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Background: The World Health Organization (WHO) reports that Asia and Africa have the highest Chronic Liver Disease (CLD) mortality rate. Cirrhosis, responsible for 22.2 fatalities per 100,000 people, is India's 10th most common cause of mortality. The increasing prevalence of chronic liver disease necessitates a study to identify predictive factors for patients who visit the emergency department. Identifying elements that enhance the predictive value of mortality in unstable patients with CLD complications is important in emergency departments. This study aims to determine Clinical and Laboratory Parameters as mortality predictors in adult chronic liver disease patients. Methodology: The study was conducted at the emergency department of a tertiary healthcare center in Northern India. Patients with chronic liver disease above 18 years of age who satisfied the inclusion criteria were clinically evaluated. Clinical and demographic details were collected, and data was analyzed. Results: Two hundred thirty-six patients were enrolled. The mean age was 50.77 ± 14.26 years. 78.4% of the participants were men. Abdominal distension, affecting 59.7% of patients, was the most common presenting ailment, followed by melena and hematemesis, affecting 41.9% and 32.6%, respectively. The mean stay in the emergency department was 10.29 ± 8.10 h. Refractory septic shock, the leading cause of mortality, accounts for 69.2% of all deaths, alongside grade 4 hepatic encephalopathy and massive Upper Gastrointestinal (UGI) bleeding, as identified in our study. Factors such as altered mental sensorium, high respiratory rate, low SpO2, increased heart rate, low systolic blood pressure, low diastolic blood pressure, and low Glasgow Coma Scale (GCS) on Emergency Department (ED) arrival are significantly associated with mortality. Conclusions: Chronic liver disease, a prevalent condition in India, most commonly seen in middle aged men and lower socioeconomic groups. The parameters independently associated with mortality in our study were presence of altered mental sensorium, Glasgow coma scale, Child Pugh class and need for ICU admission. Understanding the presentation pattern, and mortality predictors can help ED physicians in managing acute events and follow-ups. [ABSTRACT FROM AUTHOR]

Background: Endotracheal intubation is an essential resuscitative procedure in the emergency setting. Airway assessment parameters such as the Mallampati classification are difficult to perform in an emergency setting. As point-of-care ultrasound (POCUS) assessment of airway parameters does not require patients to perform any mandatory action, ultrasound may become the potential first-line noninvasive airway assessment tool in the emergency department (ED). The use of POCUS in the ED has not been sufficiently studied. Using POCUS in airway assessment for predicting difficult intubation may be the next step in successful airway management. Methodology: The study was an observational study conducted at the ED of the All India Institute of Medical Sciences (Rishikesh). The treating emergency physician recorded the patient history and systemic examination along with an indication for intubation. The POCUS assessment of airway parameters pre-epiglottis to epiglottic vocal cord ratio (Pre-E/E-VC), tongue thickness, hyomental distance, and distance from skin to the hyoid bone was performed by the study investigator. During laryngoscopy, Cormack-Lehane (CL) grading was assessed. The data was entered and analyzed. Results: Seventy patients who required intubation in the ED were enrolled in the study. Among the study population, 48.6%, 28.6%, 14.3%, 1.4%, and 7.1% were classified with the following CL grading: 1, 2a, 2b, 3a, and 3b, respectively. At a cutoff of ≥ 1.86, Pre-E/E-VC predicts difficult laryngoscopy (AUC 0.835) with a sensitivity of 83% and a specificity of 94%. At a cutoff of ≥ 5.98 cm, tongue thickness predicts difficult laryngoscopy (AUC 0.78) with a sensitivity of 83% and a specificity of 88%. At a cutoff of hyomental distance ≤ 6 cm, it predicts difficult laryngoscopy with a sensitivity of 83% and a specificity of 88%. All parameters can act as a promising tool for predicting difficult laryngoscopy, with the single best parameter being Pre-E/E-VC. Conclusion: Assessment of the airway with POCUS may be helpful to the emergency physician when the clinical airway assessment parameters fail to predict difficult laryngoscopy as most patients requiring intubation are uncooperative. Assessment of the parameters in our study Pre-E/E-VC, tongue thickness, and hyomental distance can act as a promising tool for predicting difficult laryngoscopy in the emergency scenario. [ABSTRACT FROM AUTHOR]

Background: Changing healthcare and social scenarios are reducing the learning opportunities of surgical postgraduates in our country. Majority of surgical training centers in the developed world use laboratory training as an integral part of their curricula. However, in India, most of surgical residents are still trained by traditional apprenticeship model. Aims: To describe the role of laboratory training in improving the competency of surgical postgraduates. Settings and Design: Laboratory dissection was used as an educational intervention for postgraduates in tertiary care teaching hospital. Methods and Material: Thirty-five (35) trainees from various surgical subspecialties performed cadaveric dissection led by senior faculty members. The perceived knowledge and operative confidence of trainees were assessed before and three weeks after the course using a five-point Likert scale. A structured questionnaire was administered to explore the experience of training. Results were tabulated in percentage and proportion. Wilcoxon signed-rank test was applied to find any difference between pre and post perception of knowledge and operative competence of participants. Results: Thirty four (34/35; 96%) were males; 65.7% (23/35) trainees demonstrated improvement in knowledge level after dissection (p < 0.0001) and 74.3% (26/35) in operative confidence (p < 0.0001). Majority believe that cadaveric dissection helps to improve knowledge of procedural anatomy (33/35; 94.3%) and enhances technical skill (25/35; 71.4%). Thirty participants (86%) rated cadaveric dissection as the best tool for surgical training of postgraduates better than operative manuals, surgical videos, and virtual simulators. Conclusions: Laboratory training including cadaveric dissection is feasible, relevant, effective, and acceptable to postgraduate surgical trainees with few disadvantages, which can be taken care of. Trainees felt it should be made part of curriculum. [ABSTRACT FROM AUTHOR]

Endolymphatic sac tumour (ELST) is a rare low grade malignant epithelial tumour of the petrous temporal bone, thought to arise from papillary epithelium of the endolymphatic sac. They may occur sporadically or in association with Von-Hippel Lindau disease. ELST is extremely rare neoplasm with benign histopathological appearance and clinically destructive behaviour. Because of the rarity of this tumour, it can easily be confused with other tumours such as paraganglioma, middle ear adenoma, metastatic carcinomas or choroid plexus papilloma. We report here a rare case of ELST with review of literature and discuss the differentiating features of ELST from its mimickers, showing a papillary configuration. [ABSTRACT FROM AUTHOR]

Background: Dyspnea is one of the common symptoms patients present to the emergency department (ED). The broad spectrum of differentials often requires laboratory and radiological testing in addition to clinical evaluation, causing unnecessary delay. Point of care ultrasound (PoCUS) has shown promising results in accurately diagnosing patients with dyspnea, thus, becoming a popular tool in ED while saving time and maintaining safety standards. Our study aimed to determine the utilization of point of care ultrasound in patients with acute dyspnea as an initial diagnostic tool in our settings. Methodology: The study was conducted at the emergency department of a tertiary healthcare center in Northern India. Adult patients presenting with acute dyspnea were prospectively enrolled. They were clinically evaluated and necessarily investigated, and a provisional diagnosis was made. Another EP, trained in PoCUS, performed the scan, blinded to the laboratory investigations (not the clinical parameters), and made a PoCUS diagnosis. Our gold standard was the final composite diagnosis made by two Emergency Medicine consultants (who had access to all investigations). Accuracy and concordance of the ultrasound diagnosis to the final composite diagnosis were calculated. The time to formulate a PoCUS diagnosis and final composite diagnosis was compared. Results: Two hundred thirty-seven patients were enrolled. The PoCUS and final composite diagnosis showed good concordance (κ = 0.668). PoCUS showed a high sensitivity for acute pulmonary edema, pleural effusion, pneumothorax, pneumonia, pericardial effusion, and low sensitivity for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and acute respiratory distress syndrome (ARDS)/acute lung injury (ALI). High overall specificity was seen. A high positive predictive value for all except left ventricular dysfunction, pericardial effusion, non-cardiopulmonary causes of dyspnea, and a low negative predictive value was seen for pneumonia. The median time to make a PoCUS diagnosis was 16 (5–264) min compared to the 170 (8–1346) min taken for the final composite diagnosis. Thus, time was significantly lower for PoCUS diagnosis (p value <0.001). Conclusion: By combining the overall accuracy of PoCUS, the concordance with the final composite diagnosis, and the statistically significant reduction in time taken to formulate the diagnosis, PoCUS shows immense promise as an initial diagnostic tool that may expedite the decision-making in ED for patients' prompt management and disposition with reliable accuracy. [ABSTRACT FROM AUTHOR]

In this paper, various time dissemination options, devices and software applications for synchronization of the devices to Indian Standard Time (IST) have been discussed. As CSIR-NPL is working toward the nation-wide dissemination of IST, various time dissemination options, devices and mobile applications need to be developed in order to achieve this mission. Presently, a user can access IST provided by NTP server of CSIR-NPL via network with domain name "time.nplindia.in" which can be accessed using a computer only. Two network time display devices using Raspberry Pi and ESP8266 Wi-Fi module, respectively, have been developed which are programmed to obtain proper time code from the CSIR-NPL's NTP service and display it. The realized compact and affordable IST display devices have been tested with available authenticated national time source and offer ms-level accuracy of IST synchronization. These displays, once programmed for network configuration, will work standalone provided a stable internet connection is available. Additionally, with most of the services available in mobile software application, an android application for a user/client to directly access IST has been developed. The mobile application displays accurate IST obtained from CSIR-NPL's NTP servers. This application developed by NPL, the NMI of India, will become IST dissemination service (with ms accuracy) having wider reach than any other time dissemination service. [ABSTRACT FROM AUTHOR]

Helium–neon laser heads have vast applications in various advance engineering and research fields. He–Ne laser heads in conjunction with optical interferometers are also used for precise and accurate measurements of various dimensional metrology parameters. To achieve reliable measurement observations, periodic calibration of He–Ne laser heads against the primary standard of length (Iodine stabilized He–Ne laser for realization of SI unit "Metre," wavelength 633 nm) is essential. In the present manuscript, various factors contributing in measurement errors have been recognized and evaluation of measurement uncertainty for calibration of He–Ne laser head is conducted through law of propagation of uncertainty (LPU) and Monte Carlo simulation (MCS) methods. Octave software and R programming language were used for the numerical calculations for Monte Carlo Simulation. The uncertainty values obtained through both the techniques are compared and found to be close. Using LPU, relative combined uncertainty has been ± 3.80 × 10–10 and relative expanded uncertainty has been ± 7.61 × 10–10 and using MCS relative combined uncertainty has been ± 3.84 × 10–10 and expanded uncertainty has been ± 7.68 × 10–10 obtained. [ABSTRACT FROM AUTHOR]

The sustainability agenda has evolved around a set of interconnected dilemmas regarding economic, social, and environmental goals. Progress has been made in establishing thresholds and targets that must be achieved to enable life to continue to thrive on the planet. However, much work remains to be done in articulating coherent theoretical frameworks that adequately describe the mechanisms through which sustainability outcomes are achieved. This paper reviews core concepts in the sustainability agenda to develop four propositions on integrated sustainability that collectively describe the underlying mechanisms of sustainable development. We then advance a framework for integrated sustainability and assess its viability through linear regression and principal components analysis of key selected indicators. The results provide preliminary evidence that countries with institutions that enable cooperation and regulate competition perform better in attaining integrated sustainability indicators. Our findings suggest that institutional design is important to sustainability outcomes and that further research into process-oriented mechanisms and institutional characteristics can yield substantial dividends in enabling effective sustainability policy. [ABSTRACT FROM AUTHOR]

In this paper, detailed geometry of the detection chamber, configuration of detection probe laser beams, data acquisition and processing techniques of the cold atoms in Cs atomic fountain primary standard at NPL, India has been discussed. The S/N ratio in the detected atom count was too low to make a valid estimate of signal. By implementing an efficient design of detection hardware (especially changing photodiode with lower junction capacitance) and software, the S/N ratio in NPLI-CsF1 has been improved significantly (~ 10 times). Details of the detection hardware and software used for better processing of the signal are given in this paper. This paper also depicts the precise computer control for data processing and the improvements in signal to noise ratio in the context of fountain operation. [ABSTRACT FROM AUTHOR]

Crystal engineering approach was utilized for the development of different multicomponent solid forms of telmisartan (TEL) to improve its oral bioavailability. In this context, two cocrystals, gentisic acid (GA) and maleic acid (MA), while two eutectic mixtures, para-aminobenzoic acid (PABA) and adipic acid (AA), were successfully prepared and characterized by different analytical tools. Both the cocrystals exhibited characteristic heterosynthons, viz. OHacid⋯Narom and OHacid⋯O, to propagate new network. Structural features of coformers has been correlated with the outcomes of cocrystallization approach. Coformers having auxiliary functionality in addition to complementary functional groups have high propensity to generate cocrystals. However, multicomponent where auxiliary functionality is lacking, such combinations, is shown to form eutectic mixtures owing to strong homomeric interaction. Besides, the developed cocrystals and eutectic mixtures showed higher aqueous solubility (3–5.5-fold) and intrinsic dissolution rate (1–2.6-fold) over pure TEL. In vivo studies also revealed significant improvement in relative bioavailability (2–2.6-fold). The study also shed light on the implications of eutectic mixtures in mitigating the solubility issues of drugs which are often considered negative results of cocrystallization strategy. [ABSTRACT FROM AUTHOR]

CSIR-NPL, India (NPLI) has developed its first Cesium atomic fountain (NPLI-CsF1). The indigenously developed fountain frequency standard is now fully operational and its frequency is now being evaluated along with all systematic and statistical uncertainties. Seven frequency evaluations have been recently conducted to estimate fountain frequency with respect to UTC (Coordinate Universal Time). The fountain frequency is compared with the Hydrogen MASER frequency which is contributing to UTC and hence fountain frequency is evaluated with respect to the UTC The fountain frequency is stable to few parts in 10 at <1 day averaging time. [ABSTRACT FROM AUTHOR]

Frequency corresponding to the energy difference between designated levels of an atom provides precise reference for making a universally accurate clock. Since the middle of the 20th century till now, there have been tremendous efforts in the field of atomic clocks making time the most accurately measured physical quantity. National Physical Laboratory India (NPLI) is the nation's timekeeper and is developing an atomic fountain clock which will be a primary frequency standard. The fountain is currently operational and is at the stage of complete frequency evaluation. In this paper, a brief review on atomic time along with some of the recent results from the fountain clock will be discussed. [ABSTRACT FROM AUTHOR]

This study is aimed at exploring the utility of thermoanalytical methods in the characterization of various polymorphs and solvates of nevirapine. The different forms obtained by recrystallization of nevirapine from various solvents showed morphological differences in SEM. The presence of polymorphic forms is suggested by single sharp melting endotherm different from original sample in DSC and no mass loss in TG, while appearance of desolvation peak in TG indicated the formation of solvates. The higher desolvation temperatures of all the solvates than their respective boiling point indicate tighter binding of solvent. The changes in the crystal lattice were demonstrated by X-ray powder diffraction studies. The enthalpy of fusion rule indicated the existence of monotropy in polymorphic pairs I/O and II/O, while I/II is enantiotropically related. The enthalpy of solution, an indirect measure of the lattice energy of a solid, was well correlated with the crystallinity of all the solid forms obtained. The magnitude of Δ H was found to be −14.26 kJ mol for Form V and −8.29 kJ mol for Form O, exhibiting maximum ease of molecular release from the lattice in Form V. The transition temperature was found to be higher than the melting of both the forms except for polymorphic pair I/II providing complementary evidence for the existence of monotropy as well as enantiotropy in these polymorphic pairs. [ABSTRACT FROM AUTHOR]

Background: Atorvastatin calcium (ATC), an anti-lipid biopharmaceutical class II drug, is widely prescribed as a cholesterol-lowering agent and is presently the world's best-selling medicine. A large number of crystalline forms of ATC have been published in patents. A variety of solid forms may give rise to different physical properties. Therefore, the discovery of new forms of this unusual molecule, ATC, may still provide an opportunity for further improvement of advantageous properties. Results: In the present work, eight new solvates (Solvate I-VIII) have been discovered by recrystallization method. Thermal behaviour of ATC and its solvates studied by DSC and TGA indicate similar pattern suggesting similar mode of entrapment of solvent molecules. The type of solvent present in the crystal lattice of the solvates is identified by GC-MS analysis and the stoichiometric ratio of the solvents is confirmed by 1HNMR. The high positive value of binding energy determined from thermochemical parameters indicates deep inclusion of the solvent molecules into the host cavity. The XRPD patterns point towards the differences in their crystallanity, however, after desolvation solvate II, III, IV, V and VIII transform to isostructral amorphous desolvated solvates. The order of crystallinity was confirmed by solution calorimetric technique as the enthalpy of solution is an indirect measure of lattice energy. All the solvates behaved endothermically following the order solvate-VIII (1-butanol solvate) < solvate-I (isoproplyate) < solvate-V (methanol solvate) < solvate-III (ethonalate) < solvate-VI (acetone ethanol solvate) < solvate-IV (t-butanol solvate) < solvate-II (THF solvate) < solvate-VII (mixed hemi-ethanol hydrate). The positive value of the heat capacity of the solvate formation provides information about the state of solvent molecules in the host lattice. The solvents molecules incorporated in the crystal lattice induced local chemical environment changes in the drug molecules which are observed in 13CP/MAS NMR spectral changes. Conclusions: Aqueous solubility of solvate-VIII was found to be maximum, however, solvate-I and VIII showed better reduction in total cholesterol and triglyceride levels as compared to atorvastatin against triton-induced dyslipidemia. [ABSTRACT FROM AUTHOR]

The work is undertaken to evaluate the effect of Tween 80 on the complexing ability of β-cyclodextrins to encapsulate the poorly soluble antiretroviral agent, nevirapine. The phase solubility diagram indicates 1:1 stoichiometry and is supported by electronspray ionization mass spectrometry. The complexes were characterized by DSC, FT-IR, and XRD in the solid state. The ternary systems were autoclaved before being lyophilized for the best results. Proton NMR suggests that the methyl pyridine ring of the drug is involved in inclusion and enters from the wider side of the cavity which was confirmed by COESY NMR. Solution calorimetry, a direct method to determine the thermodynamic parameters, was used to determine the complexation constant ( K) and other thermodynamic properties. The process is associated with negative ∆ H and positive ∆ S indicating a stable inclusion complex. The value of K follows the order β-CD < HP-β-CD < M-β-CD. The molar enthalpy of solution in autoclaved solid formulation is less endothermic as compared to additive molar enthalpy of solution obtained by summation of enthalpy of solution of individual components suggesting synergistic interaction between the drug and its constituents. A threefold increase of the in vitro permeability flux was observed for binary systems which was elevated to fourfold for autoclaved ternary complexes. [ABSTRACT FROM AUTHOR]

The study is aimed at exploring the utility of thermoanalytical methods in the solid-state characterization of various crystalline forms of nevirapine. The different forms obtained by recrystallization of nevirapine from various solvents were identified using differential scanning calorimetry and thermogravimetric analysis (TGA). The appearance of desolvation peak accompanied by weight loss in TGA indicated the formation of solvates: hemi-ethanolate (Form I), hemi-acetonitrilate (Form II), hemi-chloroformate (Form III), hemi-THF solvate (Form IV), mixed hemi-ethanolate hemi-hydrate (Form V), and hemi-toluenate (Form VI). The higher desolvation temperatures of all the solvates except toluenate than their respective boiling point indicate tighter binding of solvent. Emphasis has been laid on the determination of heat capacity and heat of solution utilizing microreaction calorimeter to further distinguish the various forms. The enthalpy of solution (Δ H), an indirect measure of the lattice energy of a solid, was well correlated with the crystallinity of all the solid forms obtained. The magnitude of Δ H was found to be −14.14 kJ/mol for Form I and −2.83 kJ/mol for Form V in phosphate buffer of pH 2, exhibiting maximum ease of molecular release from the lattice in Form I. The heat capacity for solvation (Δ C) was found to be positive, providing information about the state of solvent molecules in the host lattice. The solubility and dissolution rate of the forms were also found to be in agreement with their enthalpy of solution. Form (I), being the most exothermic, was found to be the most soluble of all the forms. [ABSTRACT FROM AUTHOR]

Lazaroids (or 21-aminosteroids) are potent lipid peroxidation inhibitors and are more potent antioxidants than steroids which have been shown to suppress tumor proliferation. The effects of two lazaroid compounds (U-75389G and U-83836E) were tested on the proliferation of a human brain astrocytoma cell line U-373 MG. Both lazaroids had dose-dependent growth-inhibitory effects on the proliferation of U-373 MG. For purposes of comparison, two steroids (methylprednisolone and dexamethasone) and a highly potent antioxidant (alpha-tocopherol) were tested under similar experimental conditions and were found to have antiproliferative effects as well, although at higher dose ranges. As cell growth-inhibitors, lazaroids are more effective than alpha-tocopherol while they are advantageous over glucocorticoids for their actions are devoid of the usual glucocorticoid side-effects. [ABSTRACT FROM AUTHOR]