining in acute care, such as emergency medicine (EM), where exposure to critically ill and injured patients is high, impacts the well-being of trainees and contributes to burnout. Investigating how, and if, trainees prepare for these situations is necessary to ensure they are supported. ObjectiveThis study aimed to evaluate medical students’ perspectives and emotional preparedness for handling acute care and trauma. MethodsWe conducted a pilot investigation using a remote digital survey of medical students during their EM clerkship at a large, urban academic institution. The primary outcome of interest was student-reported preparedness and comfort in handling trauma and critical care patient encounters. Secondary outcomes included awareness of well-being resources and comfort in accessing digital well-being resources. ResultsA total of 57 medical students completed the voluntary digital survey, and half of the students (n=28, 49%) reported having witnessed the care of a critically ill or a penetrating trauma patient (eg, a victim of gun violence). A majority (n=40, 70%) had thought about how these events may impact them, and over half felt unprepared to identify the emotional impact these cases may have on them (n=31, 54%) or address the emotional or mental health impact (n=36, 63%). Less than a quarter (n=14, 25%) were aware of digital mental health resources, and 58% (n=33) did not feel fully comfortable connecting with resources if needed. Students who had previously witnessed critical care were significantly more likely to report feeling well prepared in identifying the emotional impact and addressing this impact. ConclusionsIn this cross-sectional survey, students did not feel fully prepared to identify or address the emotional impact of working in EM. Additionally, they lacked awareness of or comfort with accessing digital institutional resources meant to support their well-being, such as a large web-based platform. These findings can help inform and guide interventions by educational and academic leaders. The aim would be to create and promote environments that empower students with tools to identify their own emotions and connect to well-being resources.

Background: Heart failure affects over 6 million people in the United States (US) with limited evidence to support the use of cardiac catheterization. The benefit of its use remains mostly as expert opinion. This study intends to assess the benefits and risks of cardiac catheterization in elderly patients admitted for heart failure. Methods: This was a retrospective study using data from the National Inpatient Sample, including admissions 65 years and older hospitalized for heart failure, between 2008 and 2016. The outcomes analyzed were in-hospital mortality, total hospital costs, and length of stay. Results: After controlling for covariates, cardiac catheterization was found to have a protective association with mortality (OR 0.87, 95% CI 0.833-0.912, P

The thermal properties of paraffin wax were upgraded by utilizing rice husk-derived graphene nanoparticles. In terms of performance, the stability of NPEPCM is an essential aspect. The stability of REPCM is checked using surfactants (CTAB, SDBS, SDS) and sonication time. An increment in the thermal conductivity of paraffin wax was perceived. Maximum conductivity of 0.59 Wm−1K−1 was achieved at 304 K for 1.5 wt% of RGP’s. The maximum thermal conductivity of 0.69 Wm−1K−1 was achieved using pure Graphene at 304 K. Using RGPEPW at different concentrations of RGP’s, the thermal efficiency was calculated for different flow rates of fluid and solar irradiance, and the consequence of the abridged temperature coefficient on the efficiency of FPSC observed. Maximum efficiencies of 67.5 % and 63.9 % were noted for 1 wt% of graphene nanoparticles and 1.5 wt% of RGPs at a 3 Lt/min flow rate, respectively. The improvement of 29.8 % and 22.8 % in the efficiency of FPSC is observed for 1 wt per cent of Graphene and 1.5 wt per cent of RGPs, respectively. Using RGPEPW with a 9.2 % increment in the outlet, the temperature was noticed in the afternoon at a 1.2 Lt/min flow rate. The bioengineering approach gives an understanding of engineering, biology, and environmental science involvement in the present study.

A high-quality railway track resting on an excellent foundation is required to support high-speed railway transportation. The foundations of high-speed railway tracks are generally constructed on the lifted embankment with the improved ground using different reinforcement agents like geosynthetics and rigid lateral support. The present study performed dynamic finite element simulations on a ballasted rail track laid over a geosynthetically reinforced embankment with and without facing wall support. Three foundation geometries were analyzed to examine the effect of facing wall support and geosynthetics on the lateral resistance of the foundation. An area loaded with a constant pressure was moved at a constant speed, causing the load motion at different speeds in the 90–360 km/h range. Different parameters were calculated at node paths to help understand the lateral effect of moving load. The results showed that the lateral resistance based on nodal acceleration and velocity increased with facing wall support in the range of 40%–57%. Any increment over the minimum facing wall thickness of 300 mm does not significantly increase lateral resistance. Geosynthetics provided a vital function in the foundations with a less bulk volume of soil and increased the lateral resistance by 10%.

Abstract Hydatid cyst is a zoonosis caused by ingestion of eggs of Echinococcus‐a tapeworm. Following ingestion of the eggs, oncosphere larvae are released which penetrate the intestinal wall to invade various organs of the body including liver, lungs, and skeletal muscles via. blood vessels. Due to their contractile nature and high lactic acid content, skeletal muscles are typically not a suitable site for attachment of hydatid cyst. In our case report presented below, we report a rare case of an isolated hydatid cyst of paraspinal muscle presenting as a slow‐growing asymptomatic mass in the back, posing a clinical diagnostic dilemma.

Cardiologists frequently encounter intracardiac thrombi in the course of their work. Along with tumor and vegetation, it is one of the most frequent differential diagnoses for intracardiac masses. Cardioembolic stroke patients frequently have intracardiac thrombi in the left ventricle. Although the potential for cerebral emboli persists in a large population of patients with chronic left ventricular (LV) dysfunction, the risk of LV thrombus formation is highest during the first 3 months after acute myocardial infarction. The main risk factors for the development of left atrial thrombi are rheumatic valvular disease, especially mitral stenosis and atrial fibrillation. Right heart chamber thrombi may develop in situ or occur when peripheral venous clots that are on their way to the lungs become stuck, leading to acute pulmonary embolism, and their incidence ranges from 4% to 18%. We are presenting five cases that represent a broad range of clinical circumstances involving intracardiac thrombus. When performed during systole and diastole, echocardiography can detect thrombus as a discrete, echo-dense mass with clearly defined borders that is separate from the endocardium. Since dimensions, shape, regularity or irregularity, and homogeneity are all characteristic features that define the embolic risk and therapeutic management, the morphology and structure of thrombi should be carefully assessed.

For patients who qualify, statins are among the most frequently prescribed drugs for the primary and secondary prevention of cardiovascular disease. A wide range of clinical manifestations, from generalized muscle aches to severe necrotizing myositis, are present in statin-induced myopathy. Here, we present a case of a 49-year-old woman with Vitamin D deficiency who developed statin-induced myopathy 45 days after starting rosuvastatin. A 49-year-old female was admitted to the hospital with a history of lower back pain and bilateral lower limb pain for 7 days. Her ongoing medications include ticagrelor 90 mg BD, metoprolol 25 mg OD, nicorandil 5 mg BD, telmisartan 20 mg OD, dapagliflozin 10 mg OD, metformin 1000 mg OD, vildagliptin 100 mg OD, pantoprazole 40 mg OD, and rosuvastatin 40 mg OD, which were started 45 days back when she was diagnosed with ischemic heart disease. On neurological evaluation, muscle weakness was present in the lower extremities with proximal muscle involvement more than the distal muscle, power at the hip was 2/5, knee and ankle joint were 4/5, knee and ankle reflex were 2/5, and the plantar reflex was normal, with no upper limb involvement. Laboratory investigation on the day of admission revealed elevated creatine phosphokinase (9873.00 U/L) and serum creatinine (2.45 mg/dl). Arterial blood gas analysis revealed a high anion gap with increased lactate levels. Vitamin D levels were found to be insufficient, and serum calcium was in the low normal range. Magnetic resonance imaging of the bilateral lower limb revealed bilaterally symmetrical abnormal edematous signal in muscles of the gluteal region, extensor, adductor, and flexor compartment indicative of myopathy. Volitional testing revealed the presence of spontaneous activity, and an electromyography study revealed that the interference pattern was complete with early recruitment, similar to what is seen in inflammatory myopathy. The motor unit action potential was polyphasic with short duration and amplitude. She was diagnosed with statin-induced myopathy with acute kidney injury. In this case, initiation of rosuvastatin and Vitamin D deficiency were the only positive associated factors that were responsible for myopathy and acute kidney injury and liver injury. Despite the reported incidence of myopathy and renal toxicity by rosuvastatin in the present era, rosuvastatin holds a major market across the globe. Although the case was successfully treated by withholding rosuvastatin, it added to significant morbidity and health-care costs. Therefore, this case report not only calls for increased pharmacovigilance when prescribing rosuvastatin but also adds to the already existing safety controversies surrounding this drug.

Background: Recent research has increased amount of evidence for heart disease associated with cirrhosis, which has led to the definition of the entity cirrhotic cardiomyopathy. The present study was conducted with an objective to evaluate the clinical, biochemical, and echocardiographic evaluation of patients presenting with cirrhosis and to find its correlation between the severity of cirrhosis and cardiac dysfunction. Materials and Methods: The present study was a case–control study conducted from July 2021 to September 2022. All the cases were examined using two-dimensional echocardiography, electrocardiogram, and other laboratory parameters. The Model for End-stage Liver Disease (MELD) score was calculated for each of the cases. Results: Alcohol ingestion was the most common (76%) etiological factor associated with cirrhosis. There was a significant difference between the QTc interval among cases and controls and among the MELD score group. A significant difference was observed in the left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), interventricular septal thickness (IVST), left atrial diameter, cardiac output (CO), E (Peak velocity flow in early diastole)/A (peak velocity flow in late diastole), E (Peak velocity in early diastole)/e'(passive left ventricular filling during early diastole), and deceleration time among the cases and controls. Conclusion: Based on our results, we conclude that liver cirrhosis cases revealed increased cardiac dysfunction with an increase in the MELD severity, particularly involving left ventricular diastolic dysfunction. Cirrhotic patients presented with increased CO and decreased E/A ratio. With increasing MELD score, there was a significant increase in the LVESD, LVEDD, IVST, and CO and a decreased E/A ratio.

Background and Aim: Spinal anaesthesia-induced hypotension (SAIH) is a frequent side effect of spinal anaesthesia. SAIH is usually observed in patients with hypovolemia. Ultrasonography has evolved as a non-invasive tool for volume status assessment. Methods: This prospective, blinded, observational study was conducted on 75 adult patients who required spinal anaesthesia after receiving ethical approval and registering the study. Ultrasonographic evaluation of the aorta and the inferior vena cava (IVC) was done preoperatively, and the IVC collapsibility index (IVCCI) and caval aorta index were calculated. The incidence of SAIH was recorded. The strength of the association between different parameters and SAIH was calculated. To find out the value of the optimal cut-off for the prediction of SAIH, receiver operating characteristic (ROC) analysis for various ultrasound parameters was done. The bidirectional stepwise selection was utilised for multivariate analysis to choose the single best predictor. Results: SAIH was observed in 36 patients. Among demographic parameters, age, female gender, and height showed a medium correlation. Among ultrasonographic measurements, minimum IVC internal diameter (IVCmin) and IVCCI showed a strong association with SAIH. The best parameter regarding area under the ROC curve (AUC) and diagnostic accuracy was IVCCI (0.828 and 85%, respectively). On multivariate analysis, age (95% CI [1.01, 1.12], P = 0.024) and IVCCI (95% CI [1.05, 1.18], P < 0.001) were significant independent predictors. At a cut-off point of ≥43.5%, IVCCI accurately predicted SAIH (sensitivity 81% and specificity 90%). Conclusion: Preoperative ultrasonographic assessment of IVC to evaluate its collapsibility index is a convenient, cost-effective, and reproducible tool for predicting SAIH.

“Let food be the medicine” (Hippocrates) is a historic quote that became the basis of food science and nutraceuticals. Due to their possible therapeutic advantages, extracts from food have attracted much interest in the medical community. These extracts are abundant in bioactive compounds, which are natural molecules that may be found in various foods and have been demonstrated to affect health positively. Food components have lots of bioactive components, including primary and secondary metabolites and nutritional components, for example, carbohydrates, proteins, vitamins, minerals, fatty acids, antioxidants, phenolics, and flavonoids. This study’s primary focus is on the make-up and purpose of these bioactive components found in food extracts. This review aims to give readers a thorough grasp of the bioactive substances found in food extracts and their possible physiological uses. These bioactive substances’ functional traits, such as their antioxidant, anti-inflammatory, antibacterial, anticancer, and neuroprotective actions, are also studied. Further research is required to create new functional foods, nutraceuticals, and dietary supplements with specific health advantages that can benefit from understanding these molecules’ structure and function.

Madam, cholera is an acute bacterial infection of the intestine caused by the Vibrio cholera bacteria. Cholera spreads via the faecal-oral route and causes severe diarrhoeal infection. According to the World Health Organization, every year, three million to five million cases of cholera appear; among them 100,000-200,000 deaths occur globally [1]. The disease has been associated with seven pandemics in the past. The first pandemic of cholera occurred in 1817 [2]. In the 19th century, an outbreak of cholera in the Ganges delta, in India, led to the spread of cholera across the world. Six subsequent pandemics of cholera have since then killed millions of people. Later, in 1961, 1971, and 1991, outbreaks occurred in South Asia, Africa, and America respectively. Cholera is now endemic in most Southeast Asian countries, including Pakistan. ---Continue

Sarcoidosis causes granulomatous inflammation in multiple organ systems. Lungs are the most commonly affected organs. In 50% of the cases with lung involvement, other organs are also involved. The central nervous system is one of the rarer organ systems involved – comprising 5–15% of all the cases. Neurological involvement, when present, can affect virtually every part of the central and peripheral nervous system. We present an interesting case of a 30-year-old nonalcoholic, nonsmoker man who presented with a chronic headache of 6 years. He had a recent swaying of the body for 6 months and mild forgetfulness for 4 months. The patient had 2 episodes of facial nerve palsy in the past – which had responded to the treatment of Bell’s palsy; however, the patient had some residual findings on presentation. While CSF findings suggested meningeal tuberculosis, the radiological evidence and biopsy confirmed the diagnosis of neurosarcoidosis. On follow-up after 6 weeks of steroid therapy, the patient displayed a marked improvement in headache, cognitive function, and a good response on imaging studies. Our case emphasizes that neurosarcoidosis should be considered in the differential diagnosis of chronic headaches and recurrent facial nerve palsy despite being very rare.

Abstract Isolated vulvar edema is a rare complaint during pregnancy with a long list of differential diagnosis. Here, we describe a case of vulvar edema due to obstructed labor presenting to a rural primary healthcare center in Nepal.

A total of seventy-two bacterial isolates were obtained employing enrichment culture technique from apple orchard soils contaminated with chlorpyrifos. Pure cultures of bacterial isolates were obtained using streak plate method on mineral salt medium. Bacterial isolates were characterized on the basis of morphology, culture and biochemical properties. Six bacterial isolates exhibited high extracellular organophosphorus hydrolase activity along with high tolerance towards high concentrations of chlorpyrifos. Genomic DNA extraction from bacterial isolates was done with phenol/chloroform method. Molecular Diversity of six chlorpyrifos degrading bacterial isolates was done employing RAPD-PCR technique by using 25 decamer primers, where amplification was showed by only 20 primers. A total of 337 amplified bands and 64 unique bands ranging in size from 100 to 4900bps were produced after RAPD analysis. The similarity coefficient estimated by Jaccard’s coefficient for these bacterial isolates was found to range between 31 to 64 percent.

The urban population interact with their environment and change it through the consumption of resources. The changed condition may impact the wellbeing and life nature of the urban population. The uncontrollable growth of urbanization has been reported to be dangerous for mental health and sanity of many citizens. Urban areas whether small or megacities each generate an ecological foot print.The present day urbanization, consequently requires a sustainable development pattern and changes in present day styles of boom to cause them to be more equitable and more resource and energy efficientAs of now, urban administration is to a great extent concentrated on single issues, for example, water, transportation, or waste. A multi scale administration framework that expressly inscribes interconnected asset chains and interconnected spots is essential as a way to transition closer to sustainable urbanizationwhich require, prevention of urban pollution, decreasing production capacity and supporting recycling, while discouraging non-profit development and fading poor and rich differences. . Therefore, the present study was conducted to clarify the effect of urbanization on the environmental quality, resource use and sustainability. The study conducted throughout the globe indicated sustainable urbanization can be achieved by following concept of development wherein natural resources are restored and not replaced by technology.

Abdominal pregnancy is a rare form of ectopic pregnancy where implantation of fertilised ovum occurs in the abdominal cavity. The maternal and foetal mortality is quite high, when it is diagnosed late. The major cause of death in abdominal pregnancy is haemorrhage. This case report is regarding a 31-year-old gravida two woman with 36 weeks of gestation period with Intrauterine Foetal Death (IUFD) and celiac disease. Celiac disease is a chronic malabsorptive disease of the small intestine occurring owing to hypersensitivity to gluten ingestion. Due to chronic malabsorption, the patient presented with calcium deficiency. She also had lesions of dermatitis herpetiformis over the whole body sparing only the face. It is a rare case of advanced abdominal pregnancy with the IUFD, and celiac disease. The patient was managed successfully under general anaesthesia with preparedness for difficult airway management, securing wide bore peripheral cannulas, central venous cannulation, and invasive blood pressure monitoring. Massive haemorrhage intraoperatively was managed using crystalloids, colloids, blood products, and tranexamic acid. The intraoperative period was uneventful. The patient was extubated at the end of the surgery, and followed-up in a high dependency unit.

For the narrow gap dissimilar weld between a ferritic steel and a nickel base superalloy, a nickel base alloy buttering layer is deposited on the ferritic steel side as an intermediate layer. The bonding between the buttering layer and the ferritic steel is required to be inspected from the buttering layer side. The buttering layer exhibits very high elastic anisotropy due to elongated columnar grains with preferred orientations. In this paper, the effect of elastic anisotropy on the phased array ultrasonic imaging of defects in the buttering layer is demonstrated for data acquired in full matrix capture (FMC) mode and reconstructed with the total focusing method (TFM). The anisotropy in the buttering layer leads to distorted flaw images, which limits the lateral resolution and defect detection sensitivity. Angle-dependent ultrasonic velocity measured in through-transmission FMC mode has been used for processing the FMC data to obtain high-resolution TFM images with improved sensitivity. The velocity values used are in line with the grain orientations observed by electron-backscatter diffraction (EBSD) studies. Further, an alternate approach is also proposed to obtain a TFM image with improved resolution using a suitable isotropic velocity. The approach can be implemented in any commercial phased array ultrasonic system having the FMC-TFM feature.

In last few decades, pharmaceutical waste management emerged as one of major environmental concern. These contaminants have shown their severe impact on living being. Several methods for their treatment such as UV degradation, nano-filtration, reverse osmosis and Photocatalysis are being used. Photocatalysis is a favourable and environmentally safe method for remediation of organic pollutants. Photocatalytic oxidation process involves destruction of the organic pollutants in presence of an oxidizing agent like oxygen, light source and the semiconductor photocatalyst. Metal oxides have shown greater capability towards treatment of Pharamaceutically Active Compounds (PhACs). In present review, authors have discussed about diverse metal oxides (TiO2, ZnO, CuO, Fe2O3, Ag2O, WO3, Bi2O3 and Pt), their physical and chemical properties and unique ability to recycle waste water, mechanism of action, applications and their efficiencies along with possible solutions to make them more efficient. Metal oxides do have limitations like faster recombination rate, lower ability for the full usage of light and lesser migration of photo-generated electrons. Therefore, different doping materials, those are metals, non-metals and metalloids can be applied for improving their performances is suggested. In nutshell, it can be concluded that doped metal oxides can be used as potential tools for the treatment of organic pollutants.

Two new N-{[4-(3-aryl-4-sydnonylideneamino)-5-sulfanylidene-1H-1,2,4-triazol-3-yl]methyl}benzamides have been prepared by acid-promoted condensation reactions between 3-aryl-4-formylsydnones and N-[(4-amino-5-sulfanylidene-1H-1,2,4-triazol-3-yl)methyl]benzamide, and both have been crystallized as ethanol monosolvates. N-{[4-(3-Phenyl-4-sydnonylideneamino)-5-sulfanylidene-1H-1,2,4-triazol-3-yl]methyl}benzamide ethanol monosolvate, C19H15N7O3S·C2H6O (I), and N-({4-[3-(4-methylphenyl)-4-sydnonylideneamino]-5-sulfanylidene-1H-1,2,4-triazol-3-yl}methyl)benzamide ethanol monosolvate, C20H17N7O3S·C2H6O (II), differ only in the presence of a methyl group for (II) instead of a hydrogen atom for (I), and in both of them the ethanol component is disordered over two sets of atomic sites having occupancies of 0.836 (6) and 0.164 (6) in (I), and 0.906 (6) and 0.094 (6) in (II). Combinations of O—H...O and N—H...O hydrogen bonds link the molecules into cyclic, centrosymmetric four-molecule aggregates. Comparisons are made with the structures of some related compounds.

Mesenteric ischemia is a fatal vascular emergency of the small intestine which, if not diagnosed and treated in time, has a very high mortality rate. Presenting with nonspecific symptoms such as abdominal pain, nausea, constipation, tachycardia, and gastrointestinal bleeds, it can masquerade as other causes of acute abdomen, particularly bowel obstruction. Ideal laboratory tests and markers are still lacking due to complexity in bowel’s anatomy, physiology, blood supply, and drainage. We report 10 cases of mesenteric ischemia presented in our center with their demography, laboratory findings, approach to diagnosis, and treatment along with their outcomes at discharge. Out of the ten cases, six cases presented with signs and symptoms of acute bowel obstruction without passage of stool and one with passage of black stool. These seven patients underwent laparotomy, while the remaining three cases who either presented with milder symptoms or refused surgical interventions were managed conservatively. All patients were diagnosed with either acute or chronic mesenteric ischemia based on their operative and/or radiographic findings.

Bile duct injury is a complication seen during cholecystectomy. Here, we highlight the occurrence of bile duct injury (BDI) during an open cholecystectomy who underwent hepaticojejunostomy (HJ), later presenting with a stricture of HJ. Percutaneous transhepatic biliary drainage (PTBD) was performed which led to the development of hepatic artery injury.

Introduction: Eighth Joint National Committee (JNC 8) has reclassified earlier prehypertension {Systolic Blood Pressure (SBP) 130-139 mm of Hg and/or Diastolic Blood Pressure (DBP) 80-89 mmHg} as stage 1 HTN. These patients may be at greater risk of perioperative haemodynamic instability, more so in case of laparoscopic surgeries and alpha-2 agonists premedication may be useful in such patients. Aim: To assess perioperative haemodynamic fluctuations in untreated stage 1 hypertension (HTN) patients and the role of Dexmedetomidine (Dexmed) in it. Materials and Methods: This prospective, randomised, double blind study was conducted at Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India from March 2019 to September 2020. Sixty-five patients with stage 1 HTN not on any anti-hypertensive drugs undergoing laparoscopic cholecystectomy were enrolled and randomly divided into group D (dexmedetomidine) and group NS (Normal Saline). Group D received Dexmed 1 µg/kg over 10 minutes before induction, followed by continuous infusion of Dexmed at 0.2 µg/ kg/h and Group NS received similar volume of normal saline. Serial recording of pulse rate, Mean Arterial Pressure (MAP) and oxygen saturation was done. Postoperative sedation scores, extubation time and time to first rescue analgesia were also assessed. For analysis, quantitative variables were expressed as mean±SD and compared using unpaired and paired t-test. Mann-Whitney test was used for quantitative data that did not follow a normal distribution. Qualitative variables were expressed as frequencies/percentages and compared using Chi-square test. A p-value

The primary objective of this study is to establish necessary conditions so that the normalized Fox–Wright functions possess certain geometric properties, such as convexity and pre-starlikeness. In addition, we present a linear operator associated with the Fox–Wright functions and discuss its k-uniform convexity and k-uniform starlikeness. Furthermore, some sufficient conditions were obtained so that this function belongs to the Hardy spaces. The results of this work are presumably new and illustrated by several consequences, remarks, and examples.

Acute liver failure due to yellow phosphorus is common in south India. Patients usually have an early asymptomatic phase and a rapidly progressing symptomatic phase. Early intensive care management can delay the progression to fulminant hepatic failure.Liver transplant is the only definitive management once fulminant hepatic failure sets in.

Nanoparticles and nanomaterials have gained a huge amount of attention in the last decade due to their unique and remarkable properties. Metallic nanoparticles like zinc oxide nanoparticles (ZnONPs) have been used very widely as plant nutrients and in wastewater treatment. Here, ZnONPs were synthesized by using onion peel and characterized by various sophisticated instruments like Fourier transform infrared spectroscopy (FTIR), dynamic light scattering (DLS), and field emission scanning electron microscopes (FESEM). FTIR confirmed ZnONPs synthesis due to the formation of the band in the region of 400–800 cm−1, while FESEM confirmed the spherical shape of the particles whose size varies in the range of 20–80 nm. FTIR revealed several bands from 1000–1800 cm−1 which indicates the capping by the organic molecules on the ZnONPs, which came from onion peel. It also has carbonyl and hydroxyl groups, due to the organic molecules present in the Allium cepa peel waste. The average hydrodynamic size of ZnONPs was 500 nm as confirmed by DLS. The synthesized ZnONPs were then used as a plant nutrient where their effect was evaluated on the growth of Vigna radiate (mung bean) and Triticum aestivum (wheat seeds). The results revealed that the germination and seedling of mung and wheat seeds with ZnONPs were grown better than the control seed. However, seeds of mung and wheat with ZnONPs at median concentration exposure showed an enhancement in percent germination, root, and shoot length in comparison to control. Thus, the effect of ZnONPs has been proved as a nano-based nutrient source for agricultural purposes.

The main objective of this paper is to establish some sufficient conditions so that a class of normalized Mittag–Leffler-type functions satisfies several geometric properties such as starlikeness, convexity, close-to-convexity, and uniform convexity inside the unit disk. Moreover, pre-starlikeness and k-uniform convexity are discussed for these functions. Some sufficient conditions are also derived so that these functions belong to the Hardy spaces Hp and H∞. Furthermore, the inclusion properties of some modified Mittag–Leffler-type functions are discussed. The various results, which are established in this paper, are presumably new, and their importance is illustrated by several interesting consequences and examples. Some potential directions for analogous further research on the subject of the present investigation are indicated in the concluding section.

Software-Defined Networking is gaining popularity in industries as well as in the academic since its inception. Open flow is widely accepted southbound interface and is managed by Open Networking Foundation (ONF). Open flow uses the concept of backup path for packet transmission in the switches so that if primary path fails, it may use backup path without having to pass through controller so that path stability is maintained. But this leads to high miss rate in the lookup table of all the switches of the path in the network and thus adds extra overhead of miss penalty to all the switches in path (encapsulation of the packet and sending the packet to the controller through secure channel for further processing and controller sends the packet back to the switch). This adds extra latency to end delay. In this paper we proposed mixed path where elephant flow uses double (backup) path and mice flow uses single path so as to reduce miss rate in lookup table of the switches and path stability is maintained.

Large urban trees have many benefits. However, falling branches pose a serious hazard to both people and infrastructure. In several tree species, aerial roots grow down from branches to the ground. These roots are capable of thickening to support the branches, lessening the risk of tree failure. Unfortunately, in urban environments most aerial roots die before reaching the ground. Here, we report a new method for encouraging aerial roots to reach the ground, developed by the second-year botany class at UNSW Sydney. Our class tested three experimental treatments on aerial roots of Ficus rubiginosa Desf. ex Vent. (Port Jackson Fig)-PVC pipes filled with sphagnum moss, PVC pipes filled with potting mix, and PVC pipes filled with sphagnum moss and topped with funnels to catch extra rainwater. All three treatments significantly improved aerial root growth, with 26 of the 30 (87%) treatment roots reaching the ground after one year compared to 0 of the 10 control roots. Our method was successful for roots up to 3 m above the ground, suggesting the potential growth rate of aerial roots is substantial when conditions are favourable. Our novel approach is an attractive and cost-effective alternative to slings and other artificial supports. This project is an example of using undergraduate practical classes to teach science while simultaneously addressing important real-world problems.

Successful kidney transplantation offers the best possible quality of life for patients with end stage renal disease (ESRD). Despite this, renal transplantation rates in the developing world are considerably lower than in the developed world. Identified reasons for this include lack of awareness, low education levels, lack of a clear national policy, absence of functional dialysis and transplant units with adequately trained staff, and absence of an organized system of organ retrieval from deceased donors and lack of opportunities to fund long-term immunosuppression. Measures to improve the quality of care should center on improvement of the socioeconomic status of the country. Key action points include the implementation of: (1) Chronic kidney disease (CKD) screening and prevention programs; (2) ESRD and transplantation registries; (3) transplantation legislation, covering both living and deceased organ donation; (4) international and regional collaborations for transfer of knowledge and technology. The government should make transplantation more affordable by strengthening the public sector hospitals and by making the transplant medication more affordable. With the National Organ Transplant Programme (NOTP) in the process of being established in India, the transplant community should strive to increase the organ donation awareness, improve the infrastructure for organ retrieval, storage and allocation in an equitable way.

The distribution of elastic stiffness and damping of individual phases in an α + β titanium alloy (Ti-6Al-4V) measured by using atomic force acoustic microscopy (AFAM) is reported in the present study. The real and imaginary parts of the contact stiffness k* are obtained from the contact-resonance spectra and by using these two quantities, the maps of local elastic stiffness and the damping factor are derived. The evaluation of the data is based on the mass distribution of the cantilever with damped flexural modes. The cantilever dynamics model considering damping, which was proposed recently, has been used for mapping of indentation modulus and damping of different phases in a metallic structural material. The study indicated that in a Ti-6Al-4V alloy the metastable β phase has the minimum modulus and the maximum damping followed by α′- and α-phases. Volume fractions of the individual phases were determined by using a commercial material property evaluation software and were validated by using X-ray diffraction (XRD) and electron back-scatter diffraction (EBSD) studies on one of the heat-treated samples. The volume fractions of the phases and the modulus measured through AFAM are used to derive average modulus of the bulk sample which is correlated with the bulk elastic properties obtained by ultrasonic velocity measurements. The average modulus of the specimens estimated by AFAM technique is found to be within 5% of that obtained by ultrasonic velocity measurements. The effect of heat treatments on the ultrasonic attenuation in the bulk sample could also be understood based on the damping measurements on individual phases using AFAM.