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The effectiveness of high-flow nasal oxygenation (HFNO) in patients with hypercapnic respiratory failure (RF) remains controversial. The current study compared the effectiveness of HFNO in patients with hypercapnic RF with conventional oxygen therapy (COT).The primary objective was to compare changes in the partial pressure of carbon dioxide (PaCO2) between those receiving COT and HFNO. The secondary objectives were to compare changes in the partial pressure of oxygen (PaO2), oxygen saturation (SpO2), respiratory rate (RR), serum bicarbonate level, base excess, lactate level, and incidence of the need for non-invasive ventilation (NIV) and mechanical ventilation (MV).We recruited 30 patients with mild to moderate hypercapnic RF in the HFNO group, and data of 30 patients from historical controls, who matched the inclusion criteria, were obtained from medical records for comparison (COT group). The study was terminated after two hours, and patients were managed per the existing protocol after that. Arterial blood gas (ABG) analysis was repeated at the baseline, first, second, and third hours.In the COT group, the mean RR at the baseline, first, second, and third hours was 24.5 ± 2.61, 24.9 ± 3.03, 26.03 ± 3.4, and 22.90 ± 1.86, whereas, in the HFNO group, it was 25.93 ± 3.91, 23.00 ± 3.54, 22.50 ± 3.38, and 21.90 ± 3.57, respectively. The mean PaCO2 in the COT vs. HFNO groups was 54.45 ± 5.83 vs. 62.22 ± 9.15, 57.74 ± 6.05 vs. 58.65 ± 10.43, 60.79 ± 7.48 vs. 60.41 ± 11.24, and 55.23 ± 6.63 vs. 56.95 ± 10.31. The mean SpO2 in the COT group at these points of time was 94.50 ± 1.46, 95.4 ± 1.28, 96.10 ± 1.84, and 97.53 ± 2.05, whereas, in the HFNO group, it was 95.40 ± 2.55, 98.63 ± 1.43, 99.00 ± 1.66, and 99.50 ± 1.31, respectively. The patients who needed NIV after the study period were 50% and 36.67% in the COT and HFNO groups, respectively.There was no change in PaCO2 levels with HFNO, but there was a significant improvement in SpO2 and PaO2 levels and a decreased RR. Following the termination of the study protocol, more patients in the COT group needed NIV than those in the HFNO group.

Background: Behavioral problems often go unnoticed in children; however, it is important to identify and treat the problem in childhood to prevent the long-term disability. Objective: The objective of the study was to find the prevalence of children “at risk” of behavioral problems in preschoolchildren and to identify the social, environmental, and family factors associated with the risk of behavioral problems in preschoolchildren. Materials and Methods: A cross-sectional observational study was conducted in 370 children from 3 to 6 years of age studying in preschools of Bhopal, using Preschool Pediatric Symptom Checklist. Bivariant analysis was performed using Chi-square test on STATA 11.2. Results: Overall prevalence of children at risk of behavioral problems was found to be 46.7% in the studied population. Children belonging to low-income families were at a higher risk of developing behavioral problems (p

Crimean-Congo hemorrhagic fever (CCHF) virus, a highly pathogenic viral agent is responsible for severe fatal hemorrhagic infections in many parts of the world. The early diagnosis of CCHF infection is important for successful clinical management and epidemiological control. The nucleoprotein (NP) of CCHFV being highly conserved and immunogenic is used as early diagnostic marker. In this study, we report a rapid and sensitive double antibody based antigen capture ELISA to detect Crimean-Congo hemorrhagic fever virus (CCHFV). Highly specific polyclonal and monoclonal antibody against NP has been generated and used as capture and detector antibody respectively. The assay was able to detect viral nucleoprotein in different matrices including human serum, ticks and culture supernatant. The detection limit of the developed sandwich ELISA assay was 25 ng of purified antigen. Comparison with a real time RT-PCR revealed its detection limit to be 1000 genome equivalents of CCHFV. Further the assay was comparatively evaluated with a commercial kit employing gamma irradiated CCHFV, revealing a sensitivity and specificity of 100%. This newly developed sandwich ELISA (sELISA) with high sensitivity and specificity could be used as an efficient method for the detection of CCHF virus in humans, ticks and culture supernatant. The assay will be useful as alternate tool for diagnosis of acute infection and is amenable for screening of large scale samples in resource limited settings.

Recurrent outbreaks of Crimean-Congo hemorrhagic fever (CCHF) virus infection in different parts of world are a major global health concern. The CCHF viral infection is associated with severe hemorrhagic fevers and mortality up to 40%. More than 30 countries in Asia, Europe and Africa are affected with CCHF infection. Prevention of infection through vaccine becomes more important when no effective antiviral and associated therapies are available. Further ticks play a crucial role in maintenance and transmission of CCHFV. Therefore, the control of transmission by ticks is warranted for ultimate prevention of outbreak. The study employed a series of immunoinformatics approaches to design novel multiepitope vaccine targeting highly immunodominant epitopes of major structural proteins (Nucleoprotein and Glycoprotein complex) of CCHFV. Vaccine was designed by incorporating linear and conformational B cell, helper and cytotoxic T cell epitopes from these crucial immunogenic proteins adjoined with appropriate linkers and adjuvant. This vaccine construct was also complemented with a highly immunogenic and conserved protective tick salivary antigen named subolesin to impart dual activity as a unique transmission blocking vaccine. The B-cell peptides were also experimentally validated. The designed vaccine was further in silico validated for its physiochemical properties, allergenicity and immunogenicity etc. The proposed candidate vaccine construct has the potential to function both as a vaccine against CCHF virus as well as a universal anti-tick vaccine.

Endotracheal tube is a device commonly used in patients requiring general anaesthesia and mechanical ventilation. It becomes very important to ascertain its quality so that patient’s health is not compromised and he or she is not exposed to undue risks. We hereby describe an incidence of manufacturing defect in endotracheal tube leading to compromised patient ventilation and the steps to recognize and rectify it. Keywords: Manufacturing defect, Endotracheal tube, Air leak.

Background: India is in the grab of COVID pandemic, understanding the clinical profile, comorbid condition, vaccine status of COVID patient, will help in better prevention, treatment strategies, especially in local context, therefore present study is designed to describe, the clinical profile, comorbid conditions and factors determining the death and recovery of patient both in home and hospital setting.Methods: It is a retrospective record based study of COVID-19 patient from September 2020 to May 2021 who underwent treatment either home or at hospital. Results: Majority 90% patient were hospitalised, with male preponderance, 96.4% patient were non vaccinated at the time of data collection, risk of death about 83% were more >45years age, with associated breathlessness and comorbidity.Conclusions: Higher age, comorbidity, non -vaccinated status was associated with risk of death among COVID-19 patient.

Crimean-Congo hemorrhagic fever (CCHF) is a re-emerging zoonotic viral disease prevalent in many parts of Asia, Europe, and Africa. The causative agent, Crimean-Congo hemorrhagic fever orthonairovirus (CCHFV), is transmitted through hard ticks. Tick vectors especially belonging to the Hyalomma species serve as the reservoir and amplifying host. The vertebrate animals including sheep, goat, and bovine act as a short-lasting bridge linking the virus and ticks. CCHFV causes fatal hemorrhagic fever in humans. Humans are usually infected with CCHFV either through the bite of infected ticks or by close contact with infected animals. Immunological assays, primarily enzyme-linked immunosorbent assay (ELISA) using whole viral antigen, are widely used for serosurveillance in animals. However, the whole virus antigen poses a high biohazard risk and can only be produced in biosafety level 4 laboratories. The present study focuses on the development and evaluation of safe, sensitive, and specific IgG indirect enzyme-linked immunosorbent assay (iELISA) using recombinant nucleoprotein (NP) of CCHF virus as an antigen. The codon-optimized NP gene sequence was synthesized, cloned, and expressed in pET28a+ vector. The recombinant NP was purified to homogeneity by affinity chromatography and characterized through Western blot and MALDI-TOF/MS analysis. The characterized protein was used to develop an indirect IgG microplate ELISA using a panel of animal sera. The in-house ELISA was comparatively evaluated vis-à-vis a commercially available ELISA kit (Vector-Best, Russia) with 76 suspected samples that revealed a concordance of 90% with a sensitivity and specificity of 79.4 and 100%, respectively. The precision analysis revealed that the assay is robust and reproducible in different sets of conditions. Further, the assay was used for serosurveillance in ruminants from different regions of India that revealed 18% seropositivity in ruminants, indicating continued circulation of virus in the region. The findings suggest that the developed IgG iELISA employing recombinant NP is a safe and valuable tool for scalable high-throughput screening of CCHFV-specific antibodies in multiple species.

MANET is a collection of self organized mobile nodes with dynamic topologies and no fixed infrastructure. DSR is single path routing protocol applied for MANET and gives better performance when routes are not long enough. Its performance depends on different parameters value, like number of nodes and mobile connections. Thus routing efficiency is determined based on two aspects: firstly the time needed to react on a link break and secondly the ability to optimize to a shorter route when one is available. Developing better routing protocol became challenging task due to dynamic topology. Multipath routing is effective in mobile ad-hoc networks since link breakage is less likely to occur. A multipath extension to DSR namely Quality Aware Multipath DSR is proposed. Main interest is to divert the traffic through several node disjoint routes. Here source node maintains up to five paths corresponding to same destination as a result of route discovery procedure. The proposed work is implemented in NS2 and simulation results show that the proposed protocol achieves better packet delivery ratio, throughput and decrease average delay.

Probiotics represent an area in which bacterial interaction with the hosts is being put to practical and therapeutic use. The mechanism of action of probiotics is related to its ability to compete with pathogenic microorganisms for adhesion sites, to antagonize these pathogens or to modulate the host’s immune response. Therefore, changing the actual composition of plaque from an inflammatory cytokine-rich environment to a more benign environment dominated by neutral or even helpful organisms can contribute to overall systemic health. Objective: This non systematic review summarizes the currently available data on the potential benefits of probiotics for periodontal health. Literature review: Current and relevant references were selected in order to summarize the studies conducted so far on probiotics in preventing and treating oral infections. Conclusion: Probiotics as a treatment modality deserves to be explored further with long term studies with specific focus on its role in prevention.

Background: ART centres provide the comprehensive care to the people living with HIV (PLHIV) in public sector. Patients’ satisfaction is one of the commonly used outcome measures of patient care. The objective was to assess the level of satisfaction of PLHIV and factors associated with PLHIV satisfaction with the services at ART centre.Methods: The study was a cross-sectional design carried out at a tertiary level health care centre, Raipur during March 2016 to May 2016. A total of 320 PLHIV were selected into the study using systematic sampling. A pre-designed, pre-tested questionnaire was used to obtain data from the participants.Results: The mean age of the PLHIV was 37.76 years±8.59. The highest score was in “satisfaction with interaction with the pharmacist” (15.38±2.786), and the lowest in “satisfaction with general services” (13.67±2.822). 61.3% of all 320 respondents were satisfied with the overall services provided at ART centre. Older, less educated, those who take lesser time to reach ART centre and adherent respondents were more likely to be satisfied with the services.Conclusions: The study shows generally high satisfaction with services but there is still need for improvement of services in some areas where the patients showed dissatisfaction.

Background: In spite of the progress in therapeutic science, the mortality among patients with Oral cancer is still high when compared to other cancers. However, early diagnosis and treatment are still key to improve prognosis, if a correct diagnosis is made at the initial stage of the disease. The objective of this study is to assess the health seeking behaviour and factors affecting it among oral cancer patients seeking radiotherapy at Regional cancer centre, Dr. B.R. Ambedkar Hospital, Raipur.Methods: This hospital based cross sectional study was conducted in Regional cancer centre, Dr. B.R. Ambedkar Memorial Hospital, Raipur. Data was collected from previous patient records and by interview method regarding demographic details and health seeking behaviour including various delays in presentation of the study subjects.Results: The most common primary presenting complaint among the study subjects was Ulcer (61.59%) followed by Mass (33.02%). The majority of the subjects sought care at Private hospitals (41.72%) followed by government public health care facilities (33.11%) as first health care provider. Among clinic-epidemiological factors, place of residence (p=0.001), distance from RCC, Raipur (p=0.035), Socio-economic status (p=0.01) and initial healthcare provider (p=0.027) were found to be significantly associated with delay in diagnosis and treatment of oral cancer.Conclusions: The patient health seeking behavior can be improved by proper health education and increasing accessibility to primary health care.

Mobile Ad hoc Network (MANET) is a collection of mobile nodes and is autonomous having communication through the insecure wireless links. The nodes in the network dynamically add and join the network. Due to this kind of nature nodes are vulnerable to various kinds of attacks. There are many threats in wireless Mobile Ad hoc Networks. MANETs suffers from intrusion in which a malicious node may or may not participate in route discovery mechanism with an intension to degrade the overall network performance. Intrusion has serious impact on routing and delivery ratio of packets. Many researchers have conducted different techniques to propose different types of detection and prevention schemes. Here various attacks types and a survey of the existing solutions is presented. KeywordsAd hoc Network, MANET, Security, Black hole attack, Gray hole attack, Worm hole attack.

Lymphangiomas are fluid-filled thin-walled cysts formed due to malformations in the lymphatic system. It is usually seen in children and is rarely present in adults. Majority of the cases of lymphangiomas are seen in head and neck region with occasional extension in mediastinum. We present a case of an adult with macrocystic lymphangioma in the left posterior triangle of neck. FNAC and MRI are important modalities of investigation for diagnosis of lymphangioma. Surgical excision is the main modality of treatment in case of macrocystic lymphangioma. In case of a soft cystic swelling in head & neck region, a differential diagnosis of lymphangioma should be kept in mind.

Background: Tobacco consumption in various forms in recent years is a proven risk factor and contributes substantially to the emerging epidemic. Increasing tobacco use and its impact on physical and psychosocial health is a worldwide public health concern affecting the early youth and whole life of the individuals. Tobacco is used in different forms and health effects are seen irrespective of the form in which it is used. Smokeless tobacco is found to be as addictive and harmful as smoking. Objectives: To assess the prevalence and factors influencing smokeless consumption among high school students in Raipur city. Methods: Study design: Cross-sectional, Study area: 16 selected high schools of Raipur city, in which 12 were government schools and 4 private schools. Study subjects: 1006 high-school students, Sampling technique: Two stage cluster sampling according to probability proportional to size, Study tool: Predesigned pretested questionnaire. Statistical analysis: Data was entered in Microsoft excel sheet and analyzed in Epi info 7 software. Results: The mean age of students in the study was 15 years. The prevalence of smokeless tobacco consumption was 10%. Majority male 80.9% were users, mean age of initiation was 13 years (SD 7.07), Peer pressure (76%) was the reason for initiation. Pocket money 57.1% found to be the major source of purchasing. Strong association of family member tobacco use and promotional advertisement were found. Conclusion: Study reflects smokeless tobacco use was prevalent among adolescent students and there is a need for targeted interventions to reduce the risk and deleterious consequences.

Odontomas are the most common type of odontogenic tumor occurring within the jaws and are frequently associated with the retained deciduous teeth interfering with the eruption of permanent teeth. Compound odontomas are usually diagnosed in the anterior portion of the jaws and resemble tooth-like structure. These are usually asymptomatic. Complex odontomas are normally diagnosed in the posterior part of the jaws and consist of a disorganized mass with no morphologic resemblance to a tooth. The present case report of a 16-year-old female is a typical case of compound odontoma in the maxillary anterior region associated with retained deciduous incisor, which also resulted in failure of eruption of the permanent maxillary right central incisor. An intraoral periapical radiograph revealed the presence of a radio-opaque tooth-like structure in the apical region of retained deciduous incisor and an impacted permanent right central incisor whose path of eruption was impeded by the structure. Treatment included the surgical removal of the lesion followed by orthodontic extrusion of the impacted incisor. Follow-up was done for one 1 year and no recurrence was seen.