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In this endeavor, miniaturized quad-port MIMOMB (multiple-input-multiple-output multi-band) antenna with an overall area of 400 mm2 offering wider-impedance-bandwidth of 8.31GHz-36.14GHz is reported which covers multiple bands including X-band (8.00-12.0 GHz), Ku-band (12.0-18.0 GHz), K-band (18.0-27.0 GHz), partial Ka-band (27.0-40.0 GHz), FR2: n257 (26.50-29.50 GHz), n258 (24.25-27.50) and n261 (27.50-28.35 GHz) is reported for wideband infrastructure. The proposed antenna radiating EM energy is printed on very thin Rogers RTDuroid5880 substrate with thickness 0.254mm. The radiating EM wave patch consists of hexagonal geometry which is etched with a circular-rectangular slot and partial-ground etched by a beveled shape patch for matching of impedance. The conformal capability of the proposed antenna is verified by S-for single-port, dual-port, and proposed four-port antenna. The time-domain analysis confirms the faithful reception of transmitted signals in far-field regions. The diversity performance including ECCMB, DGMB, TARCMB, CCL $_{\mathrm {MB,}}$ and MEGMB is below permissible standard values with a maximum peak gain of 7.17dBi with stable 2-D radiation patterns in principal planes. The Specific-Absorption-RateMB (SAR) analysis is carried out at different operating frequencies in Microwave-Millimeter wave bands with SAR $\le 1.60\text{W}$ /Kg in human phantom tissue and makes it suitable for on-body wireless applications.

Background and Aims: Laparoscopic trans abdominal preperitoneal (TAPP) repair of hernia is one of the most commonly performed surgeries and may cause significant postoperative pain. Among different truncal block techniques, quadratus lumborum (QL) and transversus abdominis plane blocks (TAP) are used during this abdominal surgery. We aimed to investigate whether, bilateral QL block by trans-muscular approach provided better analgesia as compared to posterior TAP block in these patients. Methods: Forty adult patients with American Society of Anesthesiologists physical status I and II, undergoing inguinal hernia repair were randomized to receive either QL or TAP block, with 20 mL of 0.25% ropivacaine bilaterally. The primary objective of the study was to compare the total fentanyl consumption (in μg) within 24 hours postoperatively. The secondary objectives studied were dermatomal spread, quality of recovery at discharge and at 3 months postoperatively. Results: There was a significant reduction in total 24-hour fentanyl consumption (552 ± 229.56 vs 735.5 ± 264 μg, P =0.01) in the QL group, with longer duration of analgesia [282.5 ± 89.9 min group TAP vs. 354.8 ± 107 min QL, (mean difference -72.34,95% confidence interval -135.516 to -9.024), P =0.03], as compared to TAP group. At T8 and T9 dermatomes, greater proportion of patients in the QL group attained analgesia. Quality of Recovery at 24 hours and at 3 months of follow-up were comparable. Conclusion: QL block provided better perioperative analgesia than TAP block, in patients undergoing laparoscopic hernia repair. It also leads to greater dermatomal spread but without any decrease in the incidence of chronic pain at 3 months postoperatively.

Abstract Background Serial lactate measurement is found to predict mortality in septic shock. Majority of patients with perforation peritonitis for emergency laparotomy are in sepsis and mortality rate is substantial. However, lactate dynamics has not been studied in this patient population. Methods After institutional ethics clearance and informed written consent, 113 patients with suspected or proven perforation peritonitis presenting for emergency laparotomy were recruited in this prospective observational trial. Baseline Mannheim peritonitis index (MPI), SOFA and APACHE II score were calculated. Lactate values were obtained at baseline, immediate and 24-h postoperative period. Primary outcome was 28-day mortality. Results Mortality was 15.04% at 28 days. Age, SOFA, qSOFA, APACHE, preoperative lactate, MPI and site of perforation were significantly different between survivors and non-survivors. Arterial lactate values at preoperative (cut off 2.75 mmol/L), immediate postoperative (cut off 2.8 mmol/L) and 24 h-postoperative period (cut off 2.45 mmol/L) independently predicted mortality at day 28. Combination of MPI and 24-h lactate value was best predictor of mortality with AUC 0.99. Conclusion Preoperative, immediate postoperative and 24-h postoperative lactate value independently predict 28-day mortality in perforation peritonitis patients undergoing emergency laparotomy. Combination of MPI and 24-h lactate value is the most accurate predictor of mortality. Trial registration Clinical Trial Registry of India - CTRI/2018/01/011103

Background and Aim: Dairy animals play an important role in the Indian economy. Knowledge of the occurrence pattern of long bone fractures in bovine may help in strategizing the possibilities of treatment and prognosis. This study aimed to find out the comparative occurrence pattern of fractures in cattle and buffaloes. Materials and Methods: A total of 278 fractures of bovine (171 in cattle and 107 in buffaloes), presented to the Department of Veterinary Surgery and Radiology, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab, India, during a study of 1 year, were investigated for the occurrence pattern, in relation to species, age, body weight, gender, bone involved, type of fracture (closed or open), and the presentation of bovine as standing or in recumbent state. Results: The overall hospital occurrence of fractures in bovine was 4.24% and most of the fractures resulted from slipping and falling on hard floor. Of 278 fractures, the majority (90.28%) involved long bones (n=251; 103 buffaloes and 148 cattle). Forelimb fractures were recorded more common in buffaloes (64.08%), whereas the cattle suffered more of hind limb fractures (60.23%). Cattle also included 11 cases of bilateral fractures of metacarpal (n=3), tibia (n=1), radius and ulna (n=1), and mandible (n=6). Fracture of olecranon constituted 6.83% (n=19) and majority (n=15) were in buffaloes. The cattle had higher percent of open fractures (54.38%) as compared to that in buffaloes (17.76%). Marginally higher percentage of cattle (33.33%) suffering from fracture were recumbent as compared to buffaloes (23.36%) and femur fractures were found to be a leading cause of recumbency (100% in cattle and 75.00% in buffaloes). Conclusion: Species-specific differences in the occurrence pattern of fractures exist among cattle and buffaloes. Cattle are found to be more susceptible (1.5 times) to fractures as compared to buffaloes. The buffaloes are vulnerable to forelimb fractures while the cattle to the hind limb. As compared to forelimb, long bone fractures of hind limb are more commonly associated with recumbency in bovine. Cattle are more prone to mandible fractures and the open fractures of long bones as compared to buffaloes.

This paper presents how machine learning techniques may be applied in the process of designing a compact dual-band H-shaped rectangular microstrip antenna (RMSA) operating in 0.75–2.20 GHz and 3.0–3.44 GHz frequency ranges. In the design process, the same dimensions of upper and lower notches are incorporated, with the centered position right in the middle. Notch length and width are verified for investigating the antenna. An artificial neural network (ANN) model is developed from the simulated dataset, and is used for shape prediction. The same dataset is used to create a mathematical model as well. The predicted outcome is compared and it is determined that the model relying on ANN offers better results

Context: Dexmedetomidine is being increasingly used in nerve blocks. However, there are only a few dose determination studies. Aims: To compare two doses of dexmedetomidine, in femoral nerve block, for postoperative analgesia after total knee arthroplasty (TKA). Settings and Design: A prospective, randomized, controlled trial was conducted in the Department of Anesthesia at AIIMS, a Tertiary Care Hospital. Materials and Methods: Sixty American Society of Anesthesiologists I–II patients undergoing TKA under subarachnoid block were randomized to three Groups A, B, and C. Control Group A received 20 ml (0.25%) of bupivacaine in femoral nerve block. Groups B and C received 1 and 2 μg/kg dexmedetomidine along with bupivacaine for the block, respectively. Outcomes measured were analgesic efficacy measured in terms of visual analog scale (VAS) score at rest and passive motion, duration of postoperative analgesia, and postoperative morphine consumption. Adverse effects of dexmedetomidine were also studied. Statistical Analysis Used: All qualitative data were analyzed using Chi-square test and VAS scores using Kruskal–Wallis test. Comparison of patient-controlled analgesia (PCA) morphine consumption and time to first use of PCA were done using ANOVA followed by Least Significant Difference test. A P < 0.05 was considered statistically significant. Results: The VAS score at rest was significantly lower in Group C compared to Groups A and B (P < 0.05). There was no difference in VAS score at motion between Groups B and C. The mean duration of analgesia was significantly longer in Group C (6.66 h) compared to Groups A (4.55 h) and B (5.70 h). Postoperative mean morphine consumption was significantly lower in Group C (22.85 mg) compared to Group A (32.15 mg) but was comparable to Group B (27.05 mg). There was no significant difference in adverse effects between the groups. Conclusion: The use of dexmedetomidine at 2 μg/kg dose in femoral nerve block is superior to 1 μg/kg for providing analgesia after TKA, although its role in facilitating early ambulation needs further evaluation.

Background and Aims: Three-in-one and femoral nerve blocks are proven modalities for postoperative analgesia following anterior cruciate ligament (ACL) reconstruction. The aim of this study was to evaluate the efficacy of magnesium (Mg) as an adjuvant to bupivacaine in 3-in-1 block for ACL reconstruction. Methods: Sixty patients undergoing arthroscopic ACL reconstruction were randomly allocated to Group I (3-in-1 block with 30 ml of 0.25% bupivacaine preceded by 1.5 ml of intravenous [IV] saline), Group II (3-in-1 block with 30 ml of 0.25% bupivacaine preceded by 1.5 ml of solution containing 150 mg Mg IV) or Group III (3-in-1 block with 30 ml containing 0.25% bupivacaine and 150 mg of Mg as adjuvant preceded by 1.5 ml of IV saline). Post-operatively, patients received morphine when visual analogue scale (VAS) score was ≥4. Quantitative parameters were compared using one-way ANOVA and Kruskal–Wallis test and qualitative data were analysed using Chi-square test. Results: Demographics, haemodynamic parameters, intra-operative fentanyl requirement, post-operative VAS scores and total morphine requirement were comparable between groups. Time to first analgesic requirement was significantly prolonged in Group III (789 ± 436) min compared to Group I (466 ± 290 min) and Group II (519 ± 274 min), (P = 0.02 and 0.05). Significantly less number of patients in Group III (1/20) received morphine in the first 6 h post-operatively, compared to Group I (8/20) and Group II (6/20) (P = 0.008 and 0.03). No side effects were observed. Conclusion: Mg as an adjuvant to bupivacaine in 3-in-1 block for ACL reconstruction significantly prolongs the time to first analgesic requirement and reduces the number of patients requiring morphine in the immediate post-operative period.

Here we report the comprehensive characterization of the secondary metabolites from the leaves of Colebrookea oppositifolia Smith, a species used as medicinal plant in the traditional medicine of Nepal. Phytochemical screening of bioactives was performed using an integrated LC-MSn and high resolution MS (Mass Spectrometry) approach. Forty-three compounds were tentatively identified, mainly aglyconic and glycosilated flavonoids and phenolic acids, as well as other bioactives such as coumarins and terpenes were detected. Furthermore, the NF-κB and AP-1 inhibitory activity of C. oppositifolia extract were evaluated, as well as its cytotoxicity against THP-1 cells, in order to assess the potential use of this herb as a source of anti-inflammatory and cytotoxic compounds. The results so far obtained indicate that C. oppositifolia leaves extract could significantly reduce the viability of THP-1 cells (IC50 = 6.2 ± 1.2 µg/mL), as well as the activation of both NF-κB and AP-1 at the concentration of 2 μg/mL. Our results indicate that Nepalese C. oppositifolia is a valuable source of anti-inflammatory and cytotoxic compounds. The phytochemical composition reported here can partially justify the traditional uses of C. oppositifolia in Nepal, especially in the treatment of inflammatory diseases, although further research will be needed to assess the full potential of this species.

Blue rubber bleb nevus syndrome (BRBNS) is a rare hereditary disease manifested by multiple vascular malformations involving skin, mucosa and musculoskeletal system. Available literature consists of mainly airway management of such patients. We describe the perioperative anaesthetic management of a child of BBRNS with gastrointestinal bleeding disorder scheduled for resection of multiple nevi and discuss the relevant anaesthetic concerns.

Background and Aims: The role of clonidine as an adjuvant to regional blocks to hasten the onset of the local anesthetics or prolong their duration of action is proven. The efficacy of dexamethasone compared to clonidine as an adjuvant is not known. We aimed to compare the efficacy of dexamethasone versus clonidine as an adjuvant to 1.5% lignocaine with adrenaline in infraclavicular brachial plexus block for upper limb surgeries. Material and Methods: Fifty three American Society of Anaesthesiologists-I and II patients aged 18-60 years scheduled for upper limb surgery were randomized to three groups to receive 1.5% lignocaine with 1:200,000 adrenaline and the study drugs. Group S (n = 13) received normal saline, group D (n = 20) received dexamethasone and group C (n = 20) received clonidine. The time to onset and peak effect, duration of the block (sensory and motor) and postoperative analgesia requirement were recorded. Chi-square and ANOVA test were used for categorical and continuous variables respectively and Bonferroni or post-hoc test for multiple comparisons. P < 0.05 was considered significant. Results: The three groups were comparable in terms of time to onset and peak action of motor and sensory block, postoperative analgesic requirements and pain scores. 90% of the blocks were successful in group C compared to only 60% in group D (P = 0.028). The duration of sensory and motor block in group S, D and C were 217.73 ± 61.41 min, 335.83 ± 97.18 min and 304.72 ± 139.79 min and 205.91 ± 70.1 min, 289.58 ± 78.37 min and 232.5 ± 74.2 min respectively. There was significant prolongation of sensory and motor block in group D as compared to group S (P < 0.5). Time to first analgesic requirement was significantly more in groups C and D as compared with group S (P < 0.5). Clinically significant complications were absent. Conclusions: We conclude that clonidine is more efficacious than dexamethasone as an adjuvant to 1.5% lignocaine in brachial plexus blocks.

Maternal connective tissue disorders such as Systemic Lupus Erythematosus (most common), Sjogren′s syndrome, mixed connective tissue disorders may lead to the rare condition of complete congenital heart block in the neonate. Rare fetal syndromes such as myocarditis, 18p syndrome, mucopolysaccharidoses and mitochondrial diseases are other causes. The mortality rate of this condition is inversely propotional to the age of presentation being 6 % in the neonatal age group. As the cardiac output in the neonate is heart rate dependent, it is crucial to maintain the heart rate in these patients. Pharamacological interventions with dopamine, isoprenaline, epinephrine and atropine are known for their variable response. Although permanent pacing is the most reliable mode of management, the access to it is often not readily available, especially in the developing countries. In such cases temporary pacing methods become lifesaving. Of all the modalities of temporary pacing (transcutaneous, transesophageal and transvenous) transcutaneous pacing is the most readily available and immediate mode. In this case report we present a two day old neonate with isolated complete congenital heart block and a resting heart rate of 50-55/min in immediate need of palliative surgery for trachea-esophageal fistula (TEF). With pharmacological intervention the heart rate could only be raised to 75-80/min. The surgery was successfully carried out using transcutaneous pacing to maintain a heart rate of 100/min.

Phaeochromocytoma is a rare cause of hypertension during pregnancy with potentially fatal consequences. If not detected and treated early in pregnancy, it is catastrophic for both the mother and the baby. Management requires close co-ordination between the obstetrician, anaesthesiologist, paediatrician and the endocrinologist. Perioperative management for an emergency caesarean section in a parturient with untreated phaeochromocytoma is an anaesthetic challenge and no standard recommendations have been reported till date. In this case report, we present anaesthetic management in such a case with successful maternal and foetal outcome.

Pregnant patients with kyphoscoliosis present a unique challenge during their anesthetic management due to the physiologic changes of pregnancy and deformity of the spine leading to pulmonary abnormalities. We present a case report of a 29-year-old second gravida with kyphoscoliosis who successfully underwent elective caesarean section under repeat spinal block after failure of first spinal anesthesia.

Micro and small businesses in rural and tribal communities are crucial drivers of sustainable economic development, playing a significant role in addressing various global challenges such as poverty reduction, job creation, resiliency and economic development. In spite of their crucial role in the national economy, small enterprises often encounter numerous challenges and constraints that can hinder their development, growth and overall performance. The present study is aimed at assessing the major problems faced by micro and small entrepreneurs among the tribal communities in the hill districts of Manipur. This empirical study is descriptive in nature and uses both primary and secondary data. The primary data were collected from 311 registered entrepreneurs using a well-structured questionnaire. The percentage technique, mean, standard deviation, t -test and analysis of variance (ANOVA) test were used to analyse the data with the aid of SPSS. There is no significant difference in the major problems faced by entrepreneurs across gender. However, labour problems were different across levels of educational background, and there was a significant difference between the nature of industry and the infrastructural problems faced by micro and small entrepreneurs. The study suggests coordinating the efforts of the government and aiding organisations in assisting the entrepreneurs to tackle the multifaceted challenges. [ABSTRACT FROM AUTHOR]

An L-strip proximity coupled circular microstrip antenna is proposed. The structure is investigated using circuit theoretic approach and simulated using IE3D simulation software. The patch is designed on a thick substrate of thickness of 11 mm for a design frequency of 3.74 GHz and provides ultra wide band operation. The numerical results for input impedance, VSWR, radiation pattern, efficiency and gain are presented. Bandwidth is found to be dependent on length of horizontal part of L-strip. A bandwidth of 69.52% is achieved (for VSWR