Search

MXene materials have received a strong boost of interest due to the prediction of behaving as topological dielectric or non conductor which is used in spintronic devices and for future technology device. In this experiment DFT (Density Functional Theory) based Quantum Express code is used to calculate the band structure and DOS of MXene material (i.e. V2C) by setting non-polarized spin polarization framework. From the geometric optimization, lattice parameter is found to be a = 2.945 Å, b = 8.836 Å, c = 28.19 Å. Since its bulk is insulating in nature, we observed MXene layer as conducting i.e. bands overlapping within fermi surface. Similar kind of scenario is observed in DOS which resembles escorted by the previously predicted results.

The quality of drinking water has been degraded and declining day by day and its impact is directly seen on human health and other organisms too. So, the way we want to solve this problem by using new technology which was not based on the Plasma Treatment. Plasma based technology which is one of the best and new technology it takes a short time for improvement of water quality. Water sample collected from various sources within Patan from different sources such as Jar water, Ground water, Tap water and Stone spout water. The concentration of ammonia in the Jar and Tap water increased at 10 seconds after the sample was treated with Plasma. The hardness of groundwater increased significantly in all time periods as compared to without treatment. Overall, the hardness of Tap water decreased when treated with Plasma. But in case of Stone Spout water, hardness increased during 5 and 15 seconds whereas it decreased at 10 seconds. The concentration of Chloride only decreased in case of Jar water whereas there was a significant increase in its amount in all other remaining samples in each time factors i.e., 5,10,15 seconds. By using this technology water quality can be improved within short time.

Climate change is difference in earth’s climate over time; it is largely caused by human activities which causes a serious threat to nature and people now and in the future too. Global temperature increased rapidly by four degrees Celsius. Climate change effects the water cycle and precipitation. Due to higher average temperatures and warmer air that can hold too much water, which can cause heavy precipitation and possible flooding. Nagarjun is the municipality which lies in the Kathmandu District (Bagmati Pradesh) of Nepal. It consists of Village development committees, Bhimdhunga, Ichangu Narayan, Ramkot, Syuchartar and Sitapaila. Nagarjun Municipality has in total 67420 populations along with 16746 households. The Major sources of drinking water are public water supply, well, springs and stream water. It depends on the sewer system more than half population able to access it but it has lack of treatment facilities for waste water and faecal sludge. These things are directly discharge through Manmati and Bhadramati Rivers.

Context: The number of geropsychiatric patients is increasing but sufficient work has not been done in this area of Nepal. Aims: To find out the prevalence of different psychiatric morbidities in elderly population and to find out if there are any age and gender specific differences. Settings and Design: Retrospective review; Psychiatric outpatient department of Lumbini Medical College and Teaching Hospital, Palpa, Nepal. Material and Methods: Data for Patients >65 years of age attending the psychiatric outpatient department of Lumbini Medical College and Teaching Hospital, Palpa, Nepal, from 1st April 2018 to 31st March 2019 were collected retrospectively in a predesigned proforma. Stastistical Analysis Used: Risks of having different psychiatric disorders was estimated using odds ratio. Results: The mean age of study group was 71.49 (S. D=6.99; range=28). 59.7% of the patients (no=179) were female and 40.3% of the patients (n=121) were male. Depressive disorder (33.7%) was the most common diagnosis. In the current study the odds of having depressive disorder was higher in females and younger subgroup of the elderly patient. Organic including symptomatic mental disorders was found in 13.66% of the patients. Dementia (12.3%) was the most common diagnosis followed by delirium (0.7%) and organic psychotic depression (0.7%). The risk of having dementia increased with increase in age [OR ( 75yrs)=10.022, 95%CI=3.406; 29.486]. High prevalence of alcohol related problems (8.3%) was found in our study. Alcohol related problems were more in males and younger subgroup. The prevalence of bipolar affective disorder (BPAD) in outpatients was estimated to be 6.1% (SD=1.5). Conclusions: Depressive disorder was the most common psychiatric disorder (33.7%) followed by somatoform disorder (15.7%). The risk of having dementia was increased in older age group which was statisticsically significant. As for gender, alcohol dependence syndrome was found to be more common in males whereas dementia was found to be more common in females. The odds of male patient suffering from depression, anxiety, mixed anxiety depression, somatoform disorder was around half when compared to females.

Background: Crystalloid cardioplegic solutions are believed to reduce hemoglobin significantly and increase the transfusion rate. However, recent reports indicate that the del Nido cardioplegia may preserve blood morphology parameters. Methods: In “The del Nido versus cold blood cardioplegia in aortic valve Replacement” trial patients undergoing aortic valve replacement were randomized into the del Nido (DN) or cold blood cardioplegia (CB) group. For the subanalysis, patients who underwent blood transfusions were excluded from the study. Red blood cell (RBC) count, hemoglobin, white blood cell (WBC) count and platelet (PLT) count were measured before the surgery, 24-, 48-, and 96 hours postoperatively. Furthermore, percental variation in first-last measure was compared in groups. In addition, indexed normalized ratio (INR) and activated partial thromboplastin time (aPTT) were compared preoperatively and 24 hours after the surgery. Results: Eighteen (24%) patients from the del Nido group and 22 (29.3%) patients from the CB group received blood product transfusions (p = 0.560) and were excluded from further analysis. As such, 57 patients remained in DN group and 53 patients remained in CB group. No difference was found in RBC, hemoglobin, WBC, and platelet count in time intervals. Percental variation in first-last measure revealed higher fall in RBC (p = 0.0024) and hemoglobin (p = 0.0028) in the CB group. No difference was shown in preoperative and 24-hour postoperative INR and aPTT. Conclusions: The del Nido cardioplegia does not decrease blood morphology parameters when compared to cold blood cardioplegia and may be used alternatively regardless of bleeding and coagulopathy risk.

This study conducted a spatio-temporal analysis of runoff, total suspended sediment, suspended particulate carbon, nitrogen, and phosphorus loadings within the 2.06 km2 Steppler subwatershed in southern Manitoba of Canada based on 11 years of field monitoring data collected at nine stations. Results showed that the nutrient losses were very small because of the implementation of multiple BMPs in the study area. However, a high spatio-temporal variation of runoff and water quality parameters was found for the nine fields within the subwatershed. The average runoff coefficient was 0.19 at the subwatershed outlet with sediment, suspended particulate carbon, total nitrogen, and total phosphorus losses of 73.8, 6.10, 4.54, and 0.76 kg/ha respectively. Spring snowmelt runoff was about 74.5% of the annual runoff at the subwatershed outlet, while for sediment, suspended particulate carbon, total nitrogen, and total phosphorus, the proportions were 61.1%, 63.6%, 74.9%, and 81.2% respectively during the monitoring period, which suggests that BMPs designed for reducing nutrient loadings from snowmelt runoff would be more effective than BMPs designed for reducing pollutant loading from rainfall storms in the study area. Research findings from this study will benefit the enhancement of current BMPs and the development of new BMPs in the region to minimize soil and nutrient losses from agricultural fields and improve water quality in receiving water bodies.

Introduction: A variety of psychiatric manifestations can be seen in children and adolescents below the age of 19 years. This study aims to examine the socio-demographic, morbidity profiles, and clinical correlates of child and adolescent patients attending the psychiatry out-patient clinic of Lumbini Medical College and Teaching Hospital (LMCTH). Methods: It was an observational, cross-section study involving case record analysis of all children and adolescent patients attending the psychiatry out-patient clinic between December 1, 2018 to November 30, 2019 in LMCTH, Nepal. Socio-demographic and clinical data were entered into computer software and analysed. Results: One hundred and forty cases fulfilling inclusion criteria were included in the study. There were 96 (68.6%) females and 44 (31.4%) males. Majority of the patients were from 16-19 years age-group. Cases from urban areas predominated the picture. Most common psychiatric diagnosis was conversion disorder (29, 20.7%) followed by depressive disorder (25 or 17.9%) and anxiety disorder (14, 10%). Majority of females had conversion disorder (25 or 26%) followed by seizure disorder (23, 24%) and depressive disorder (15, 15.6%) whereas majority of males had equal count of depressive disorder and seizure disorder (10, 22.7%) followed by anxiety disorder (7, 15.9%). Conclusions: Psychiatric illness was most common in children and adolescents in the age group 16-19 years, followed by 11-15 years age-group. They were more common in female sex, and slightly higher in those from urban background. Common psychiatric diagnoses were conversion disorder followed by depressive disorder and anxiety disorder.

A high-speed mesoscopic imaging of cancer tissues along with the use of advanced machine learning shows a promising result in the detection and identification of cancer’s stages.

This paper focuses on the application of solar energy along with microcontrollers to design and run a motor to pump water from various sources. The solar water pump is one of the applications or appliance that perform task with the use of solar radiation. The solar water pump consists of solar PV array, solar pump, inverter, AC water pumping device etc. Solar energy radiation is converted in electrical current or power source which is then used to run a pump and draw water directly from ground, wells, rivers, lakes etc. In this paper, the relationship between flow rate of the water and luminous intensity of the solar irradiance is studied and the data are linearly fitted to find out the correlation between these parameters. Also the study about efficiency of the solar powered water pump shows that the operation of this type of pumping system is quite efficient than other types of fossil fuel engines like diesel, petrol, kerosene etc. in long run. The use of Arduino Uno, flow sensor, LDR sensors in the solar powered water pump helps to analyze the relation between these parameters and know the conditions favorable for excess supply of water in short time efficiently. These solar powered devices are the future of clean and green future of this world. Thus it is not only necessary but also compulsory to enhance the usage of solar energy throughout the globe.

Air is one of the essential elements of human’s surroundings. The earth’s atmosphere is full of air which contains gases such as Nitrogen, Oxygen, Carbon Monoxide and traces of some rare elements. But quality of the air has been degrading for some decades due to various activities conducted by the human beings that directly or indirectly affect the atmosphere leading to the air pollution. There are different techniques to measure air quality.However, with the evolution of time the expensive and less efficient analog devices have been replaced by more efficient and less expensive electronics device. In this research, MQ135 sensor is used to measure air quality of a particular location. I2C display is used to monitor the data. Indeed, with the increasing in number of vehicles, unplanned urbanization and rapid population growth, air pollution has considerably increased in the last decades in various areas of Kathmandu. Thus, this project ‘Air Pollution Monitoring System’ was focused on collection of the data specific location of Chandragiri municipality of Kathmandu city. In conclusion,analysis of the data is done with the help of origin software which shows that the Arduino device in this device works perfectly for measuring the air pollution. Air quality of the selected area is found to be less than 500 PPM which concludes that the air quality of this area is normal.

BACKGROUND The evidence regarding the impact of patient's age and gender on del Nido cardioplegia cadio-protection capability in adults is strongly limited. METHODS A group of 75 patients undergoing aortic valve replacement (AVR) with del Nido cardioplegia was divided into Group 1 (male) and Group 2 (female). Creatine kinase (CK-MB isoenzyme) and high sensitivity troponin T (hs-TnT) values at 24 hours and 48 hours, occurrence of cardiac activity during crossclamp and ventricular fibrillation (VF) during reperfusion were compared. The impact of age on hs-TnT,CK-MB, VF during reperfusion and cardiac activity during crossclamp was investigated using regression models. RESULTS No difference between the groups was reported in 24-hour CK-MB (median 15.57 ng/mL; IQR 12.13-22.82 ng/mL vs. 13.97; 12.09-17.147 ng/mL; P=0.168), 48-hour CK-MB (6.19; 4.22-7.71 ng/mL vs. 6.07;4.56-7.06 ng/mL; P=0.707), 24-hour hs-TnT (259.2; 172.0-376.9 pg/mL vs. 193.0; 167.8-351 pg/mL.1; P=0.339), 48-hour hs-TnT (169.1; 124.9-293.0 pg/mL vs. 159.2; 123.12-211.77 pg/mL; P=0.673), VF during reperfusion (25% vs. 18,5%; P=0.774) and cardiac activity during arrest (39.6% vs. 37.1%; p= 1.0). Values of CK-MB at 24 hours, hs-TnT at 24 hours and hs-TnT at 48 hours were not dependent on age. The CK-MB at 48 hours was dependent on age (P=0.039). Probit regression failed to reveal the impact of patients' age on postclamp VF occurrence (P=0.11) or electrical activity during arrest (P=0.57). CONCLUSIONS Considering our study results, it can be hypothesized that the del Nido cardioplegia provides adequate myocardial protection in AVR patients regardless of age and gender.

The atmosphere of planet plays a great role in numerous weather phenomena which affects our life directly. To understand these phenomena, it requires knowledge about the relation between temperature and humidity.The effects of temperature on humidity influence the potential for precipitation. It also directly influences the human health and well-being. Relative humidity and dew point are the two parameters that are used by the meteorologists for understanding the interaction between temperature and humidity. Therefore there is a necessary of a smart monitoring system which is fully automated, accurate and capable enough to monitor all the parameters with accuracy. Besides, it should be portable and less expensive. For this purpose, the digital portable wireless temperature and humidity monitoring device is designed. This project consists of HC-05 Bluetooth module, DHT-11, Arduino UNO, 16 X 2 LCD, and smartphone. The data are recorded at different part of Kathmandu Valley with this device wirelessly by using smartphone and analyze it with the help of Origin software.

The temperature,humidity,atmospheric pressure and altitude are the most important parameters of the environment.If those parameters are known,it will help to select the best crops for specific location which increases the productivity in agricultural field.This is very useful for countries like Nepal where the most of people in this country depends on agriculture.In this research,an Arduino based device is constructed which measures those parameters and record the data in real time.The DHT22 and BMP180 sensors are used for measurin those parameters whereas RTC and SD Card module is used to record the data in real time. Data can be displayed on LCD and serial monitor of computer or laptop.The data were collected at Tri-Chandra Multiple College,Ghantaghar and at Gaurighat,Chabahil with the help of Arduino based device.In this project, the digital portable weather station monitoring system has been designed and data from this device compared with the data obtained from HTC-2 standard device and error analysis has been done.

No Abstract Available

After the 2015 Mw 7.8 Gorkha, Nepal earthquake, the Government of Nepal founded the National Reconstruction Authority (NRA) which is dedicated to the reconstruction of buildings and infrastructures in the earthquake. The NRA developed a policy to provide three-stage grants to the house owners to reconstruct their damaged house in owner-driven principle. To receive the grant, a building should be seismic resistant complying with building code NBC 105. Based on NBC 105, various prototype model buildings, minimum requirements and guidelines were formed. However, due to the lack of availability of expert engineers for designing the buildings, the owner built the houses according to their style and requirement. From the investigation of houses built in Dhading district, out of a total of 53109 houses reconstructed, 4.01% of buildings were constructed without following the minimum requirements and mandatory rule of thumb. Those buildings were required to check against NBC 105 with structural analysis. Structural engineers were deployed to assist the house owners to check the seismic capacity of buildings. The research presents the existing scenario of reconstructed building typology and discusses the major non-compliance issues prevalent in load-bearing and frame structures. A comparison of pre-and post-Gorkha earthquake housing typology is made by qualitative analysis of field data and an evaluation of the inspection level at which noncompliance mostly occurs is also illustrated in this research. The research shows out of the total buildings about 15.2 % of buildings are non-compliant according to the building code and could not be recommended for tranches.

The intensification of global water cycle, associated with anthropogenic climate change, is affecting the characteristics of hydrologic extreme events throughout the world [...]

Sinus bradycardia is common in children and adults, especially during sleep. The heart rate can drop below 30 beats per minute. Up to 35% of healthy individuals below 25 years of age, trained athletes, and those with a rare form of the familial syndrome with potassium/sodium hyperpolarization-activated cyclic nucleotide-gated channel 4 (HCN4) mutation may have asymptomatic sinus bradycardia without any heart diseases. The increased vagal tone has been associated with profound bradycardia in various pathophysiologic settings including pain. Herein, we report the first case of a young Caucasian female with transient symptomatic bradycardia due to postpartum hypervagotonic sinus node dysfunction (SND).

Aim: This study determined the epidemiology of developing leukemic transformation in patients with myeloproliferative neoplasms (MPN). Methods: We utilized the Surveillance, Epidemiology and End Results 13 database to identify 83 cases of leukemic transformation in MPN (n = 9335). Results: The 5-year cumulative incidence of leukemic transformation was higher in male versus female (2.17 vs 1.09%; p < 0.001), and in myelofibrosis (2.19%; 95% CI: 1.36–3.34%), compared with essential thrombocythemia (0.37%; 95% CI: 0.19–0.65%) and polycythemia vera (0.72%; 95% CI: 0.46–1.07%; p < 0.001). Patients had a median survival of 2 months after leukemic transformation, worse in older patients and without any impact of prior MPN subtypes. Conclusion: Myelofibrosis has a higher risk of leukemic transformation. Overall survival is dismal regardless of MPN subtypes.

Much emphasis is now being given to research and development of plant factories with fully closed and artificially controlled environment, aimed at supplying various vegetables safely and constantly. Plant factories daily produce large amount of high quality vegetables under artificially controlled environments. However, the demands from the customers are not constant, and the unsold vegetables should be disposed due to their short shelf-life and the risk of foodborne illness after the short period of storages. So, one of the important issues to be considered is to establish suitable storage systems for providing an acceptable length of shelf-life and for minimizing the risk to foodborne illnesses. This section deals with the application of the supercooled technique to the storage systems for extending the shelf-life of the high quality leaf lettuces produced by the plant factories.

The Kathmandu valley was formed by draining the lake through Bagmati River of the Chobar gorge in the ancient time. The bedrock inside the surface of Kathmandu valley consists of clay sediment i.e Kalimati (It means the black soil in Nepali) clay which is also called the dense impenetrable black mud. This type of soil is very fertile. The people of the valley utilized the geographic structure and the natural resources with skill to enhance civilization, which is shown from the traditional water supply or the hiti (Dhunge Dhara in Nepali) system. It is also called the water spout or rainspout. This study was conducted during the period from January to June 2020. Published literature such as paper, manuals, reports, and database were collected from different sources and went on thoroughly. The study found that the population of Kathmandu and Lalitpur is increasing rapidly but the source of drinking water is decreasing gradually. In the past, Dhunge Dhara was feeding the communities for drinking water as there are all together 237 Dhunge Dhara in Kathmandu and Lalitpur area. In the Kathmandu Valley, the source of water spouts decline is due to the development of various engineering infrastructures such as roads, buildings, towers, and so on. Similarly, rapid growth of urbanization took place near the source of water spouts. As a result, there could not be the chance of ground water recharge. The water from the rainfall flows directly through the waste pipe to the river. In the past, there were irrigation canals called Rajkulo (Canal made by the King in the Kathmandu Valley), these canals effectively recharged the ground water. As the valley is converted into the city of concrete, it causes stoppage of ground water recharge near the hiti. Consequently, there is no water in the water spouts i.e. in Dhunge Dhara. The study would like to suggest that the traditional Dhunge Dhara in the valley must be preserved through the initiation of the local, provincial and central government.

Objectives To compare the cardioprotective efficacy of a solution that requires only a single infusion at the start of the ischemic duration versus a solution that requires multiple infusions. Methods Aortic valve replacement was performed for 150 patients, who were randomized into the del Nido (DN) cardioplegia group or the cold blood (CB) cardioplegia group. The DN cardioplegia was delivered every 90 minutes and the CB cardioplegia was delivered every 20 to 30 minutes, or whenever cardiac activity was observed. The primary endpoints were electrical cardiac activity during crossclamp, ventricular fibrillation during reperfusion, and postoperative troponin and creatine kinase (CK-MB isoenzyme) at 24 and 48 hours. Results Electrical activity during crossclamp occurred in 29 (39.7%) patients in the DN group versus 34 (45.3%) patients in the CB group (adjusted P = 1.0). The number of procedures with ventricular fibrillation after removing the crossclamp was 41 (54.7%) in the CB group versus 17 (22.7%) in the DN group (adjusted P = .001; relative risk, 2.41). Troponin values appeared to be lower in the DN group (median, 223.10; interquartile range, 168.35-364.77 pg/mL vs 285.5; 196.20-419.45 pg/mL at 24 hours and 159.60; 125.42-217.20 pg/mL vs 201.60; 160.62-268.45 pg/mL at 48 hours) and CK-MB (median, 14.94; interquartile range, 12.16-20.39 ng/mL vs 17.43; 13.66-22.43 ng/mL at 24 hours and 6.19; 4.41-7.63 ng/mL vs 7.38; 4.74-10.20 ng/mL at 48 hours), but no significance was found. Conclusions The del Nido cardioplegia protocol is an acceptable alternative for cold blood cardioplegia in patients undergoing aortic valve replacement.

BACKGROUND The incidence of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is higher among African Americans than among other races, but to the authors' knowledge, the characteristics of NLPHL in this population have not been evaluated. The authors compared clinical features, treatments, and survival of black and white patients with NLPHL using the National Cancer Data Base. METHODS The authors extracted the records of 602 black and 1950 white patients with NLPHL who were diagnosed between 1998 and 2011. Overall survival (OS) was compared using the log-rank test. RESULTS Black patients were on average younger than white patients (median age, 42 years vs 45 years; P =.0001), more often female (49% vs 29%; P

The blastoid variant of mantle cell lymphoma (MCL), which accounts for less than one-third of MCL, may arise de novo or as a transformation from the classical form of MCL. Blastoid variant, which predominantly involves men in their sixth decade, has frequent extranodal involvement (40-60%), stage IV disease (up to 85%) and central nervous system (CNS) involvement. Diagnosis relies on morphological features and is challenging. Immunophenotyping may display CD23 and CD10 positivity and CD5 negativity in a subset. Genetic analysis demonstrates an increased number of complex genetic alterations. Blastoid variant responds poorly to conventional chemotherapy and has a short duration of response. Although the optimal therapy remains to be established, CNS prophylaxis and the use of aggressive immunochemotherapy followed by autologous stem cell transplant may prolong the remission rate and survival. Further studies are crucial to expand our understanding of this disease entity and improve the clinical outcome.

Purpose The choice between combined-modality therapy (CMT) and chemotherapy alone for early-stage Hodgkin lymphoma (HL) remains controversial. Our objective was to define factors affecting treatment selection and resulting survival outcomes in the United States. Patients and Methods We identified 20,600 patients treated with CMT or chemotherapy between 2003 and 2011 from the National Cancer Data Base. Factors affecting treatment selection were studied in a mixed-effects logistic model. Survival outcomes were compared using a propensity score analysis to account for indication bias. Results Only 49.5% of patients received CMT, and this proportion steadily declined between 2003 (59.4%) and 2011 (45.2%), particularly in younger patients. Apart from classical prognostic factors (age, stage, tumor location, histology, comorbidities), treatment selection was significantly influenced by sex, black race, distance to facility, and type of insurance. Uninsured patients had the lowest odds of receiving CMT. A significant random effect related to facility-specific treatment preference was also evident. Estimated 5-year overall survival (OS) was 89.6%, and relative survival (RS) was 94.3%. After adjustment for guarantee-time and indication biases, CMT was associated with better OS (hazard ratio [HR], 0.61; 95% CI, 0.53 to 0.70) and RS (excess HR, 0.42; 95% CI, 0.33 to 0.54) than chemotherapy alone. This effect was without significant heterogeneity in subset analysis and was not sensitive to unobserved confounding. Conclusion Socioeconomic factors affect selection of curative treatments in HL. Widespread abandonment of CMT beyond circumstances sanctioned by guidelines may affect survival. Further research should focus on developing strategies that minimize toxicity and access disparities without compromising survival.

Background: The incidence of melanoma in older patients is on the rise. Prior studies have shown disparities in surgical management and poor survival of older patients with melanoma. Methods: This is a retrospective study of adult patients diagnosed with cutaneous invasive and in situ melanoma between 2000 and 2011 in the National Cancer Data Base. Characteristics and management of older patients (≥60 years) were compared with younger patients (20–59 years) using χ2 testing. Results: Of 476,623 total cases, 54% ( n = 258,153) were diagnosed among older patients. The reported cases in the older patients increased by 1.74-fold between 2000 and 2011. The majority were white (96%), men (65%), with early-stage disease (76% stage 0-II), and superficial spreading melanoma histology (39%). Older patients, compared with younger patients, were more likely to be men (65% versus 49%, p < 0.0001), and have in situ melanoma (28% versus 21%, p < 0.0001); less likely to have nodal metastases (7% versus 9%, p < 0.0001), receive care in academic centers (30% versus 35%, p < 0.0001), undergo wide excision or major amputation for stage I–III disease (68% versus 72%, p < 0.0001) and systemic therapy for stage III (18% versus 45%, p < 0.0001) and IV disease (30% versus 50%, p < 0.0001). Conclusion: Older patients with melanoma are less likely to receive care in academic centers, undergo wide excision for stage I–III disease and receive systemic therapy for stage III–IV disease. Particularly, the utilization of systemic therapy is markedly low. This disparity is particularly important with the availability of less intense more effective therapies.

Objectives Large licensing trials did not find any association between the use of fondaparinux and the development of heparin-induced thrombocytopenia (HIT). Fondaparinux is in fact recommended as an option for the management of HIT. Since the first report of fondaparinux-associated HIT in 2007, additional reports have been published. However, the rarity of these cases, differences in case definition, and lack of larger case series have prevented better understanding of this disease. The objective of this study was to determine the clinical manifestations of fondaparinux-associated HIT, the predictive value of pretest probability (4Ts) scoring system, and the outcomes associated with current management. Methods Using several search terms, we reviewed all cases of fondaparinux-associated HIT reported and indexed in PubMed till May 2013. All references were also checked for additional reports. We categorized the cases of fondaparinux-associated HIT as confirmed, probable, and possible based on our case definition. Results A total of eight cases of fondaparinux-associated HIT were identified. Fondaparinux-associated HIT occurred in the setting of pro-inflammatory state, prior HIT, or exposure to heparin products. Bilateral adrenal hemorrhage or infarct, reflecting hypercoagulability or disseminated intravascular coagulation, was seen in 25% of patients. The pretest probability (4Ts) scoring system used for HIT appears to correctly risk stratify all the cases. Although functional assays can be used for the diagnosis, in the presence of recent exposure to heparin products, only the demonstration of fondaparinux-dependent platelet activation should be considered confirmatory. Non-heparin anticoagulants are effective therapy; however, one-third of the patients had poor outcomes. Conclusion The risk of fondaparinux-associated HIT, although low is real, which along with documented cases of fondaparinux failure mandate its cautious use in the management of HIT.

Plant factories daily produce large amount of high quality vegetables under artificially controlled environments. One of the important problems to be considered is to establish suitable storage systems to achieve an acceptable length of shelf life and to minimize the risk to food borne illnesses. Temperature control is an essential part of food storage in food production and distribution network. Recent researches into food storage technologies have proposed alternative method of extending the shelf life of vegetables, including the use of superchilling (partial freezing) and supercooling (cooling below the freezing point without phase change). This study deals with the application of the supercooling technologies to the extension of the shelf life of the high quality leaf lettuces produced by the plant factories.

Primary central nervous system (CNS) lymphoma, most frequently a diffuse large B-cell lymphoma, is a rare aggressive lymphoma confined to the CNS, thus requiring differentiation from other brain malignancies such as glioblastoma. Although stereotactic biopsy can confirm the diagnosis, this is invasive, not always feasible and can be inconclusive after steroid use. Hence, cranial magnetic resonance imaging (MRI) with contrast and cerebrospinal fluid analysis are frequently used to make a prompt diagnosis. We report a case of a woman with two brain masses who presented unique diagnostic challenge.

Background: This paper aims to explore distribution pattern of medicinal plants and their uses for the local communities. We have explained here 12 medicinal plants with their identification and medicinal uses.Methods: The plants were surveyed through the direct visit in a different interval of time after that plant was identified. Results: 12 species were described as their medicinal value with identifying Characters. The knowledge of medicinal which provide the potential use for local communities.Conclusions: The Knowledge of the medicinal plant gives people as community as proper uses about the medicinal, herbs shrubs and tree. Due to this, we must preserve the plant as for future generation.

Low plasma potassium level can cause muscle weakness, lassitude, constipation as well as rhabdomyolysis and arrhythmias, when severe. In muscle, low plasma potassium increases resting membrane potential (hyperpolarization) of myocytes that tend to make muscle more refractory to excitation, leading to muscle weakness. Hypokalemia can be associated with a myriad of causes including drugs of abuse. We present a case of hypokalemia and muscle weakness following use of cocaine and heroin.

Several studies have reported excellent long-term overall survival (OS) of patients with hairy cell leukemia (HCL) without racial disparity. Studies in other cancers have demonstrated worse mortality among African American (AA) individuals.We used the Surveillance, Epidemiology, and End Results 18 database to identify HCL patients diagnosed between 1978 and 2011. Kaplan-Meier curves were plotted to estimate OS. Univariate analysis using the life table method and multivariate Cox regression model were used to determine the independent effect of race on OS.The study population included 78% men and had a median age of 56 years. Race included 93% white, 3.5% Asian/Pacific Islander, and 3.5% AA. The 10-year OS was significantly less for AA as compared with white and Asian/Pacific Islander individuals (54% vs. 72% vs. 75%; P.001). A Kaplan-Meier survival curve showed a significantly worse OS for AA versus other races (P.001). In a multivariate analysis, AA race remained an independent predictor for a worse OS (hazard ratio 1.77; 95% confidence interval, 1.30-2.40; P.001) after adjusting for age, sex, year of diagnosis, and marital status.In this population-based study, only half of AA patients but more than two-thirds of HCL patients from other racial groups were alive at 10 years. Such drastic racial differences in OS of HCL patients at the population level mandates further evaluation of the contributory biological, socioeconomic, health system, and other factors. Understanding and overcoming such racial disparities might close the racial differences in OS of this potentially curable disease.

Uterine fibroid, one of the most common tumors in women, is estrogen dependent, which commonly regresses after menopause. Fibroid degeneration after menopause, therefore, is rare. Here the authors report a case of 56-year-old postmenopausal woman who presented with acute abdominal pain, low grade fever, and leukocytosis as a result of fibroid degeneration. Keywords: post-menopause; uterine fibroid; degeneration; acute abdomen (Published: 3 February 2015) Citation: Journal of Community Hospital Internal Medicine Perspectives 2015, 5 : 25917 - http://dx.doi.org/10.3402/jchimp.v5.25917

New architectures of manufacturing systems have been proposed aiming at realizing more flexible control structures of manufacturing systems which can cope with dynamic changes in volume and variety of products. They are so called as holonic manufacturing systems, autonomous distributed manufacturing systems, random manufacturing systems and biological manufacturing systems. The objective of the present research is to develop an integrated process planning and scheduling system which is applicable to the holonic manufacturing systems. In the previous paper, a systematic method is proposed to select suitable sequences of machining equipment, by applying the genetic algorithm (GA) and the dynamic programming (DP) methods. The method is extended, in the present paper, to consider the production schedules of the machining equipment.