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Olanzapine is a readily available atypical antipsychotic usually prescribed in adults for psychotic disorders. Olanzapine overdose or poisoning is rarely seen in children. It is often due to accidental intake of drug and sometimes suicidal.We are reporting two case of olanzapine poisoning in children presenting with altered sensorium and pinpoint pupils. The mainstay of treatment of olanzapine poisoning is supportive and symptomatic measures. Both children recovered well and were discharged.

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological condition that involves the acute onset of headache, confusion, optical impairments, and seizures with accompanying vasogenic edema on brain imaging. Here is a 12 years old male patient presented with complaints of swelling in the face and legs, headache and vomitings. He had a history of fever, sore throat and tonsillitis 12 days back. On physical examination weight and height of the patient was between 25-50th percentile, BP was 142/92 mmHg (>99th centile), he had pretibial +2 edema and periorbitol edema. At presentation urine analysis showed haematuria, proteinuria at nephritic level, elevated urea and creatinine, increased ASO titre, low C3 and C4 levels. After admission, he had an episode of convulsion when BP was 162/98 mm hg. Magnetic resonance imaging brain showed bilateral occipital, parietal, frontal cortex and subcortical white matter T2/Fluid-attenuated inversion recovery (FLAIR) hyperintensitie, suggestive of PRES. EEG was found to be normal. MRI was found to be normal in the first month after starting on antihypertensive and anticonvulsive treatment. In the first year of the follow-up, the blood pressure, neurological examination and urinalysis findings were found to be normal. Thus, it is suggested that early diagnosis of PRES in patients with clinical features and prompt treatment will prevent permanent neurologic sequale.

Background: Patients with chronic kidney disease have impaired immunity due to disease per se and because of immunosuppressant treatment used for their disease. Catheters used for hemodialysis acts as conduit for microorganisms to cause infections. This leads to increase in morbidity and mortality.Methods: 100 patients of renal failure requiring hemodialysis were selected. Relevant pathological and radiological investigation done to rule out already existing infection, later on tests were repeated after catheter insertion and hemodialysis to check for infection and sepsis. Using appropriate statistical analysis was done and p value

Background: Central venous catheterization is a relatively common procedure in many branches of medicine particularly in anaesthesia and intensive care medicine. Central venous catheters give an easy access for giving drugs as well as for sampling of blood, but they can also be a cause of blood stream infection and sepsis.Methods: Patients who requiring central venous catheter were selected, relevant blood investigations were done before insertion of catheter and after 48 hours after insertion. With the suspicion of new infection, physical examination and laboratory work-ups were carried out to identify the other source of infection.Results: Total 96 patients were selected with mean age of 40.0±13.89 years. The incidence of central line-associated bloodstream infection/catheter-related bloodstream infection (CLABSI/CRBSI) in our hospital based study in intensive care units comes out 34.37%. The CLABSI/CRBSI patients (n=33) on general physical examination 5 patients have bradycardia, hypertension hypothermia oliguria altered mental status hypotension tachypnea tachycardia and 26 patients have developed fever during the course of illness. The predominant organism isolated in CLABSI/CRBSI patients is Staphylococcus aureus. Central venous catheters are useful in getting access and also source of blood stream investigation. Site of catheter, duration of catheter and co morbidities acts as risk factor for infection.Conclusions: By knowing the risk factors to cause catheter related infections, risk of getting infection can be lowered by using aseptic technique during insertion and proper catheter care and this can further reduces morbidity and mortality related to central venous catheters.

The modern developments have made our lives’ more digital. As they make our day-to-day activities simpler, they are in wide usage leading to accumulation of huge amounts of data. The analysis of such data will provide useful results for further advancements which can be obtained by the concept of Data Mining. These newly emerging digital exercises involve sharing of personal information to unknown sources, questioning the privacy of the individual. To avoid such situations, techniques of Privacy-Preserving Data Mining involving various data distortions are used. One such technique is Privacy-Preserving Data Classification, balancing both privacy and utility in classification aspects. In this work, the performance analysis of Classification using Support Vector Machine (SVM) on data sets that are heterogeneously distorted is evaluated.

Background: Increased secretion of brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) occurs mainly with increased tension in the ventricular walls, decreased oxygen supply, acute myocardial infarction, chronic cardiac heart failure, and in hypertrophy of the heart. Objective was to find out the prevalence and profile of NT-pro BNP levels in patients with type 2 diabetes mellitus (DM) without overt heart failure.Methods: Hospital based cross sectional observational study was conducted in the Department of Medicine, Pt. JNM Medical College and associated Dr. BRAM Hospital Raipur, Chhattisgarh involving 106 patients of type 2 DM during the period of April 2019 to April 2020, after ethical approval from institutional ethical committee.Results: The levels of NT pro BNP was found to be elevated in 87.7% patients of DM type 2. Majority of them were from 51-60 years age group (35.5%). Elevated NT proBNP levels was seen in 23.58% of patients having grade I diastolic dysfunction, 3.7% patients with grade II diastolic dysfunction and 1.88% patients having grade III diastolic dysfunction on echocardiography out of the 106 patients. Regardless of presence of diastolic dysfunction on echo, 93 (87.73%) patients out of the total study group of 106 patients had elevated BNP suggesting cardiac dysfunction. In the present study, 30.19% patients with diabetes were found to have varying degrees of diastolic dysfunction on echocardiography.Conclusions: The prevalence of elevated NT pro BNP was 87.7%. Commonly observed age group with elevated NT pro BNP was 51-60 years. NT pro BNP was elevated in 88.7% of males and in 88.36% of females. Prevalence of elevated NT pro BNP was higher in grade 1 diastolic dysfunction with DM duration of more than 5 years (33.3%). Higher prevalence of elevated NT pro BNP was seen in grade I diastolic dysfunction (23.58%).

Background: The primary aim of the current investigation was to evaluate the role of NT-proBNP in the diagnosis of diastolic heart failure and its correlation with echocardiography.Methods: Hospital based observational and analytical study undertaken on a total of 65 patients of diastolic heart failure fulfilling clinical inclusion criteria. The enrolled patients had a mean age of 54.5 years with a female preponderance (33 females vs. 32 males). Patients underwent clinical evaluation and echocardiography examination. NT-proBNP estimation was done using autoanalyzer working on principle of electrochemiluminisense. Patients were divided into various grades of diastolic dysfunction on the basis of echocardiography. Statistical analysis was done to find the significance of levels of NT-proBNP and its correlation with the grading of diastolic heart failure.Results: There was a statistically significant higher level of serum NT-proBNP in patients with diastolic heart failure and the increasing levels were directly proportional to severity of diastolic dysfunction. The mean level of NT-proBNP increased from 361.08 pg/ml to 3570 pg/ml in increasing severity of diastolic dysfunction.Conclusions: Results suggested positive correlation of rising NT-proBNP levels with increasing severity of diastolic dysfunction.

Background: Sickle Cell Disease(SCD) is a complex disorder with multi-organ complications. Cardiovascular abnormalities are well-recognized complication in SCD with cardiac enlargement and systolic murmurs being the most common findings. Multiple pathologic and clinical studies have shown that patients with pulmonary hypertension and diastolic left ventricular dysfunction represent a particularly high-risk subgroup. These cardiopulmonary complications contribute to a markedly low functional capacity and associated high risk of both sudden death and severe multi-organ dysfunction in SCD patients. The aim of study was to assess prevalence of Pulmonary hypertension and Left ventricular diastolic dysfunction by using 2D Echocardiography in the patients of sickle cell anemia. Material and Methods: This study was conducted in the Department of Medicine, Pt. Jawaharlal Nehru Memorial Medical College and Dr. B.R.A.M. Hospital, Raipur (C.G.) among the patients presenting in O.P.D. and admitted in medicine ward from Dec. 2013 to Sep. 2015. A total of 100 patients were taken fulfilling the inclusion criteria for the study. Detailed clinical history was recorded and all patients underwent complete clinical examination. Hb electrophoresis and 2D Echocardiography of all patients were done. Results: In our study out of 100 patients, 33 patients (33%) were male while 67 patients (67%) were female. 70 subjects were having sickle cell trait out of which 18 patients were male and 52 were female, whereas 30 subjects were having sickle cell disease out of which 15 patients were male and 15 were female. Mean Hb level was 8.41 ± 1.74 gm%. In our study population maximum Hb was 12 gm% whereas minimum Hb was 4 gm%. Diastolic dysfunction was present in 50% of the total cases (100) among them 45.45% were males, 52.23% were females. Diastolic dysfunction was almost equally prevalent among female compared to male (p=0.51).Mean age of women with diastolic dysfunction was 29.37 ± 9.89 yrs, whereas mean age of men with diastolic dysfunction was 29.82 ± 10.24 yrs. Statistically there was no association was found between age and LVDD prevalence ( p=0.99).In our study we found prevalence of LVDD in studied genotypes i.e. AS and SS to be almost similar (P = 0.62, non-significant). Our study showed that diastolic dysfunction is more closely associated with moderate (Hb level 7-10 gm%) and severe anemia (Hb level 4-7gm%) than mild anemia (Hb level >10%). Statistically it was found to be significant (p=0.006).Mean Hb level of patients with diastolic dysfunction was 7.88 ± 1.81 gm%, whereas mean Hb level of patients without diastolic dysfunction was 8.94 ± 1.49 gm% (P

Objectives To describe trends in admissions to English hospitals and 30-day in-hospital mortality associated with a primary diagnosis of burns. Design Descriptive population-based study. Setting England. Participants Patients admitted to hospital with a primary diagnosis of burns between 1991 and 2010. Main outcome measures Age-specific and age-standardised admission rates, and 30-day in-hospital mortality percentages. Results During 1991–2010, there were 188,597 admissions to hospitals in England with a primary diagnosis of burns. Annual numbers of admissions decreased between 1991 and 2002, followed by a steeper increase up to 2010. Rates were higher in males, in the age groups 0–4 and ≥85 years, and in persons from deprived areas of residence, most ethnic minorities, and urban areas. There were 3196 in-hospital deaths within 30 days of admission for burns between 1991 and 2010. Between 2000 and 2010, this mortality decreased from 1.99% to 0.91%. The highest rates of 30-day in-hospital deaths occurred in the elderly and the lowest in children. Conclusion Although in-hospital mortality from burns has decreased in recent years, if the recent upward trend in hospital admissions is genuine, it will have resource implications for regional burns units, and also suggests the need for a renewed emphasis on primary prevention. Observed inequalities with respect to age, gender, deprivation, ethnicity, and urban-rural status provide a rational basis for targeting primary prevention initiatives.

Summary Background and aim There are limited studies that look at morbidities in patients who have undergone axillary lymph node dissection (ALND) for skin cancer. To date, there has been no study examining the functional status of the upper limb postoperatively. This study studies the disability in upper limb function of patients postoperatively and looks for factors that influence this. Methods Twenty-five patients who have undergone level I–III ALND were interviewed using the Disability of Arm, Shoulder and Hand (DASH) and European Quality of Life (EuroQol) questionnaires to determine their upper limb functional status and overall quality of life. These data were then compared with epidemiological and surgical factors collected from the patients' notes retrospectively to look for influencing factors. Results The majority of patients had low disability scores, with only 12% of patients having a score of 40 and above (out of 100). Age of patient, seniority of operator, surgery on the same side of hand dominance, seroma formation and physiotherapy had no significant effect on DASH scores. A higher DASH score was associated with the patients viewing themselves as ‘less healthy'. Conclusion ALND for cutaneous skin cancers does not result in a significant increase in upper limb disability in the majority of patients.

Isolated glossopharyngeal and vagal nerve palsy is a rarely reported phenomenon. We present a patient with unilateral isolated cranial nerve IX and X palsy after arthroscopic rotator cuff surgery on the contralateral shoulder. To our knowledge, this is the first time that this combination of neural injuries has been reported after arthroscopic shoulder surgery, and indeed, the first time that a glossopharyngeal and vagal nerve injury have been described together after an orthopedic operation.

Abbreviations: AJCC, American Joint Committee on Cancer; CI, confidence interval; miRNA, microRNA

This study reports on 565 consecutive endoscopic carpal tunnel releases using the Agee one-portal technique of which 25 (4.4%) were converted to the open technique. The follow-up period was from 4 to 52 months. Immediate symptomatic relief was reported in 562 wrists (99.5%). There were 25 complications (4.4%) including pillar pain (8 wrists), digital neuropraxia (n = 6), median nerve contusion (n = 3), incomplete division of the flexor retinaculum (n = 3), superficial infection (n = 3), reflex sympathetic dystrophy (n = 1), and tenderness of the scar (n = 1). We describe the evolution of our selection of patients and surgical technique. We recommend caution in performing ECTR in short patients who are liable to have small wrists because of the risk of contusion of the median nerve. We present some technical modifications that may make the technique safer.

A 32-year-old man presented with chemical burns to his penis following accidental application of depilatory cream to the area. The gentleman consequently sustained deep dermal burns to his penis, experiencing genital swelling and dysuria. This injury was managed conservatively in our burns unit and the patient was discharged shortly after. We present this unusual case of penile burns which has not previously been described in the literature despite depilatory creams being inexpensive and relatively easy to use, and subsequently popular choice amongst available hair removal options.

The paper presents a CFD based model for prediction of aerodynamic instabilities like rotating stall and surge in axial flow compressors. The model is based on quasi 3D Euler equations with source terms to represent momentum and energy transfer in the rotors. The numerical results are compared with experimental data of research compressors and the results compare well with experimental data. The model captures both the two modes of instabilities, namely rotating stall and surge. The tendency of the system to surge at high value of Greitzer’s B parameter and to show rotating stall at low value of B parameter is captured by the model. The results show stalling and unstalling during a surge cycle. The model can serve as a useful tool in preliminary instability investigation of compression systems. Nomenclature Symbols as Sonic Speed (m/s) AC Effective Compressor Area B Greitzer’s B parameter C C P s l A V a 2 u = e Specific Internal Energy (Joules/Kg) f & g Flux matrices lC Effective compressor length lr Effective helical rotor length n Number of harmonic waves p0 Total Pressure (Pascal) p Static Pressure (Pascal) rps Revolutions per second R1,R2,R3 Reimann invariants T0 Total Temeprature (K) T Static Temperature (K) VP Plenum Volume w Conserved variables x Axial coordinate y Circumferential coordinate i Cell number in axial direction j Cell number in circumferential direction u Axial component of velocity (m/s) v Circumferential component of velocity (m/s) ∗Presently at Aeronautical Development Agency, Bangalore, India. ‡ Professor of Aerospace Engineering. Copyright © by the American Institute of Aeronaitics and Astronautics, Inc. All Rights Reserved. γ Ratio of specific heats η Isentropic Compressor efficiency ρ Density ω Rotating Stall Frequency t ∆ time step used in computation

Lead acts as cumulative metabolic poison. Occupational lead poisoning occurs frequently in developing country as it has many industrial uses like manufacture of pipes, storage batteries, ship building. Toxic effect of lead on the body is known as Plumbism. It affects multiple organs, specifically bones, blood, brain, increased risk of cardiovascular disease, coronary artery disease and platelet dysfunction. Lead encephalopathy is rare in adults due to the capacity of the mature brain to sequestrate lead away from its mitochondrial site of action within the cerebral and cerebellar neurons. It is a life threatening condition and should be treated as an emergency. Here by, we present a case of 18 year old young man with lead encephalopathy with brief review of literature.

Chromosome 22q11 deletion gives rise to various phenotypes, including cardiac malformations, velopharyngeal abnormalities, absent thymus, and neurological defects. We assessed, in a prospective study, chromosome 22q11 deletion in 50 of 144 patients with velopharyngeal incompetence in the absence of overt clefting. 18 (12.5% of the whole cohort and 36% of patients tested for the deletion) had the 22q11 deletion. This frequency differs from an estimated population prevalence of 0.025% and suggests a need for screening for the 22q11 deletion in these patients.

Twenty endoscopic carpal tunnel releases were performed in 15 patients with quiescent seropositive rheumatoid arthritis using the Agee technique. Patients were not considered for endoscopic carpal tunnel release if there was florid synovitis with crepitus or loss of active finger flexion, if there was evidence of flexor tendon rupture or if they had previously undergone surgery in the region. Access to the tunnel was significantly easier than normal and visualization of the flexor retinaculum was satisfactory in all cases. There were no complications. We conclude that endoscopic carpal tunnel release can he safely performed in selected patients with rheumatoid arthritis. The absence of a palmar scar can be a great advantage to these disabled patients.

Pseudouridylation is a prevalent post-transcriptional RNA modification that impacts many aspects of RNA biology and function. The conversion of uridine to pseudouridine (Ψ) is catalyzed by the family of pseudouridine synthases (PUSs). Development of robust methods to determine PUS-dependent regulation of Ψ location and stoichiometry in low abundant mRNA is essential for biological and functional understanding of pseudouridylation. Here, we present a framework, NanoPsiPy, for identifying Ψ sites and quantify their levels in poly-A RNA at single-nucleotide resolution using direct RNA long-read Nanopore sequencing, based on the observation that Ψ can cause characteristic U-to-C basecalling errors in Nanopore direct RNA sequencing data. Our method was able to detect low and high stoichiometric Ψ sites in human mRNA. We validated our method by transcriptome-wide quantitative profiling of PUS7-dependent Ψ sites in poly-A RNA from a MYCN -amplified neuroblastoma cell line. We identified 8,625 PUS7-dependent Ψ sites in 1,246 mRNAs that encode proteins involved primarily in ribosome biogenesis, translation, and mitochondrial energy metabolism. Our work provides the first example of using direct RNA long-read Nanopore sequencing for transcriptome-wide quantitative profiling of mRNA pseudouridylation regulated by a PUS. We envision that our method will facilitate functional interrogation of PUSs in biological and pathological processes.