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Background: Urinary tract infection (UTI) is defined as growth of micro-organisms >105 CFU/ml in mid-stream urine samples. [1] Globally, urinary tract infection is considered a major public health concern with the second most common bacterial infection affecting individuals of different ages. It is estimated that worldwide 150 million cases of UTI occur per year and bacteria are responsible for about 95% of all the cases with each year. [3, 4] This study was designed to describe the pattern of microorganisms causing UTI and their antibiotic sensitivity. Materials and Methods: This is a hospital based cross-sectional study conducted in the Department of Microbiology from January 2022 to June 2022 after taking ethical approval from Institutional Review Committee, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. The patient profiles or records visiting a tertiary care hospital of both sex and every age group who were having symptoms and clinical diagnosis of urinary tract infection were included. Results: A total of 2247 urine samples were collected, 501(22.29%) of the urine sample yielded significant growth of uropathogenes. The most common bacteria was found to be Escherichia coli (E. coli) that accounts for 73.05% followed by Enterococcus species 11.57%, Klebsiella pneumoniae 8.98% and amikacin and nitrofurantoin was found to be the most sensitive antibiotic to gram negative uropathogens. Conclusion: The prevalence of uropathogenes was found to be higher in our study. Significant bacteriuria was seen in the female than male. The total number of patient with culture positivity was higher in younger age groups with high frequency of antibiotic resistance

The present study aims to investigate the use of response surface methodology (RSM) modelling and experimental investigation for the optimization of lead(II) adsorption onto spent tea grains (STG). Independent process variables were optimized and found to be in the range of 38.75 mg/l (initial concentration), 5.20655 (pH), 119.32 rpm (stirring speed), and 3.25 g/l (STG dose) for a contact time of 135.05 min. The optimum adsorption capacity was found to be 8.9087 mg/g through RSM modelling with a maximum of 18.146 mg/g. The batch study was performed by varying different parameters: pH (2.0–7.0), initial concentration (5–50 mg/l), dose (0.1–1 g/100 ml), contact time (15–180 min), and stirring speed (30–200 rpm). The characterization STG was done by proximate and ultimate analysis, FTIR spectroscopy, XRD analysis, thermogravimetric analysis (TGA), and SEM-EDX. By fitting equilibrium data onto Langmuir isotherm model, the maximum adsorption capacity was found to be 24.272 mg/g. The optimum pH found for lead(II) adsorption onto STG was 5. At optimum conditions, the maximum removal efficiency of STG for lead(II) ions’ adsorption is 94.33%. Based on the findings it is safe to conclude that the STG could be used as a potential adsorbent. HIGHLIGHTS Agricultural waste converted into low-cost adsorbent.; Removal efficiency and uptake capacity of lead(II) ions onto prepared adsorbent STG shows great potential.; A detailed study was done using RSM modelling and various batch experimentation to find optimum values of parameters influencing adsorption.; The present study can be used for developing sustainable treatment technology using STG as an alternative to activated carbon currently used.;

Rice followed by wheat is the dominant cropping system in the middle Indo-Gangetic plains (IGP). Lower productivity (4.8 t ha−1) of this cropping system in Bihar, compared to the national average (6.8 t ha−1) due to several climate- and production-related issues, is a matter of concern for the farmers and the policymakers. Keeping all these in view, an experiment with rice–wheat cropping system was carried out during 2020–21 and 2021–22 in 17 adopted villages of 13 districts of Bihar under the Project “Climate Resilient Agriculture Program (CRAP)” to evaluate the feasibility of early transplanting of rice in the month of June with the aim of achieving higher system productivity by early harvesting of rice and subsequent timely sowing of wheat before 15 November with the provision of assured irrigation. In this study, the concept of an innovative community irrigation approach and single-phase 3-hp submersible pump was employed. Long-duration rice variety (150 days) Rajendra Mahsuri-1 was sown during 20–25 May in the nursery and transplanted through puddling operation during 15–20 June in 17 locations. Under delayed conditions, the nursery sowing and transplanting window were 10–15 June and 10–15 July, respectively. Timely sown rice grown with the provision of a community irrigation system achieved a grain yield of 5.2 t ha−1 and 85.8% higher water productivity, compared to late-sown crops. Following the harvest of rice, the HD-2967 variety of wheat was planted in the first fortnight of November and harvested in the first week of April, yielding 4.9 t ha−1 with the application of 2–3 irrigations based on soil type and evaporative demand. Timely harvesting of wheat facilitated farmers of the region to take an additional crop of summer green gram. With an assured irrigation system and shifting planting dates and thereby managing climatic risks, the overall productivity of the rice–wheat cropping system was achieved to the tune of 10.1 t ha−1 with a cropping intensity of 300% for better adaptation and sustainable production.

Pediatric critical care is highly sophisticated and precise and is possible only in specialized areas such as pediatric intensive care units (PICUs) or high dependency units equipped with round-the-clock monitoring facilities, skilled and trained staff, and treatment equipment. The need for critical care beds was sharply felt during the COVID-19 pandemic and the Government of India launched the COVID-19 emergency response and health system preparedness package: phase II (ECRP-II) with a hub and spoke model to strengthen pediatric critical care delivery at district level under the skilled supervision of state-level PICUs of the identified center of excellence (CoE). The CoEs will have well-equipped PICUs providing tele-ICU service, mentoring, and technical hand-holding to the district pediatric unit. This model was envisioned to be extended to critically ill children with nonCOVID illnesses after the pandemic abates. For achieving the proposed objectives under the ECRP-II scheme, this guideline aims to provide a practical framework for setting up comprehensive pediatric care units at district hospitals and medical colleges (spoke) well connected with a CoE (hub) for teleconsultation, knowledge exchange, referral, and back referral between hub and spokes.

Anthropogenic deterioration of streams and rivers has affected their surface-subsurface linkages. This has led to the degradation of hyporheic zones, a sensitive interface between a stream channel and its surrounding sediments, responsible for transforming pollutants, natural solutes and supporting benthic communities. Several authors have reported the influence of stream restoration measures on hyporheic exchanges and have called for the inclusion of hyporheic zone restorations in stream management. Engineered Hyporheic Zones (EHZ) are the creation of artificial transition areas due to induced hyporheic flows, brought about by some feature modifications done to the stream channel or its subsurface. These feature modifications and their implications have been investigated through lab experiments, outdoor flumes, modelling and field studies for several years. This paper attempts to summarize the endeavours made in the study of EHZ and its applications in water quality improvement and habitat restoration. A comprehensive review of up-to-date literature with specific focus on the influence of engineered structures on hyporheic exchanges is presented, followed by the comparison of preferences opted for different studies and their limitations. The paper ends with suggestive future scope in EHZ studies and its potential as a low cost alternative treatment technology for river restoration. HIGHLIGHTS Active management of Hyporheic Zones can improve river health.; Surface and subsurface feature modifications influence hyporheic flux.; Hyporheic Zones can be engineered for target pollutant removal.; Engineered HZ can be a viable, low-cost, alternative treatment technology in developing countries.;

Class imbalance in a dataset is a major problem for classifiers that results in poor prediction with a high true positive rate (TPR) but a low true negative rate (TNR) for a majority positive training dataset. Generally, the pre-processing technique of oversampling of minority class(es) are used to overcome this deficiency. Our focus is on using the hybridization of Generative Adversarial Network (GAN) and Synthetic Minority Over-Sampling Technique (SMOTE) to address class imbalanced problems. We propose a novel two-phase oversampling approach involving knowledge transfer that has the synergy of SMOTE and GAN. The unrealistic or overgeneralized samples of SMOTE are transformed into realistic distribution of data by GAN where there is not enough minority class data available for GAN to process them by itself effectively. We named it SMOTified-GAN as GAN works on pre-sampled minority data produced by SMOTE rather than randomly generating the samples itself. The experimental results prove the sample quality of minority class(es) has been improved in a variety of tested benchmark datasets. Its performance is improved by up to 9% from the next best algorithm tested on F1-score measurements. Its time complexity is also reasonable which is around $O(N^{2}d^{2}T)$ for a sequential algorithm.

Introduction: Acute surge in coronavirus disease-2019 (COVID)-associated mucormycosis (CAM) cases was reported during mid-May 2021, which was later declared an epidemic in various states of India including Bihar. Objective: We carried out a rapid investigation of CAM cases to describe the epidemiological and clinical profiles and find plausible predictors to guide the initiation of public health actions. Methods: A team of public health specialists contacted all the CAM cases reported to our hospital to collect relevant information using a case-investigation-form. In addition, the team visited the Flu Clinic and Ear, Nose, and Throat (ENT) outpatient department (OPD) to capture CAM cases on daily basis during the period of the acute surge of CAM cases. Results: About 88% of 130 CAM cases reported during the period of the acute surge were in the advanced stage of mucormycosis. The majority of the CAM cases were younger (less than 60 years) [76.2%], diabetics [65.4%], un-vaccinated [86.9%], and had used steroids for management of COVID-19 [64.6%]. Other findings of public health importance were summarized and possible public health actions were recommended for the prevention of outbreaks in future. Conclusion: Optimum management of diabetes including screening for each COVID case, rational use of steroids only when necessary, strict adherence to COVID appropriate behavior by health professionals as well as the public, increasing COVID vaccine coverage, CAM awareness, and setting up a CAM surveillance mechanism may be the key to prevent and control CAM outbreaks in future.

The wastewaters from pharmaceutical manufacturing units, hospitals, and domestic sewage contaminated with excretal matters of medicine users are the prime sources of pharmaceutical pollutants (PPs) in natural water bodies. In the present study, PPs have been considered one of the emerging pollutants (EPs) and a cause of concern in river health assessment. Beyond the reported increase in antibiotic-resistant bacteria (ABRB), PPs have been found adversely affecting the biotic diversity in such water environments. Considering Algae, Macroinvertebrates, and Fishes as three distinct trophic level indicators, the present study puts forward a framework for showing River Health Condition (RHC) based on the calculation of a River Health Index (RHI). The RHI is calculated using six Indicator Group Scores (IGS) which individually reflect river health in a defined category of water quality characteristics. While Dissolved Oxygen Related Parameters (DORP), Nutrients (NT), and PPs are taken as causative agents affecting RHCs, scores of Algal-Bacterial (AB) symbiosis, Macroinvertebrates (MI), and Fishes (F) are considered as an effect of such environmental conditions. Current wastewater treatment technologies are also not very effective in the removal of PPs. The objective of the present study is to review the harmful effects of PPs on the aquatic environment, particularly on the chemical and biotic indicators of river health. Based on predicted no-effect concentrations (PNEC) for algae, macroinvertebrates, and fishes in the aquatic environment and measured environmental concentration (MEC) in the river, the estimated risk quotient (RQ) for norfloxacin in the Isakavagu-Nakkavagu stream of river Godavari, Hyderabad is found 293 for algae, 39 for MI, and 335 for fish. Among PPs, in Indian rivers, the presence of caffeine is the most frequent, with algae at the highest level of risk (RQmax= 24.5).Broadly six PPs, including azithromycin, caffeine, diclofenac, naproxen, norfloxacin, and sulfamethoxazole are found above PNEC values in Indian rivers. The application of IGS and RHI in understanding and presenting the river health condition (RHC) through colored hexagons has been demonstrated for the river Ganga near Varanasi (India) as an example. Identification of critical indicator groups, based on IGS provides a scientific basis for planned intervention for river health restoration to achieve an acceptable category.

Chronic kidney disease (CKD) is characterized by loss of kidney function and generally it is associated with several alterations in pulmonary functions, including restriction, obstruction, and impaired diffusion capacity. It became challenging to maintain oxygenation in a CKD patient associated with COVID 19 on non-invasive ventilation (NIV). In patients with end stage renal disease (ESRD), several factors likes, fluid overload, anaemia, immune suppression, extraosseous calcification, malnutrition, electrolyte imbalance, and acid-base disorder affecting the lungs indirectly. Here we are reporting NIV failure in two COVID 19 patients during dialysis. Both patients were stable on NIV before starting dialysis and underwent oxygen desaturation and shifted to invasive mechanical ventilation during hemodialysis. The possible mechanism of the oxygen desaturation is alveolar hypoventilation in the absence of hypercapnia, which may be due to the removal of CO2 from the body by some route (dialysate) other than the lungs.

Abstract Acute Kidney Injury (AKI) is one of the major complication of the Coronavirus Disease 2019 (COVID-19) infection, commonly manifested during the second week of infection. The pathophysiology and mechanisms of AKI in patients with COVID-19 have not been fully elucidated and seem to be multifactorial. There is currently no common consensus regarding the optimal amount of fluid resuscitation specifically for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients in shock. There is paucity of knowledge regarding prevention of post-intubation hypotension and oliguria in COVID-19 patients. We suggest fluid resuscitation by 1 L of crystalloid immediately following endotracheal intubation of adult COVID ARDS patients to compensate vasodilation and improve renal perfusion. Conservative fluid strategies should be followed in patient having history of congestive heart failure, chronic kidney disease, adrenal insufficiency and in patient who have already developed AKI with oliguric phase.

Background: Studies have reported that dental procedures may serve as a portal of entry for bacteria into the blood circulation, commonly termed as bacteremia which may inhabitate the heart and joints subjected to repair and replacement by prosthesis and may lead to complications in immunocompromised patients. Dental procedure may play a pivotal role in the development of infective endocarditis and infection around the prosthetic joint. Antibiotic use is suggested for all dental procedures requiring gingival manipulation or of the periapical region of teeth or mucosal incision in these patients. Objective: The present study has been conducted to inspect the antibiotic prescribing practices of general dentists among 250 dental practitioners. Methods: The study was conducted on 250 dental surgeons practicing in the urban Indian population of various parts of the country. A validated questionnaire was developed by a multidisciplinary dental and medical team and was circulated on the subject of the basic knowledge and awareness about antibiotic prophylaxis in susceptible patients. The data from the participants were collected, collated, and statistically analyzed. Results: The present study comprised 250 dental surgeons; 178 out of 250 were male, whereas 72 were female. Antibiotic prophylaxis guidelines were followed by 169 practitioners (67.60%), whereas 81 (32.40%) dentists did not follow any guidelines. Out of 169, 67 followed the American Academy of Orthopaedic Surgeons (AAOS) guidelines (39.64%), 58 followed American Heart Association (AHA) guidelines (34.30%), whereas 44 followed general physician's guidelines (26.03%). On screening the underlying conditions for which antibiotic cover was prescribed, it was shown that majority of the dental surgeons did the same for patients with cardiac valve repair or replacement (230; 92%), followed by infective endocarditis (212; 84.80%); organ transplant (212; 84.405); diabetes (189; 75.60%); prosthetic joint replacement (150; 60%); and congenital heart defect (110; 44%). Conclusion: Patients should then be trained to perform meticulous oral hygiene and advised to schedule regular dental checkups to maintain optimal dental health. Dentists should use antibiotic prophylaxis in only conditions associated with a valid scientific basis and should follow the standard protocols recommended by the American Dental Association, AHA, or AAOS.

We know that oxygen therapy plays one of the important role for treating hypoxemia and it is widely used across a whole range of specialties and it involves administration of oxygen at concentrations greater than that in ambient air. We are reporting the first case of twisting of reservoir bag on using non-rebreathing face mask for providing supplemental oxygen in awake prone position in a 60 year old male tested COVID-19 positive. To prevent this twisting we recommend if a manufacturer do slight modification in making of these non-breathing face mask by adding a 1-2 cm L- shaped Plastic connector to the neck end of the oxygen reservoir bag. The sudden deflation of these reservoir bag not only increase the dead space, decrease alveolar ventilation but substantially compromised the gas exchange. So any twisting of these non-rebreathing face mask should be avoided. This twisting may compromise the patient condition due to rapid increase in PaCO2 and detrimental in patients with restrictive airway disease. On keeping the patient in prone position the twisting of the reservoir bag frequently occurs and this simple and useful modification may be beneficial for supplementation of oxygen therapy to COVID-19 patients requiring high fractional inspired oxygen concentration.

Government of India (GOI) initiated Smart Cities Mission in June 2015. In order to guide the process, evaluate the performance, and finally move towards making a Sustainable Smart Cities program, the objective is to develop software based Environmental Decision Support System for Sustainable Smart Cities in India (EDSS-SSCI). Identification and finalization of indicators to be used in the framework for evaluation of Sustainable Smart Cities in Indian context is the objective of the present study. The analyses indicate that Smart Cities Mission guidelines of GOI include 14 performance parameters related with environment, out of which 11 qualify the criteria required for being considered as environmental indicator as per World Bank Environment Development (WBED) considerations and 3 of them do not meet the requirements in terms of clarity of design and quantification for development costs. Further, a set of 20 additional environmental performance indicators are identified from the available literature on requirements of Sustainable Cities, many of which are generally used as monitoring parameters in various programs of GOI. Subjecting these 20 additional indicators for suitability as environmental indicators based on WBED criteria and City Key Indicators criteria result in finalizing a set of 13 indicators which meet all requirements and qualify to be used in development of framework for EDSS-SSCI. 10 of these indicators are already part of monitoring programs of Ministry of Urban Development (MoUD), 2 have been suggested by Bureau of Standards (BIS 2016) and 1 considered important by Japan International Corporation Agency (JICA 2016). Thus, taking 11 environmental indicators from Smart Cities Mission Guidelines and 13 selected indicators for Sustainable Cities, a total of 24 environmental indicators are finalised to be used in the framework of EDSS-SSCI for benchmarking, performance evaluation and guiding the investment plans for most effective resource utilization under Indian conditions.

Background: Presently, there is no gold-standard regenerative material for the treatment of periodontal intrabony defects. The use of bone grafts in combination with guided tissue regeneration membrane is a predictable treatment option but is expensive. Platelet concentrates are increasingly being used due to their ease of use and cost-effectiveness. Aims: The objective of the present study is to compare clinically and also by Cone Beam Computed Tomography (CBCT), the effect of platelet-rich fibrin combined with synthetic beta-tricalcium phosphate to synthetic beta-tricalcium phosphate alone in the treatment of periodontal intrabony defects. Materials and Methods: 10 patients possessing 2 almost identical interproximal intrabony defects in either side of mandible were selected and the defects were further divided into 2 groups randomly: Control Group A (Beta-tricalcium phosphate placed) and Test Group B (Beta-tricalcium phosphate with platelet-rich fibrin placed). Regeneration of soft tissue and hard tissue (using CBCT) were evaluated after 6 months from baseline in both groups. Statistical Analysis Used: The intragroup and intergroup comparisons were done using Paired and student t-test. Results: Intragroup showed significant improvement in both soft tissue and hard tissue parameters. Mean of all parameters was better in the test group; however, the intergroup difference was not statistically significant. Conclusions: Within the limitations of the present study, the use of beta-tricalcium phosphate bone graft combined with platelet-rich fibrin and beta-tricalcium phosphate bone graft alone are both equally effective for the treatment of periodontal intrabony defects.

The Ganga River, the longest river in India, is stressed by extreme anthropogenic activity and climate change, particularly in the Varanasi region. Anticipated climate changes and an expanding populace are expected to further impede the efficient use of water. In this study, hydrological modeling was applied to Soil and Water Assessment Tool (SWAT) modeling in the Ganga catchment, over a region of 15 621.612 km2 in the southern part of Uttar Pradesh. The primary goals of this study are: ① To test the execution and applicability of the SWAT model in anticipating runoff and sediment yield; and ② to compare and determine the best calibration algorithm among three popular algorithms—sequential uncertainty fitting version 2 (SUFI-2), the generalized likelihood uncertainty estimation (GLUE), and parallel solution (ParaSol). The input data used in the SWAT were the Shuttle Radar Topography Mission (SRTM) digital elevation model (DEM), Landsat-8 satellite imagery, soil data, and daily meteorological data. The watershed of the study area was delineated into 46 sub-watersheds, and a land use/land cover (LULC) map and soil map were used to create hydrological response units (HRUs). Models utilizing SUFI-2, GLUE, and ParaSol methods were constructed, and these algorithms were compared based on five categories: their objective functions, the concepts used, their performances, the values of P-factors, and the values of R-factors. As a result, it was observed that SUFI-2 is a better performer than the other two algorithms for use in calibrating Indian watersheds, as this method requires fewer runs for a computational model and yields the best results among the three algorithms. ParaSol is the worst performer among the three algorithms. After calibrating using SUFI-2, five parameters including the effective channel hydraulic conductivity (CH_K2), the universal soil-loss equation (USLE) support parameter (USLE_P), Manning’s n value for the main channel (CH_N2), the surface runoff lag time (SURLAG), and the available water capacity of the soil layer (SOL_AWC) were observed to be the most sensitive parameters for modeling the present watershed. It was also found that the maximum runoff occurred in sub-watershed number 40 (SW#40), while the maximum sediment yield was 50 t·a−1 for SW#36, which comprised barren land. The average evapotranspiration for the basin was 411.55 mm·a−1. The calibrated model can be utilized in future to facilitate investigation of the impacts of LULC, climate change, and soil erosion. Keywords: Remote sensing, Geographic information system, Soil and Water Assessment Tool, Hydrological modeling, SUFI-2, GLUE, ParaSol, Sediment yield

The implications of the methylene tetrahydrofolate reductase (MTHFR) gene and the level of homocysteine in the pathogenesis of coronary artery disease (CAD) have been extensively studied in various ethnic groups. Our aim was to discover the association of MTHFR (C677T) polymorphism and homocysteine level with CAD in north Indian subjects. The study group consisted of 329 angiographically proven CAD patients, and 331 age and sex matched healthy individuals as controls. MTHFR (C677T) gene polymorphism was detected based on the polymerase chain reaction and restriction digestion with HinfI. Total homocysteine plasma concentration was measured using immunoassay. T allele frequency was found to be significantly higher in patients than in the control group. We found significantly elevated levels of mean homocysteine in the patient group when compared to the control group (p = 0.00). Traditional risk factors such as diabetes, hypertension, smoking habits, a positive family history and lipid profiles (triglyceride, total cholesterol, HDL-cholesterol, LDL-cholesterol, VLDL-cholesterol), were found significantly associated through univariate analysis. Furthermore, multivariable logistics regression analysis revealed that CAD is significantly and variably associated with diabetes, hypertension, smoking, triglycerides and HDL-cholesterol. Our findings showed that MTHFR C677T polymorphism and homocysteine levels were associated with coronary artery disease in the selected population.