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Manal M Khan, Ved Prakash Rao Cheruvu, Deepak Krishna, Reena Minz, Michael Laitonjam, Rishabh Joshi Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, IndiaCorrespondence: Ved Prakash Rao CheruvuDepartment of Burns and Plastic Surgery, All India Institute of Medical Sciences, 1st Floor, Hospital Building, Saket Nagar, Bhopal, Madhya Pradesh 462020, IndiaTel +91 8872209777Email vedprakash.plasticsurg@aiimsbhopal.edu.inPurpose: To analyze the demographic, clinical, and microbiological profile of patients presenting to our unit with chronic wounds of various etiologies with an intent to give a current overview of chronic wounds.Patients and Methods: We performed a prospective observational study of patients presenting with chronic wounds from October 2018 to September 2019. The study was conducted at the Department of Burns and Plastic Surgery of a tertiary care institute in a non-metropolitan city in Central India. A total of 103 patients were included in the study. Data collected from the patients included demographic details, history, clinical features, and relevant laboratory reports. Wound swabs obtained by Levine’s technique were sent for culture and sensitivity studies. Treatment was instituted according to the clinical picture and modified if necessary. Progress was monitored until the wound healed, either by conservative management or by surgical intervention. Patients were followed up for six months thereafter.Results: Most of the patients presented with lower limb wounds (n=81, 78.64%). Swab specimens from 103 wounds were cultured. Among the isolates, gram-negative organisms were more common than gram-positive organisms. Staphylococcus aureus was the most common species isolated, followed by Pseudomonas aeruginosa. The frequency of infections caused by other gram-negative organisms like Klebsiella pneumoniae, Escherichia coli, and Proteus mirabilis was on the rise. There were significant differences in the patterns of antimicrobial resistance in our patients. Sharp debridements were required in almost all cases for wound preparation. Most of the patients (n=74, 71.84%) underwent surgical intervention for achieving wound closure. Split-thickness skin grafting (STSG) was the most common surgical intervention performed (n=45, 43.68% patients), followed by local and distant flaps.Conclusion: Our study gives a current overview of the causes, clinical presentation, prevalent microbial flora, and their antibiotic susceptibilities prevalent in chronic wounds presenting to our unit. Treatments administered are discussed with emphasis on the different reconstructions performed.Keywords: anti-bacterial agents, biofilms, drug resistance, multiple bacterial, Pseudomonas aeruginosa, Staphylococcus aureus, wound healing

Photovoltaic technology, a rising renewable energy source, relies heavily on irradiation and temperature for performance. Defects like shading, hot spots, and soiling can disrupt the current–voltage curve, challenging inverters to operate at maximum power point (MPP). Indirect measurement and real-time loss detection methods are essential due to the inaccessibility of PV cell circuits. The conventional methods of performance measurement consider the performance based on standard test conditions. The main focus of the present work is to develop a novel performance ratio, which captures real-time efficiency involved in Solar farm operations using data-driven methodologies. The major contributions of this work are: Monitoring health and performance of solar farms by collecting 8 months of SCADA data using IEC standard 61724; Developing a data-driven model to predict ideal I-V curve and MPP at each transient state in the absence of panel-level data; Developing a new performance ratio which provides insights into the transient operational state of the inverter and the deviation of real-time data from the MPP. The results reveal the interplay of different inverters and the evolving overall performance of solar farm over time. This underscores necessity for maintenance and highlights the potential for enhancing solar farm’s output.

Aim: This study was designed to enumerate regulatory T‑cells (Tregs) and estimate transforming growth factor‑β1 (TGF‑β1) levels in type 1 diabetic (T1D) patients with respect to disease duration and associated autoimmune diseases. Methods: One hundred and fifty patients and twenty healthy controls were recruited in the study. The patients were subcategorized into eight categories on the basis of disease duration (new onset [NO] and long standing [LS]) and associated diseases, i.e., celiac disease (CD) and autoimmune thyroid disease (AiTD). Treg cells were assessed as CD4+ CD25hi+, FOXP3+ cells and serum TGF‑β1 levels were assessed by ELISA. Results: The frequency of Tregs and levels of TGF‑β1 were significantly increased in the patients compared to the healthy controls. Among the different categories of the patients, no significant differences were seen for TGF- β1 levels, but for Tregs in patients with T1D and AiTD (P = 0.035). A significant correlation was also found between percentage count of Tregs and TGF‑β1 levels in NO cases in all disease subcategories, but not in LS patients. Conclusion: Thus, there was an increased percentage of Tregs and serum levels of TGF‑β1 in T1D patients, irrespective of the disease duration and associated autoimmune diseases. The significant correlation in these two parameters at the onset of the disease, but not in LS disease, indicates that the immunological milieu in LS autoimmune diseases is more complicated with disease‑associated conditions such as prolonged hyperglycemia, insulin therapy, and/or continued gluten in diet. Treatment and modulation of these long‑term complications for improving immunological parameters require further research. [ABSTRACT FROM AUTHOR]

Anti-glomerular basement (anti-GBM) disease is an uncommon disorder with a bimodal age of presentation. Patients presenting with dialysis-dependent renal failure have poor renal outcomes. There is limited data regarding the clinical presentation and outcomes of anti-GBM disease from India. We conducted this prospective study to analyze the clinical presentation and outcomes of anti-GBM disease at a large tertiary care hospital in North India over 1 1/2 years. Subjects with a biopsy proven anti-GBM disease (light microscopic examination showing crescents and immunofluorescence examination showing linear deposition of IgG) with or without positive anti-GBM antibodies in serum were included in the study and followed-up for at least 12 months. All the patients were treated with steroids, cyclophosphamide, and plasma exchange. A total of 17 patients (nine males) were included. The mean age at presentation was 39.11 ± 16.58 (range 11-72) years. Twelve patients (70%) presented with rapidly progressive glomerulonephritis (RPGN), 4 (23.5%) presented with Goodpasture syndrome, while 1 (5.8%) had nephritic syndrome, 7 (41%) were hypertensive, and 14 (82.3%) required dialysis at the time of presentation. Four patients (23.5%) had associated anti-neutrophil cytoplasmic antibody positivity (anti-myeloperoxidase antibodies in all). Fourteen (87.5%) patients had crescentic glomerulonephritis, while 5 (31.25%) showed necrotizing (n = 4) or granulomatous (n = 1) in the vasculitis. Of 16 patients who received treatment, four (23.25%) achieved complete remission. In this single-center study, the majority of anti-GBM disease patients presented with RPGN and had crescentic glomerulonephritis on biopsy with poor treatment outcome. [ABSTRACT FROM AUTHOR]