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Abstract A mask identification and social distance monitoring system using Unmanned Aerial Vehicles (UAV) in the outdoors has been proposed for a health establishment. The above approach performed surveillance of the surrounding area using cameras installed in UAVs and internet of things technologies, and the captured images seem useful for tracking the entire environment. However, innate images from unmanned aerial vehicles show an adaptable visual effect in an uncontrolled environment, making face-mask detection and recognition harder. The UAV picture first had to be converted to grayscale, then its contrast was amplified. Image contrast was improved using Optimum Wavelet-Based Masking and the Enhanced Cuckoo Methodology (ECM). According to the contrast-enhanced image, Gabor-Transform (GT) and Stroke Width Transform (SWT) methods are used to derive attributes that help categorise mask-wearers and non-mask-wearers. Using the retrieved attributes, a Weighted Naive Bayes Classification (WNBC) detected masks in the images. Additionally, a deep neural network-based, the faster Region-Based Convolutional Neural Networks (R-CNN) algorithm combined with Adaptive Galactic Swarm Optimization (AGSO) is being used to identify appropriate and incorrect face mask wear in images, as well as to monitor social distancing among individuals in crowded areas. When the system recognises unmasked individuals, it sends their information to the doctor and the nearby police station. One unmanned aerial vehicle’s automated system alert people via speakers, ensuring social spacing. The problem involves a large percentage of appropriate and incorrect face mask wear using data from GitHub and Kaggle, including a training repository of 16,000 images and a testing data set of 12,751 images. To enhance the performance of the model’s learning, the methodology of 10-fold cross-validation will be used. Precision, recall, F1-score, and speed are then measured to determine the efficacy of the suggested approach.

Abstract The traditional methods used in big data, like cluster creation and query-based data extraction, fail to yield accurate results on massive networks. To address such issues, the proposed approach involves using the Hadoop Distributed File System (HDFS) for data processing, the map-reduce programming paradigm for data processing, and query optimization techniques to quickly and effectively extract accurate outcomes from a variety of options with a high processing capacity. The methodology proposed in this work makes use of Gaussian Mixture Model (GMM) for data clustering and the Salp Swarm Algorithm (SSA) for optimization. The security of preprocessed data stored on networked clusters with interconnections has been ensured by SHA algorithms. Finally, incorporating into consideration the important parameters, evaluation findings for the experimental performance of the model in the indicated methodology are produced. For this work, the estimated range of input file sizes is 60–100 MB. The processing of 100 MB of input files yielded an accuracy of 96% and results for specificity and sensitivity of 90% and 93%, respectively. The outcomes have been compared with well-known methods like fuzzy C-means and K-means approaches, and the results show that the proposed method effectively distributes accurate data processing to cluster nodes with low latency. Moreover, it uses the least amount of memory resources possible when operating on functional CPUs. As a result, the proposed approach outperforms existing techniques.

Background: Blood pressure (BP) monitoring is the basic hemodynamic parameter necessary to monitor the hemodynamic changes occurring under general anesthesia (GA) to maintain adequate perfusion to major organs such as the heart, brain, and kidneys. Physicians heavily rely upon peripheral hemodynamic measurements despite availability of devices suitable for measurement of central blood pressure through non-invasive manner paving a gap in the literature concerning the effects of GA on central pressure. Aims and Objective: In this comparative cross-over study, authors have aimed to find out the degree of changes in central and peripheral BP after the introduction of GA among adult patients of different age groups scheduled for routine surgical procedures with an objective to maintain vital functions more precisely – considering the fact that vital organ perfusions (heart, brain etc.,) depend more on the required values of CBP than that of PBP. Material & Methods: Following approval from IEC, sixty adult patients with ASA physical status 1 or 2 undergoing routine surgical procedures under general anesthesia were enrolled in this prospective cross-over study where each patient was case as well control for measurement and comparison of his/her central and peripheral blood pressure. Patients, being divided into three groups as per age range - 20-40 years (Group A), 40-60 years (Group B), and 60-80 years (Group C) had their normal Riva Rocci BP cuff (Space Lab Inc. USA) placed in one arm for peripheral BP measurement and special Riva Rocci (Uscom Ltd., Australia).) BP cuff for on another arm for Central BP measurement. After patient’s arrival into operation theatre, baseline hemodynamic parameters were taken followed by sequential measurements of CBP and PBP with an interval of 2 minutes till 30-40 mins of operation. There were alternative measurements of these pressures with recording of data from either of the devices as mentioned for further comparison and analysis. Results: From baseline values, it was found that all the three groups were comparable in respect of age, height, weight, PBP and CBP. When measured pressure of all groups combined, that there was a fall in both Central and Peripheral SBP as well as DBP after giving intravenous induction agent (propofol) and rise in both central and peripheral SBP and DBP after laryngoscopy and intubation. Degree of systolic blood pressure change in both peripheral & central that is fall of BP in 3rd reading & rise of BP in 5th reading was greatest in group C, followed by group B, then group A [p - 0.005]. While comparing three subgroups, the baseline Augmentation Index (AI) was highest in group C and lowest in group A. Following the administration of general anesthesia (GA), the change in Augmentation Index (ΔAI), was most pronounced in the third reading corresponding to the time after the administration of the induction agent. Conclusion: Measurement of CBP through peripheral placement of cuff is a unique feasible method to detect real changes of circulation with actual pressure in vital organs. Thus, the study suggests that central blood pressure measurements can provide a more accurate reflection of hemodynamic changes during general anesthesia, especially in older individuals or those with different cardiovascular conditions allowing better vital management of body circulation.

Abstract The presence of cracks in concrete structures can lead to corrosion as it exposes the steel reinforcement to environmental factors. When moisture and oxygen reach the steel, corrosion weakens the bond between the steel and the surrounding concrete. This weakening can reduce the load-carrying capacity and, in severe cases, lead to failure. Understanding the relationship between corrosion and bond strength is vital for reinforced concrete structures. This paper investigates the impact of corrosion on bond strength in reinforced concrete structures by examining the bond performance of concrete with both corroded and uncorroded reinforcement bars. The study considers concrete grades M20, M25, and M30, as well as corrosion levels varying from 0 to 20% in intervals of 5%. To conduct the study, cylindrical samples with different levels of corrosion were created using the corrosion acceleration process with the impressed current technique. Pull-out tests were then carried out to determine the bond-slip relationship and the degradation of bond strength due to corrosion. The test results show that lower-grade concrete (M20) experiences a significant decrease in bond strength compared to higher grades (M25 and M30), with M20 showing a 30.7% reduction and M25 showing a 25.8% reduction in bond strength relative to M30 in controlled specimens. The bond stress-slip relationship reveals a non-linear response, with reduced bond stress and slips for all grades of concrete as corrosion levels increase. Additionally, the reduction in bar diameter due to corrosion ranged from 11.3 to 11.6 mm at 5% corrosion and from 9.4 to 9.7 mm at 20% corrosion, significantly impacting the load-carrying capacity of the reinforced concrete structures. These findings underscore the importance of considering concrete grade and corrosion levels when assessing and maintaining bond performance in reinforced concrete structures.

Introduction: Ankylosing Spondylitis (AS) is an inflammatory disorder of unknown cause that primarily affects the axial skeleton, peripheral joints, and extra-articular structures. Typically, the condition starts in the second or third decade. Lower back pain lasting longer than three months, morning stiffness lasting more than 30 minutes, relieved by daily activities, are signs of disease onset. Aim: To establish a correlation between disease severity score Ankylosing Spondylitis Disease Activity Score (ASDAS) and Magnetic Resonance Imaging (MRI) scoring in patients with AS. Materials and Methods: This cross-sectional study was conducted on 66 patients attending the Medicine Emergency/Outpatient Department (OPD)/ward of ESIPGIMSR and ESI Hospital, Basaidarapur, New Delhi, India, who were diagonsed with AS based on the modified New York Criteria. Clinical assessments included ASDAS based on Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP), while MRI disease activity scores were determined using the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI scoring. The sample size was calculated with a coefficient limit of 10% and a confidence level of 95%. Data analysis was performed using Statistical Packages for Social Sciences (SPSS) version 21.0, a widely used statistical computing and graphics tool. Pearson’s correlation coefficients were computed to explore relationships between variables, including age, disease duration, ASDAS-ESR, and MRI changes. Results: In present study, a total of 66 patients were included, out of which 51 (77.3%) were males and 15 (22.7%) were females. The age group of patients included in present study was 33 years to 44 years with a mean of 37.96 years. In present study, the disease duration ranged from a minimum of two years to a maximum of 10 years with a mean of 5.4 years. The mean ASDAS CRP was 3.687 (minimum-2.80, maximum-4.60), and the disease activity as assessed by MRI score (SPARCC) had a minimum value of 8.85 and a maximum value of 26.2 with a mean of 16.359. In present study, the X-ray grading of sacroiliitis revealed that 19.7% of the subjects were classified as Grade-2, 60.6% as Grade-3, and 19.7% as Grade-4. Conclusion: The clinical disease activity index may not always reflect active inflammation, which is detectable by MRI. Incorporating MRI into diagnostic and treatment strategies for AS is crucial for the accurate assessment of disease severity and better patient outcomes.

Abstract The increasing number of private cars, public transportation vehicles, and pedestrians, as well as the absence of adequate space for these ground amenities, are one of the primary causes of traffic congestion and accidents in the Kathmandu Valley. Investigations have indicated that the Kathmandu Valley has the greatest traffic accidents despite the heavy presence of the government and its agencies there. Most teens and young adults suffer injuries while using motor vehicles. The study's primary objective is to foresee and prevent such complications by planning for sufficient subsurface infrastructure (a cut‐and‐cover rectangular tunnel) for the Kathmandu Valley's transportation network. The overlying pressure, lateral earth pressure, live load, uplift pressure, and live surcharge are some of the forces acting on the tunnel, creating unique stress and moment zones. The tunnel meets the following geometric requirements: (a) Each of the tunnel's two cells has a clear span of 10 m and a clear height of 5.5 m. The side walls, inner walls, top slab, and bottom slab are all 700 mm thick. Soil has built up to a height of 4 m over the tunnel's roof. The analytical method is used in the tunnel segment's analysis. Furthermore, the designed tunnel has been evaluated for stability, considering the deflection and shear resistance. The analysis indicates that the tunnel meets the stability requirements. This implies that the structure is capable of withstanding the applied forces without excessive deflection. Non‐linear dynamic time history analyses of the El Centro earthquake and the Gorkha earthquake were computed. From the El Centro earthquake, the maximum displacement was 23.63 mm at 10.59 s, and from the Gorkha earthquake, the maximum displacement was 16 mm at 0.19 s for the modeled structures.

Key Clinical Message An interesting case that shows the importance of identifying a pathogenic TTN gene mutation through genetic assessment in unexplained cardiomyopathy, especially with family history. This case highlights the need for genetic counseling and testing for at‐risk relatives, and advocates for personalized management considering both genetic and lifestyle factors. Abstract This case report examines a 33‐year‐old Hispanic male with bipolar disorder, schizophrenia, and a history of substance use, presenting with acute respiratory failure and cardiac arrest. The patient's nonischemic dilated cardiomyopathy (DCM) highlights the critical role of genetic factors, particularly titin gene (TTN) mutations, in cardiomyopathy pathogenesis. Through genetic analysis, we explore the intersection of lifestyle factors and genetic predisposition in DCM, underscoring the importance of comprehensive genetic testing for accurate diagnosis and targeted therapy. This case contributes to the evolving understanding of DCM etiology, emphasizing the necessity of considering both environmental and genetic factors in clinical assessment and management.

Recent research conducted by Nadler presented the concept of multi-valued contractive signals. There can be only one fixed point for the contraction signal of a complete metric space F into itself, according to the Banach contractions signal concept. Nadler presented a theorem that is very similar to this one for multi-valued contraction signals. Fixed points do occur, therefore multiple-valued contraction signals on two-dimensional metric spaces are studied in this paper. Although we acquired some new conclusions from our investigation, the results obtained are inferior to those obtained by Iseki’s theorems. We investigate the equivalence of the existence of fixed points of single-valued and multi-valued signals for particular classes of signals by proving some equivalence theorems for the completeness of 2-metric spaces. These theorems show that the existence of fixed points for single-valued signals is equivalent to the existence of fixed points for multi-valued signals.

BackgroundThe aim of this study is to compare the diagnostic value of metagenomic next-generation sequencing (mNGS) vs. conventional culture methods (CM) in chronic infection and acute infection.MethodsWe retrospectively analyzed the bronchoalveolar lavage fluid (BALF) of 88 patients with acute infection and 105 patients with chronic infection admitted to three hospitals from 2017 to 2022.ResultsThe results showed that the sensitivity and specificity of mNGS were higher than those of CM. The number of patients who changed the antibiotic treatment in the mNGS positive group was larger than that of patients in the mNGS negative group in both the acute infection group (60.5 vs. 28.0%, P = 0.0022) and chronic infection group (46.2 vs. 22.6%, P = 0.01112). High levels of temperature (OR: 2.02, 95% CI: 1.18–3.70, P: 0.015), C-reactive protein (CRP) (OR: 15, 95% CI: 2.74–280.69, P: 0.011), neutrophil count (OR: 3.09, 95% CI: 1.19–8.43, P: 0.023), and low levels of lymphocyte count (OR: 3.43, 95% CI:1.26–10.21, P: 0.020) may lead to positive mNGS results in the acute infection group while no significant factor was identified to predict positive results in the chronic infection group.ConclusionmNGS could provide useful guidance on antibiotic strategies in infectious diseases and may be more valuable for the diagnosis and treatment of acute infection vs. chronic infection.

Abstract Background With the difficulties in choosing colistin sulfate and polymyxin B sulfate (PBS) for carbapenem-resistant gram-negative bacteria (CR-GNB), we compared the efficacy and safety of these two old polymyxins in treatment of critically ill patients infected with CR-GNB infection. Methods One hundred four patients infected with CR-GNB in ICU were retrospectively grouped by PBS (68 patients) or colistin sulfate (36 patients). Clinical efficacy including symptoms, inflammatory parameters, defervescence, prognosis and microbial efficacy were analyzed. Hepatotoxicity, nephrotoxicity, and hematotoxicity were evaluated by TBiL, ALT, AST, creatinine, and thrombocytes. Results Demographic characteristics between colistin sulfate and PBS were not significantly different. Most of the CR-GNB were cultured in respiratory tract (91.7% vs 86.8%), and almost all were polymyxin-sensitive (98.2% vs 100%, MIC ≤ 2 μg/ml). The microbial efficacy in colistin sulfate (57.1%) was significantly higher than PBS (30.8%) (p = 0.022), however, no significant difference in clinical success was seen in both groups (33.8% vs 41.7%), as well as mortality, defervescence, imaging remission, days in the hospital, microbial reinfections, and prognosis, and almost all patients defervesce within 7 days (95.6% vs 89.5%). Conclusions Both polymyxins can be administrated in critically ill patients infected with CR-GNB and colistin sulfate is superior to PBS in microbial clearance. These results highlight the necessity of identifying CR-GNB patients who may benefit from polymyxin and who are at higher risk of mortality.

In this study, an attempt is made to investigate how the operational parameters such as capacitance, voltage, feed rate, and rotating speed affect the material removal rate, tool wear, overcut, and taper angle for micro-EDM drilling of aluminium 6061 utilizing brass C360 electrode. A novel Taguchi-GRA-CRITIC hybrid optimization methodology is used to obtain the optimal combination of micro-EDM drilling process parameters. The experiment was designed using the Taguchi L18 orthogonal array, and responses were recorded for each experiment. Grey Relational Analysis (GRA) is applied to improve the multi-response of the planned experiment. The weighting values corresponding to various responses are determined using CRITIC (criterion importance through intercriteria correlation) analysis. The hybrid methodology determines the best combination of process parameters for different responses. ANOVA was used to discover the most critical parameters. Finally, confirmation experiments were conducted with optimal parameters to identify improvement in grey relational grade over the initial parameters. The study's findings indicate that, compared to the initial process parameter setting, the grey relational grade (GRG) increased by 92.36% with the optimal parameter setting.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in humans can lead to various degrees of tissue and organ damage, of which cardiovascular system diseases are one of the main manifestations, such as myocarditis, myocardial infarction, and arrhythmia, which threaten the infected population worldwide. These diseases threaten the cardiovascular health of infected populations worldwide. Although the prevalence of coronavirus disease 2019 (COVID-19) has slightly improved with virus mutation and population vaccination, chronic infection, post-infection sequelae, and post-infection severe disease patients still exist, and it is still relevant to study the mechanisms linking COVID-19 to cardiovascular disease (CVD). This article introduces the pathophysiological mechanism of COVID-19-mediated cardiovascular disease and analyzes the mechanism and recent progress of the interaction between SARS-CoV-2 and the cardiovascular system from the roles of angiotensin-converting enzyme 2 (ACE2), cellular and molecular mechanisms, endothelial dysfunction, insulin resistance, iron homeostasis imbalance, and psychosocial factors, respectively. We also discussed the differences and mechanisms involved in cardiovascular system diseases combined with neocoronavirus infection in different populations and provided a theoretical basis for better disease prevention and management.

In recent decades, the epicardial adipose tissue (EAT) has been at the forefront of scientific research because of its diverse role in the pathogenesis of cardiovascular diseases (CVDs). EAT lies between the myocardium and the visceral pericardium. The same microcirculation exists both in the epicardial fat and the myocardium. Under physiological circumstances, EAT serves as cushion and protects coronary arteries and myocardium from violent distortion and impact. In addition, EAT acts as an energy lipid source, thermoregulator, and endocrine organ. Under pathological conditions, EAT dysfunction promotes various CVDs progression in several ways. It seems that various secretions of the epicardial fat are responsible for myocardial metabolic disturbances and, finally, leads to CVDs. Therefore, EAT might be an early predictor of CVDs. Furthermore, different non-invasive imaging techniques have been proposed to identify and assess EAT as an important parameter to stratify the CVD risk. We also present the potential therapeutic possibilities aiming at modifying the function of EAT. This paper aims to provide overview of the potential role of EAT in CVDs, discuss different imaging techniques to assess EAT, and provide potential therapeutic options for EAT. Hence, EAT may represent as a potential predictor and a novel therapeutic target for management of CVDs in the future.

Most patients diagnosed with chronic obstructive pulmonary disease (COPD) present with hallmark features of airway mucus hypersecretion, including cough and expectoration. Airway mucus function as a native immune system of the lung that severs to trap particulate matter and pathogens and allows them to clear from the lung via cough and ciliary transport. Chronic mucus hypersecretion (CMH) is the main factor contributing to the increased risk of morbidity and mortality in specific subsets of COPD patients. It is, therefore, primarily important to develop medications that suppress mucus hypersecretions in these patients. Although there have been some advances in COPD treatment, more work remains to be done to better understand the mechanism underlying airway mucus hypersecretion and seek more effective treatments. This review article discusses the structure and significance of mucus in the lungs focusing on gel-forming mucins and the impacts of CMH in the lungs. Furthermore, we summarize the article with pharmacological and nonpharmacological treatments as well as novel and interventional procedures to control CMH in COPD patients.

Introduction: Sociodemographic factor, awareness of the health effects and legislative law can lead to an increase in cessation of tobacco. Tobacco related knowledge and awareness are found to be better in people working in the health care sector as compared to the general population. The objective of the study was to find the prevalence of quitting rate amongst the health workers and perceived harmful effects on health, tobacco types and awareness of the anti -smoking legislation law in India among the health care workers working in a tertiary care hospital. Methods: A cross-sectional study was conducted among 306 hospital staff (196 housekeeping staff and 110 nursing orderlies) at a tertiary care hospital of Faridabad in 2018. Convenience sampling was conducted, and data were collected through pre tested semi structured questionnaires on sociodemographic details, awareness of ill effects of tobacco and intention to quit. Results: Among 133 current tobacco users, intention to quit smoking was present in only 96 respondents (72.18%). There was association between age, marital status and type of family with the intention to quit. 63 respondents (21%) were unaware that smoking causes lung cancer and 115 (38%) of the total respondents did not consider smokeless tobacco as a causal risk factor for cancer. A total of 180 respondents (58.8%) were not aware of anti-tobacco control laws in India. Moreover, it was found that health concern was commonest reason of intention to quit. Conclusions: Intention to quit tobacco among study participants was low, so there is need to look for knowledge gaps about harms of different types of products and anti-tobacco legislation. More comprehensive tobacco cessation services should also be prioritized in the heath sector. Keywords: awareness of ill effects, COTPA, India, intention to quit, tobacco

Abstract Background The effect of maternal amino acid (AA) infusion before and during cesarean delivery on neonatal temperature remains unknown. We hypothesized that thermogenic effects of AA metabolism would help maintain body temperature of newborn babies and their mothers. Methods Seventy-six parturients scheduled for elective singleton term cesarean delivery were equally randomized to receive intravenous 200 ml of AA or placebo approximately 1 h before subarachnoid block (infusion rate:100 ml/h). The primary outcome was the newborn rectal temperature at 0, 5 and 10 min after birth. The secondary outcomes included the maternal rectal temperature at six time-points: T0 = before starting study solution infusion, T1 = 30 min after starting infusion, T2 = one hour after starting infusion, T3 = during spinal block, T4 = half an hour after spinal block, T5 = at the time of birth and T6 = at the end of infusion, as well as maternal thermal discomfort and shivering episodes. Results There were no differences in newborn temperature between the two groups at any of the time-points (intervention-time-interaction effect, P = 0.206). The newborn temperature (mean [95%CI] °C) at birth was 37.5 [37.43–37.66] in the AA and 37.4 [37.34–37.55] in the placebo group. It showed a significant (P

AbstractAntiphospholipid syndrome (APS) is an autoimmune disease mainly characterised by vascular thrombosis and pregnancy morbidity. APS has broad spectrum of clinical manifestations. The digestive system involvement of antiphospholipid syndrome is a critical but under-recognised condition. Digestive system involvement may be the result of direct (autoimmune-mediated) or indirect (thrombotic) mechanisms. Liver is the most commonly involved organ, followed by intestines, oesophagus, stomach, pancreas and spleen. This review describes possible digestive system manifestations in APS patients, and illustrates the epidemiology and possible pathophysiology of APS. The role of different treatment strategies in the management of digestive system manifestations of APS were also discussed.Key messagesAntiphospholipid syndrome is a multi-organ, multi-system disease and its clinical manifestation spectrum is gradually expanding. Since the first diagnosis of APS, the clinical manifestations of digestive system have been reported successively. This narrative review describes the major digestive system manifestations of APS and illustrates the epidemiology, pathophysiology and the role of therapeutic strategies of these patients.

The coronavirus disease 2019 (COVID-19) is a single-stranded RNA (+) virus and causes infectious disease by the viral strain "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2). Now, COVID-19 has become pandemic, and there are neither potential vaccines nor drugs discovered. Its RNA contains genes for structural (S, E, M, N) and non-structural proteins (PLpro, 3CLpro, RdRp, Hel). Interaction between the S protein of SARS-CoV-2 and the ACE 2 receptor of the host cell plays a vital role in the entry of the virus into the cell. Favipiravir, ribavirin, remdesivir, galidesivir, lopinavir, ritonavir, chloroquine, and hydroxychloroquine are the few effective drugs against SARS-CoV-2. Live attenuated virus (mutant MERS-CoV and SARS-CoV or recombination with another live attenuated virus) can act as vaccine platforms against SARS CoV-2 along with DNA vaccine and subunit vaccine.

Background: With rise in prevalence of conventional risk factors like diabetes, hypertension, smoking, dyslipidemia and obesity the incidence of coronary artery disease in young patients have increased in the recent decades even in developing world. There have been multiple studies done in Nepal studying the angiographic profile of coronary disease in general population. However, only few studies has been done till date on the angiographic profile in the young population in our country. Aims and Objectives: In this study, we aim to determine the angiographic profile of young patient ≤ 40 years in a tertiary care centre of Nepal. Materials and Methods: A retrospective analytic study was done in Shahid Gangalal National Heart Centre from January 2019 to December 2019. Individuals of both genders with age ≤ 40 years who underwent coronary angiography were included. Results: Total 109 patients were included. Out of 109, 89 were male and 20 were female. The mean age for male was 35.55 ± 4.31 and for female was 38.55 ± 1.90 (P = 0.003). Among 61 (55.96%) patients who had significant coronary artery disease, 33 patients (30.27%) with single vessel disease, 15 patients (13.76%) had double vessel disease, and 13 patients (11.92%) had triple vessel disease. Left anterior descending (LAD) artery was found to be most frequently involved in all patterns of Coronary artery disease (CAD). Smoking was the most common coronary risk factor present in 29.3% of patients followed by hypertension, family history of premature CAD and diabetes in 14.6%, 7.5% and 5.5% of patients respectively. Overall, the prevalence of smoking was more in males (31.4%) than in females (20%). Conclusion: Single vessel disease (SVD) was most prevalent in young patients with significant CAD. LAD is the most commonly involved coronary artery followed by Right coronary artery (RCA) and Left Circumflex (LCX).

Herein, we describe the growth and morphology of well-defined dyed crystals of KH2PO4 (potassium dihydrogen orthophosphate; KDP) containing organic azo (sunset yellow; SSY) dye in the {1 0 1} & {0 0 1} pyramidal growth sectors. An understanding on selective dye inclusion in various growth sector of host crystal is proposed, which will help in designing novel tailor-made dyed photonic crystals. The structural analysis and the identification of various functional groups present in as grown KDP crystals were carried out using powder XRD, FTIR and Raman studies. Solid state transmittance spectra for dyed KDP crystals displayed three absorption peaks at 230 nm, 311 nm and 477 nm, which were blue shifted for SSY dye in KDP crystal relative to neutral aqueous solution of SSY dye. These blue shifts in the absorption maxima confirm the successful incorporation of sunset yellow dye into the pyramidal growth sectors of dyed KDP crystals. The band around 409 nm in the photoluminescence emission spectrum indicates a violet emission. SSY dye doped KDP crystals showed enhanced dielectric properties and thermal stability as compared to pure KDP crystal. The mechanical strength of the KDP crystals estimated using Vickers microhardness test was found to decrease with the increase in SSY dye doping.

Ferroelectric single crystals of 0.64Pb(Mg1/3Nb2/3)O3-0.36PbTiO3 (PMN-PT), which have attracted lot of attention because of its excellent ferroelectric and piezoelectric response, has been successfully grown in the vicinity of morphotropic phase boundary, using high temperature solution method with PbO/B2O3 as flux. The crystals were characterized for its dielectric, ferroelectric, piezoelectric and pyroelectric properties along with the investigation of its domain structure. A high Curie temperature (Tc = 190 °C) was observed in the dielectric study. Well-saturated ferroelectric hysteresis loops with high remanent polarization, good switching and fatigue resistant nature indicated the high ferroelectric quality of the crystals. A high value of piezoelectric coefficient (d33∗ = 1398 pm/V) was obtained from the butterfly loops. True-remanent hysteresis study unveiled the practically usable polarization value, which actually serves as memory component in devices and has never been reported for PMN-PT crystals. Time-dependent compensated hysteresis analysis was carried out to study the resistive-leakage nature of the grown crystals which is also a new study for this system. Weibull statistics was used to analyze the distribution of hardness number and to find the values of critical load for the flux grown PMN-PT crystals which helps to critically analyze materials suitability for device fabrication. Keywords: PMN-PT, Flux growth, True-remanent polarization, Time-dependent compensated hysteresis, Piezoelectricity, Micro-hardness

Single crystals of pure and xylenol orange (XO; C31H32N2O13S) dye doped (0.01, 0.05 and 0.1 mol%) ammonium dihydrogen phosphate (ADP; NH4H2PO4) were grown by slow evaporation method with the vision to improve the properties of pure ammonium dihydrogen phosphate crystal. The theoretical morphology of the grown crystals was drawn using Bravais–Friedel–Donnay–Harker (BFDH) law. The selective nature of xylenol orange dye to selectively stain the particular growth sectors of ADP crystal was studied. The structural analysis of as grown crystals was carried out using powder XRD study. The identification of the functional groups present in the ADP material was done using Fourier transform infrared (FTIR) spectroscopy. The linear optical study on pure and dye doped crystals was carried out using UV–vis–NIR spectroscopy. The optical band gap, extinction coefficient, refractive index and optical conductivity were calculated using the transmittance spectra for all the samples. In photoluminescence studies, the blue emission intensity got quenched and an orange emission at 597 nm was seen as a result of XO doping. The thermal stability and decomposition temperature of ADP crystal were found to decrease as an effect of dye doping. The piezoelectric charge coefficient, SHG conversion efficiency, mechanical strength and wettability were also enhanced as a result of XO dye doping. Keywords: Nonlinear optical materials, Dye-doped crystals, Optical properties, Piezoelectricity, Mechanical properties

The present work reports the growth and characterization of single crystals of pure triglycine sulphate (TGS) and maleic acid doped triglycine sulfate (MA-TGS). Both the crystals were grown by conventional slow evaporation solution technique. The crystal structure, composition and morphology of both pure TGS and MA-TGS crystals were studied using single crystal and powder X-ray diffraction, scanning electron microscope, and CHNS analysis. The results revealed monoclinic crystal system for both the crystals with space group P21. Thermal stability and melting point of the grown crystals were determined by employing thermogravimetric and differential thermal analysis (TG-DTA) technique. The dielectric study showed an increase in Curie temperature along with a decrease in maximum permittivity due to MA doping. Enhanced piezoelectric, ferroelectric and mechanical properties were obtained for the doped crystal. The value of piezoelectric charge coefficient, d22 was estimated from ‘Displacement-Voltage (D-V)’ butterfly curves and was observed to increase from 56.23 pm/V for pure TGS single crystal to 72.02 pm/V for MA-TGS single crystal. An increase in the ferroelectric parameters (spontaneous and remanent polarizations) was observed for doped TGS crystal. Also, the value of true-remanent polarization was determined using remanent hysteresis task for MA-TGS crystal. Mechanical stability of grown crystals was examined using the nanoindentation technique and various parameters such as the hardness, stiffness and Young’s modulus were evaluated. Nanoindentation results revealed that both the crystals have a greater capability to withstand deformation caused by applying various loads. However, the mechanical strength of MA-TGS crystal was observed to be better than that of pure TGS crystal. Comparative structural, ferroelectric, piezoelectric and mechanical studies provide useful scientific information of an important class of TGS crystals. Keywords: X-ray diffraction, Dielectric property, Piezoelectric property, Ferroelectric property, Nanoindentation

Nowadays, diabetes and obesity are two main health-threatening metabolic disorders in the world, which increase the risk for many chronic diseases. Apelin, a peptide hormone, exerts its effect by binding with angiotensin II protein J receptor (APJ) and is considered to be linked with diabetes and obesity. Apelin and its receptor are widely present in the body and are involved in many physiological processes, such as glucose and lipid metabolism, homeostasis, endocrine response to stress, and angiogenesis. In this review, we summarize the literatures on the role of the Apelin–APJ system in diabetes and obesity for a better understanding of the mechanism and function of apelin and its receptor in the pathophysiology of diseases that may contribute to the development of new therapies.

Cardiovascular disease (CVD) and cancer are the leading causes of death worldwide. With an increasing number of the elderly population, and early cancer screening and treatment, the number of cancers cases are rising, while the mortality rate is decreasing. However, the number of cancer survivors is increasing yearly. With the prolonged life span of cancer patients, the adverse effects of anti-tumor therapy, especially CVD, have gained enormous attention. The incidence of cardiovascular events such as cardiac injury or cardiovascular toxicity is higher than malignant tumors' recurrence rate. Numerous clinical studies have also shifted their focus from the study of a single disease to the interdisciplinary study of oncology and cardiology. Previous studies have confirmed that anti-tumor therapy can cause CVD. Additionally, the treatment of CVD is also related to the tumors incidence. It is well established that the increased incidence of CVD in cancer patients is probably due to an unmodified unhealthy lifestyle among cancer survivors or cardiotoxicity caused by anti-cancer therapy. Nevertheless, some patients with CVD have a relatively increased cancer risk because CVD and malignant tumors are highly overlapping risk factors, including gender, age, hypertension, diabetes, hyperlipidemia, inflammation, and obesity. With advancements in the diagnosis and treatment, many patients simultaneously suffer from CVD and cancer, and most of them have a poor prognosis. Therefore, clinicians should understand the relationship between CVD and tumors, effectively identify the primary and secondary prevention for these diseases, and follow proper treatment methods.

The magnetic MgFe2O4 nanoparticles (NPs) were fabricated via a facile co-precipitation technique and was comprehensively characterized by XRD, FTIR, SEM, EDX and VSM. The prepared NPs were used as catalyst in presence of ultrasound (US) irradiation to activate persulfate (PS) for generation of sulfate radicals (SO4·-) for boosted degradation of toxic Brilliant Green (BG) dye. Preliminary experiments revealed that highest BG dye degradation efficiency of 91.63% was achieved at MgFe2O4 catalyst dose of 1.0 g/L, PS dose of 300 mg/L, and initial dye concentration of 70 ppm within 15 min of US irradiation. However, only US, US in presence of PS oxidation and US in presence of MgFe2O4 catalyst have shown 20.2%, 83.6% and 45.0% of BG dye removal, respectively. Furthermore, response surface methodology (RSM) based central composite design (CCD) was executed to investigate the effect of interaction between independent variables such as MgFe2O4 catalyst dose (0.5–1.5 g/L), PS dose (150–350 mg/L), initial BG dye concentration (50–150 ppm) and US irradiation time (4–12 min). The RSM based quadratic model was used to predict the experimental data, and the prediction accuracy was confirmed by analysis of variance (R2 = 0.98). The established RSM model has predicted the optimum experimental conditions as MgFe2O4 catalyst dose of 0.75 g/L, PS dose of 300 mg/L, initial dye concentration of 75 ppm and sonication time of 10 min. Subsequently, the treatment cost analysis was performed for all thirty experimental runs of CCD, and the RSM predicted response was found to be evidently optimum as this has delivered best economic condition (140 $/kg of BG removed) with respect to relative dye removal (%). COD removal and residual sulfate analysis have demonstrated satisfactory reduction of COD (90.31%) as well as sulfate ions (42.87 ppm) in the dye solution after treatment. Results of degradation pathway analysis portrayed the transformation of BG molecule (M/Z ratio 385) into simpler fractions with M/Z ratio of 193, 161, 73, and 61. Moreover, the toxicity analysis revealed that sono-catalytically activated PS system has efficiently reduced the toxicity level of BG dye from 93.9% to 5.13%.

Drilling and blasting play a very important role in driving the economy of opencast mines, as various mining activities related to strata handling are dependent on the size of the rock mass created due to blasting. Thus the analysis of fragments created from rock explosion is essential in order to monitor its compatibility with the deployed mining machineries/HEMMs (such as shovel, dumper, dragline, etc.). As over fragmentation as well as under fragmentation both tend to increase the cost of mining, the generation of fragment size in the desired range is necessary. Several factors control the rock fragmentation in blasting, such as the burden, bench height/drilling depth, stemming column, powder factor and hole diameter. The assessment of rock fragmentation with respect to the aforementioned parameters helps to enhance the blast performance and, hence, this study intends to carry out digital image analysis for monitoring the mean fragment size and boulder percentage. A highly consistent result has been obtained using forty blasting datasets carried out in the four different opencast mines of the Talcher Coalfield (India), namely Balram OCP, Ananta OCP, Lakhanpur OCP, and Lajkura OCP. Keywords: Digital image analysis, Rock fragmentation, Bench blasting, Mean fragment size, Boulder percentage

Shital Niwas, presently serving as the “Office of the President of Nepal”, is a 96-year-old palace located at Maharajgunj, Kathmandu. It is a Rana-era building mixing Malla architecture with European Palladian (also called neoclassical) style building with a central courtyard system. It suffered damage during 2015 Gorkha earthquake. The block surrounding the northern courtyard was severely damaged, so after the earthquake it was demolished. Significant part of the building that stands is still operational and accommodates critical functions, thus its seismic safety is important. Initially, damage assessment was conducted and damage grade was assigned as per EMS-98 classification. Low strength of mud mortar masonry, heavy weight of the walls and floors, presence of long unsupported walls under flexible diaphragms, high ratio of openings, and absence of earthquake-resistant features are some of the seismic deficiencies of present building. To reduce seismic risk, existing materials were characterized, the present performance of the building was evaluated and deficiencies were identified. Based on the deficiencies, different intervention options were investigated, and finally retrofitting with steel plates and carbon fiber reinforced polymer (CFRP) bands were selected after detailed analysis and design.

Electrical storm is a life-threatening emergency condition defined as three or more episodes of ventricular tachycardia or ventricular fibrillation (VF) within 24 hours requiring anti-tachycardia therapy, electrical cardioversion, or defibrillation. However, studies of the incidence of electrical storm after chronic total occlusion-percutaneous coronary intervention (CTO-PCI) are limited, 7 and post-procedural VF after revascularization of CTO has not been described. The purpose of this article was to present a case of post-operative VF electrical storm after revascularization of CTO of the left anterior descending (LAD) artery to determine whether the electrical storm was caused by reperfusion arrhythmia or compromise of either branch vessels or the collateral circulation during intervention.

Congenital absence of the right coronary artery (RCA) is a rare coronary anomaly. Few cases of this condition have been reported. Congenital absence of the RCA is considered as a benign anomaly. However, in certain cases, these patients may develop life-threatening clinical complications that include acute myocardial infarction, stroke, or sudden death. We report two patients who were diagnosed with congenital absence of the RCA and presented with acute myocardial infarction. We discuss our experience in diagnosis and treatment of this disease. Congenital absence of the RCA with acute myocardial infarction is an uncommon clinical emergency. Therefore, early detection, correct diagnosis, and appropriate treatment are important.

This report presents a very rare case of fibrous tumour in the pulmonary artery. A 32-year-old male patient presented at the First Hospital of Jilin University with the chief complaint of chest pain accompanied by cough and haemoptysis. Laboratory test results showed a D-dimer level of 60 ng/ml, and protein S activity of 51.0%. Echocardiography and enhanced computed tomography (CT) of the lung revealed a thrombus-like mass in the main pulmonary artery trunk, and the left pulmonary artery and its branches. The patient was initially diagnosed with pulmonary embolism, but after performing arterial endarterectomy, the presence of a tumour in the corresponding areas was confirmed. Histopathology and immunohistochemistry indicated the presence of a malignant solitary fibrous tumour. Chemotherapeutic agents were administered following surgery. The patient was prescribed ongoing oral Apatinib (250 mg, once daily) as a tumour-targeting therapy. The patient refused permission for postoperative CT. The patient was still alive at the 2-year follow-up.

Introduction: Medical thoracoscopy has recently gained renewed interest due to its minimal invasive nature and high yield diagnostic outcome. This study aims to observe diagnostic yield and safety of medical thoracoscopy in undiagnosed exudative pleural effusion. Methods: This is a descriptive cross-sectional study conducted in two tertiary care hospitals in Chitwan from March 2018 to May 2018. Ethical approval from the Institutional Review Board was obtained. Convenient sampling was done that included all the patients who met criteria for undiagnosed exudative pleural effusion after diagnostic thoracocentesis. Patients having contraindication to procedure and who refused consent were excluded. Statistical analysis was performed using IBM SPSS Statistics 20 and data are presented as mean (±SD) and frequency (percentage). Results: A total of 14 patients underwent rigid medical thoracoscopy. All 14 patients had unilateral pleural effusion. The overall diagnostic yield was 100%. Malignancy was the most frequent histopathology diagnosis seen in 11 (78.57%) patients, the commonest being metastatic adenocarcinoma in 8 (57.1%). Pleural tuberculosis and acute-on-chronic pleuritis were seen in 2 (14.3%) and 1 (7.1%) patients, respectively. Pleural deposits and hemorrhagic pleural fluid were the two commonest findings, seen in 10 (70.1%) and 9 (64.3%) patients, respectively. Two (14.3%) patients clinically treated as tuberculous pleural effusion was re-diagnosed to have metastatic adenocarcinoma. Common procedure-related minor complications observed were mild to moderate pain and mild bleeding, observed in 3 (21.4%) and 2 (14.3%) patients, respectively. Conclusions: Medical thoracoscopy is a safe, well-tolerated and high yield procedure in undiagnosed exudative pleural effusion. This art of medicine should be promoted in daily medical practice.

Modularization is one of the key strategies for increasing responsiveness to customers. In modular product architecture a wide variety of product configurations can be generated by altering a limited number of modules and components. Product modules are identified by grouping highly coupled components in the same module. A Design Structure Matrix (DSM) is a compact presentation of the interaction between the components. In this paper, Analytical Hierarchy Process (AHP) and Genetic Algorithm (GA)-based methodology is proposed for the clustering of highly coupled DSM components in modules. Multi-criteria DSMs are proposed, which are aggregated by using weights generated by AHP. A genetic algorithm is designed to change the order of components in DSM and to bring highly coupled interactions near the diagonal. An illustrative case study is also made to validate the proposed algorithm. Two large sized and two small size modules are identified by selecting high density clusters around the diagonal. The clustered DSM also shows independent components and loose coupling between the two modules.

RESUMO EM PORTUGUÊS: O movimento anti Vedanta em Lanjigarh abalou o distrito de Kalahandi, no interior do estado indiano de Odisha. Ele foi um movimento ferozmente combatido (2002-2014) pelos Adivsis (Dongria Kondh) contra o estado de Odisha e VAL, o metal pesado baseado em mineração MNC, licenciado sob a política neoliberal. O projeto havia desalojado 302 famílias adivasis e minou as montanhas de Niyamgiri, às quais os Adivasis estavam ligados para o seu sustento e propósitos religioso-culturais. Os deslocados se mobilizaram em torno de questões de ameaças culturais, ambientais e medidas inadequadas de R&R contra a perda de meios de subsistência e o habitat natural. O artigo analisa empiricamente: (i) as ameaças impostas à identidade Adivasi por este processo de modernização, pondo em risco seus padrões culturais, relações sociais, organizações econômicas e ecossistema primitivo; (ii) os paradoxos inerentes a esse discurso de desenvolvimento baseado no neoliberalismo, a medida em que o estado impõe um determinado modelo de desenvolvimento (ultrapassando o direito dos sujeitos de experimentar o desenvolvimento de forma diferente); (iii) como a sociedade civil orientou o movimento para assegurar a implementação de disposições legais relevantes, tais como o quinto cronograma da constituição, o artigo 244, PESA 1996, FRA 2006 e os Odisha scheduled areas act 1956, para proteger os adivasis. Conclui que o estado está sendo forçado a dividir espaço com a sociedade civil como resultado do neoliberalismo.

Abstract Background Myanmar lies in the Greater Mekong Subregion where there is artemisinin-resistant Plasmodium falciparum malaria. As the artemisinin compound is the pillar of effective antimalarial therapies, containing the spread of artemisinin resistance is a national and global priority. The use of insecticide-treated bed nets/long-lasting insecticidal nets (ITNs/LLINs) is the key intervention for ensuring the reduction of malaria transmission and the spread of resistant strains, and for eventually eliminating malaria. This study aimed at assessing household ownership of, access to, and utilization of bed nets in areas of Myanmar with and without artemisinin resistance containment measures. Methods Secondary data from a nationwide community-based malaria survey conducted by the National Malaria Control Program in 2014 were analyzed. Based on evidence of artemisinin resistance, Myanmar was divided into tiers 1, 2, and 3: townships in tiers 1 and 2 were aggregated as the Myanmar Artemisinin Resistance Containment (MARC) areas and were compared with tier 3 townships, which were defined as non-MARC areas. The chi-square test was used to compare groups, and the level of significance was set at P ≤ 0.05. Results Of the 6328 households assessed, 97.2% in both MARC and non-MARC areas had at least one bed net (any type), but only 63% of households had ITNs/LLINs. Only 44% of households in MARC areas and 24% in non-MARC areas had adequate numbers of ITNs/LLINs (one ITN/LLIN per two persons, P

Background: Fine-needle aspiration cytology (FNAC) is still an important first line diagnostic procedure in developing countries. FNAC of breast lesions is quite specific and sensitive investigation and the results are comparable to histopathology. Aim: To evaluate applicability of parameters of different cytological grading (CG) systems, for aspirates of breast cancers, and its correlation with histopathology grading parameters. Materials and Methods: A cross-sectional observational study was carried out on 30 female patients with ductal carcinoma breast, diagnosed on FNAC and subsequently confirmed histopathologically. The cytological smears were graded using six different cytological parameters/criteria described by Robinson et al. (Robinson grading system) and modified Scarff-Bloom-Richardson (SBR) grading system considering three parameters. The results of cytological grade (CG) were compared with parameters of gold standard modified SBR histological grading (HG) system. Results: Important influential cytological parameters to predict final RBS cytological score came out to be chromatin, nucleoli, nuclear size, cell uniformity, and cell dissociation with statistically significant P value (0.0001) except for mitotic count. The important influential predictor of final SBR histological score is nuclear pleomorphism. Conclusion: SBR HG has good correlation with both RBS and SBR CG systems. The cytological nuclear grade provides important prognostic information which is very sensitive and equally specific hence should be done in breast aspirates and is now replaced by Core Needle biopsy. In developing country like India FNAC of breast aspirates still holds diagnostic value in the classification of breast lesions as compared to core guided image biopsy.

Abstract Background Myanmar lies in the Greater Mekong sub-region of South-East Asia faced with the challenge of emerging resistance to artemisinin combination therapies (ACT). Migrant populations are more likely than others to spread ACT resistance. A vital intervention to reduce malaria transmission, resistance spread and eliminate malaria is the use of bed nets. Among seasonal and stable migrants in an artemisinin resistance containment region of Myanmar, we compared a) their household characteristics, b) contact with health workers and information material, and c) household knowledge, access and utilization of bed nets. Methods Secondary data from community-based surveys on 2484 migrant workers (2013 and 2014, Bago Region) were analyzed of which 37% were seasonal migrants. Bed net access and utilization were assessed using a) availability of at least one bed net per household, and b) one bed net per two persons, and c) proportion of household members who slept under abed net during the previous night (Indicator targets = 100%). Results Over 70% of all migrants were from unstable work settings with short transitory stays. Average household size was five (range 1–25) and almost half of all households had children under-five years. Roughly 10 % of migrants were night-time workers. Less than 40% of households had contact with health workers and less than 30% had exposure to information education and communication (IEC) materials, the latter being significantly lower among seasonal migrants. About 70% of households were aware of the importance of insecticide-treated bed-nets/long-lasting insecticidal nets (ITNs/LLINs), but knowledge on insecticide impregnation and retreatment of ITNs was poor (< 10%). Although over 95% of households had access to at least one bed net, the number with one bed net per two persons was grossly inadequate (13% for stable migrants and 9% for seasonal migrants, P = 0.001). About half of all household members slept under a bed net during the previous night. Conclusions This study reveals important short-falls in knowledge, access and utilization of bed nets among migrants in Myanmar. Possible ways forward include frequent distribution campaigns to compensate for short transitory stays, matching household distributions to household size, enhanced information campaigns and introducing legislation to make mosquito repellents available for night-time workers at plantations and farms. Better understanding through qualitative research is also merited.

Aim: This study aims to objectively assess the dentition status in South Indian postmenopausal women and compare the dental health of osteoporotic participants with nonosteoporotic individuals. Materials and Methods: A total of 150 consecutive ambulatory South Indian postmenopausal women (>50 years of age) were assessed for their dental health using an internationally validated scoring system. Bone mineral density (BMD) was assessed using a dual-energy X-ray absorptiometry scanner. Results: About 39% of the participants were found to have osteoporosis and 23% had osteopenia at any site. More than half of them (57%) had poor dental health, and the predominant problems were cavities (43.5%) and loss of teeth (75%). Among 112 women who had tooth loss, the mean tooth loss was 4.8. The mean tooth loss among patients with normal BMD was 1.09 ± 1.2, in osteopenia was 2.1 ± 2, and in osteoporosis was 5.4 ± 2.8 (P < 0.01). The odds of having osteoporosis among the patients with three or more tooth loss were found to be 4.2 (95% confidence interval = 2.4–7.3). Conclusion: Postmenopausal women with osteoporosis had significantly higher number of tooth loss. Tooth loss may thus be used as a surrogate marker to predict osteoporosis.

Solitary fibrous tumours are unusual neoplasms that develop from mesenchymal cells, usually originating from the pleura. A pericardial solitary fibrous tumour is an extremely rare occurrence. We report a 64-year-old woman who presented to the hospital with chief complaints of dyspnoea and abdominal distension. Echocardiography and enhanced computed tomography revealed an intrapericardial tumour with local invasion to the right atrium. Histopathological examination of a biopsy specimen showed a patternless distribution of spindle-shaped cells in a collagen stroma, with a high mitosis rate. Immunohistochemistry was positive for vimentin, CD34, and Bcl-2. The final diagnosis was a pericardial malignant solitary fibrous tumour with right atrial invasion. Surgical resection of the tumour was not performed because of its invasion into the myocardium. We systematically reviewed the literature on cardiac solitary fibrous tumours up to 2019.