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Classic Toxic Epidermal Necrolysis (TEN) in Lupus Erythematosus (LE) is rare and that caused by oxcarbazepine is even rarer. It can be triggered/induced by various insults, the most prominent being drugs. Herein, we describe a young female, a diagnosed case of LE with lupus nephritis, with recent-onset central nervous system vasculitis (incidentally detected on neuroimaging while she was being evaluated for a recent-onset behavioural change), who within a month of exposure to the drug developed an extensive exfoliating skin rash with mucosal lesions, which on histopathological evaluation showed TEN in LE, triggered by Oxcarbazepine, which was commenced for seizure prophylaxis. She was managed with pulse methylprednisolone, followed by intravenous immunoglobulin (IVIg), after which she made a satisfactory recovery. It is highlighted that TEN in LE patterns must be recognized in an emergency and Acute Syndrome of Apoptotic Panepidermolysis (ASAP) concept applied promptly without awaiting diagnoses. Further, many common drugs possibly trigger this pathology making the rara-avis not rare anymore!

Background There is limited literature from India on effect of fathers' deployment on the mental health of children. This cross-sectional analytical study investigates the difference in anxiety levels of children whose fathers are deployed in a field location and compares it with children currently located with their fathers. Method Data were collected in an army school from 200 children aged 10–17 years with fathers deployed in field locations (n = 99) and fathers currently residing with the children (n = 105) via interviewer administered and self-completed Screen for Child Anxiety-Related Disorders (SCARED) questionnaire. Results Anxiety scores were on an average, minimally raised above the cut-off level for children who had fathers deployed. In addition, panic disorder scores were also above the cut-off levels for these children. While scores were normal in all other domain, they were higher than that for children residing with their fathers, although the difference was not significant. Girls with fathers deployed had scores higher than cut-off scores for domains such as panic, separation anxiety and school avoidance, while boys had scores higher than cut-off scores only for panic disorders. However, the girls had significantly higher scores than boys in all domains. Girls in both groups (with and without father deployed) had higher scores than cut-off scores for panic disorders. Conclusion Anxiety levels in children were not found to be unduly affected by the deployment of fathers. But girls were found to have clinically relevant panic disorder, school avoidance and separation anxiety scores as compared with boys in the similar situation of parental separation.

Background Injury surveillance is the cornerstone of any prevention program. However the same pertaining to women’s boxing is meager. We hence intended to analyse the incidence, pattern and characteristics of injuries in female boxers during the 4th Elite Women’s National Boxing Championship, 2019, in India. Methods A total of 235 female Indian boxers participated in the tournament. Injuries from the competition injury database maintained in accordance with the injury code proposed by the Australian Sports Injury Data Dictionary were compiled to observe the pattern and analysed. The outcomes measured were incidence in terms of injury rate and injury risk and injury pattern in terms of site, nature, mechanism, severity and time of injury. Results The injury rate was observed to be 43.98 injuries per 1000 athlete bouts of exposure (95% confidence interval [CI]: 33.71-54.07) and 293.21 injuries per 1000 athlete hours of competition (95% CI: 225.94-360.47). The most commonly injured site was head, face and neck regions. Most injuries were bruises/contusions followed by cuts and epistaxis. No concussions were reported. Conclusion This study observed that women are less prone to injuries than their male counterparts, even though a logical comparison is difficult because of the lack of data and standardization in women's boxing.

Background The objective of this study was to evaluate pattern and distribution of neovascularization of optic disc (NVD) and elsewhere (NVE) in proliferative diabetic retinopathy (PDR). Methods A cross-sectional study was conducted among freshly detected cases of PDR. Fundus fluorescein angiographic images of 61 eyes were assessed. Parameters studied for NVD were their number and location and for NVE were their number, location, type of leak, and distance from center of optic disc. Results Of 61 eyes, 29 eyes (47.5%) had NVD with a total of 49 leaks. Of these 49 NVD leaks, the maximum was concentrated in the superotemporal quadrant with 21 leaks (42.9%; 95%CI 28.8–57.8%). Of 61 eyes, 50 eyes (82%) had NVE with 97 leaks. Of 97 NVE leaks, 41 were found in the superotemporal quadrant (42.3%; 95%CI 32.3–52.7%). Maximum NVE was found within the circle of radius 3–6 mm centered on optic disc (p value = 0.001) with no leaks in central macula. Of 29 eyes with NVD, only 7 eyes had >1/3 area of disc involvement. Also, of 18 eyes with concurrent NVD and NVE, only 2 eyes had >1/3 area of disc involvement which is a high-risk characteristic of PDR. Conclusion Neovascular lesions have a predilection for superotemporal part for both NVD and NVE. NVE leaks were almost double the number of NVD leaks. Maximum NVE leaks were found at posterior pole with no central macular involvement. This study provides comprehensive data and further adds to knowledge of neovascularization for early diagnosis and management of PDR.

An asymptomatic woman aged 24 years was informed about the presence of a heart murmur by her attending obstetrician while she was hospitalised for a spontaneous abortion 6 months ago and was subsequently referred to us to rule out underlying heart disease. After clinical examination and relevant laboratory evaluation, a diagnosis of severe valvular pulmonary stenosis (PS) was established. Interestingly, our patient had undergone an open thoracotomy for surgical closure of a patent ductus arteriosus (PDA) under general anaesthesia 12 years ago in the absence of any appreciable shunt across the ligated ductus at present. Considering the severe gradient across her pulmonary valve, she underwent a successful percutaneous balloon pulmonary valvuloplasty (PBPV) procedure with excellent haemodynamic outcome. The pertinent literature concerning the rare combination of PDA in association with PS as well as the technicalities of PBPV procedure in an adult are discussed.

Dabigatran, a novel oral anticoagulant, is a direct thrombin inhibitor and is being increasingly used owing to the advantage of dosing without the need for laboratory monitoring. While extensive skin necrosis is known to be associated with oral anticoagulants such as warfarin and factor Xa inhibitors, dabigatran toxicity typically manifests with bleeding, especially in the elderly. We describe a 70-year-old woman who was prescribed dabigatran for the treatment of unprovoked deep venous thrombosis. She developed bleeding diathesis along with extensive skin necrosis and acute kidney injury shortly after commencing the drug. Haemodialysis was given in view of dabigatran toxicity and complications of kidney dysfunction which resolved promptly over a week. However, the patient succumbed to severe sepsis from secondary skin infections. It is crucial to closely monitor for signs of dabigatran toxicity, especially in the elderly patients.

In current-scenario the traditional remedies are widely accepted globally. Lots of semisynthetic as well synthetic drugs are available all over the world. The poly-herbal remedies are harmless alternatives for the treatment of obese patients and it has less side effects. Parasitic infections like worm infections are common infection that affecting wide-range of people world-wide, while easily cured/treated by plant derived medicines/herbal remedies. The aim of the current study is to formulate a polyherbal tablets (antihelminthic tablets) including compositions like Ginger, Fenugreek seeds, Spinacia oleracea leave, Baliospermum montanum muell, Curcuminoids, Lycopene, vitex Negundo by direct compression method by using several excipients and subjected for the assessment of pre-compression as well post-compression parameters. Finally, for in-vivo assessment of the unit dosage form was done on rats. The formulation of polyherbal tablets has been developed with the aid of design expert software. The formulation F19 is provided in both pre compression and post-compression parameters. Good outcomes for all formulations designed. The findings of the stability research indicated that polyherbal tablets had been stable during all the experiments. The results reveal that the F19 formulation was superior based on the tablet evaluation. All excerpts exhibited inhibitor efficacy in the treatment of obesity against helminthics.

Solar energy, wind energy etc. are the main sustainable energy sources used around the world. These sustainable energy sources are used in day-to-day life in various forms for numerous purposes. One of the highly used sustainable energy sources is the solar energy which with the help of photovoltaic (PV) cells can be made use for the generation of electrical power. However, these sources generate less voltage values and thus it requires a high gain converter. In this paper, a modified Luo with flyback DC to DC converter is presented that assures high voltage gain, single switch, less stress across the components and less ripple current. Furthermore, the simulations along with the hardware prototype for the presented converter is carried out and presented in this paper.

This paper presents performance of gallium arsenide (GaAs) light emitting diode (GaAsLED) for wireless systems such as mobile communication system. Due to the fact mobile communication systems require effective signal transmission it is possible to aid with quantum photonic devices such as light emitting diodes at the transmitting ends which can provide effective and efficient photons transmission from one base station (BS) to another base station through the optical link under ground surface. At the receiving end the photons in the form of light are fed into a photodetector for further information processing as electrical signals. Simulation results portray the current-voltage characteristics of quantum photonic device namely GaAs LED for various scenarios. Further, the bit error rate performance analysis of GaAsLED cellular system is analysed in indoor and outdoor fading channels. The obtained results could be used for the implementation of 5G systems in mobile wireless systems.

Object detection in underwater acoustics especially sea floor object has been overwhelming mission chiefly owing to strident environment of sonar images as well as because of visibly existing sonar images. Side Scan Sonar is the primary sensor for Autonomous Underwater Vehicles to perform survey on sea water. Hence, we are using this SSS images for categorizing several objects like sand, mud, clay, graves, ridges and sediments in underwater sea through any size subsequent to training. We applied two-layer CNN architecture to train the model as well as we utilized three pre-trained network models such as VGG-19, ResNet50 and EfficientNet model for evaluating the performance of the model based on training and validation accuracy measures. Moreover, we utilized deep learning based transfer learning approach in which the parameters are tuned for classifying the images into sediments, clay, mud, stones etc. Our experimental outcomes shows that pre-trained EfficientNet model generates better accuracy of 100% after fine tuning the parameter in object recognition along with classification using SSS images.

SYN Flood Attack is one form of distributed denial of service attack that attains the handshake process of TCP. This attack consumes all available server resources and provokes legitimate traffic which aims to make the server unavailable. It causes serious damage to cloud server and networking protocols. The main objective of this research work is to train the neural network for detecting the attack and to secure network connection. A novel binary fruit fly optimization algorithm with deep learning is proposed to predict the syn flood attack. The proposed algorithm is implemented using the KDD cup dataset. DL- BFFA algorithm has achieved 99.96% detection accuracy for detecting the SYN Flood Attack. A comparison study is conducted to validate the proposed model.

The objective of proposing this research paper is to give insights to the amount of signal transmission from a source node to destination node via either a line of sight(LOS) wireless channel link or non line of sight (NLOS) in wireless smart cities. Smart cities globally are on the arise, information flow from various intelligent devices such as internet of things(IoT) are captured and transmitted as they traverse either directly or indirectly where performance assessment in such scenarios using mean square error(MSE) and probability of error(Pe) metrics at the backend section baseband section gains significant. By considering wireless signal transmission from various mobile nodes in a simulation testbed mean square error analysis and probability of error are obtained in matrix laboratory(MATLAB)software. Simulation results show that mean square error analysis of LOS is by far improved in 3 dB in comparison to NLOS environment for single antenna technology specified by single input single output(SISO) and multiantenna technology represented in the form of multiple input multiple output(MIMO) technology. Further, probability of error (Pe) of SISO and MIMO systems are also analysed and similar improvement in performance is also obtained for baseband analysis of smart cities. The obtained simulation results, can contribute to further research in upcoming 5G and 6G systems relating to wireless products.

The purpose of this study was to report the clinical characteristics and long-term visual outcomes in a cohort of children with idiopathic intracranial hypertension (IIH).Retrospective, observational cohort study.Consecutive children who met the diagnostic criteria for definite IIH at a tertiary care pediatric hospital between 2009 and 2020.The charts of pediatric patients with IIH were reviewed. The main outcome measure was long-term visual impairment, with an analysis of clinical features by age and risk factors for a poor visual outcome.There were 110 children (75 females) with IIH. At presentation, younger children with IIH were less likely to present with headaches (p = 0.01) and more likely to be asymptomatic (p = 0.03). There was a strong association with female sex (p 0.001) and higher body mass index (p 0.001) in adolescents in comparison to younger children. Of the 90 patients with long-term visual outcome data, only 8 (9%) had evidence of mild visual impairment (1 loss of visual acuity, 7 loss of visual field) with no cases of severe visual impairment. On risk factor analysis, the only variable associated with a poor visual outcome was greater severity of papilledema at diagnosis.In this large series of pediatric IIH, the long-term visual outcomes were favourable, with evidence of mild visual impairment in less than 10% of patients.

In future, neurodegenerative diseases will take over cancer's place and become the major cause of death in the world, especially in developed countries. Advancements in the medical field and its facilities have led to an increase in the old age population, and thus contributing to the increase in number of people suffering from neurodegenerative diseases. Economically it is a great burden to society and the affected family. No current treatment aims to replace, protect, and regenerate lost neurons; instead, it alleviates the symptoms, extends the life span by a few months and creates severe side effects. Moreover, people who are affected are physically dependent for performing their basic activities, which makes their life miserable. There is an urgent need for therapy that could be able to overcome the deficits of conventional therapy for neurodegenerative diseases. Stem cells, the unspecialized cells with the properties of self-renewing and potency to differentiate into various cells types, can become a potent therapeutic option for neurodegenerative diseases. Stem cells have been widely used in clinical trials to evaluate their potential in curing different types of ailments. In this review, we discuss the various types of stem cells and their potential use in the treatment of neurodegenerative diseases-plural based on published preclinical and clinical studies.

Subscription-based crowdfunding (SBC) is an emerging platform for creators of digital experiential content (e.g., music, comics, stories, videos) to build their brand and garner support from fans. A unique feature that sets SBC apart from other crowdfunding models is the creator-centered freemium model. That is, creators can offer free content to attract fans who can then subscribe to financially support a creator, and in return the backers have access to the creator’s premium content and exclusive perks. In doing so, creators receive regular (e.g., monthly) subscription payments from their backers to sustain ongoing creative activities. The SBC context engenders unique creator-centric dynamics and mechanisms that are ill understood in the crowdfunding literature. This study investigates the effects of SBC creators’ two information control strategies: (1) earnings concealment and (2) private postings. From a brand management lens, we theorize that earnings concealment improves brand authenticity and private postings increase brand exclusivity. These will lead to a positive impact on the financial (backer base) and nonfinancial (fan participation) outcomes of an SBC campaign. Further, we propose a reinforcing dynamic between information control and SBC performance in which better SBC outcomes will increase creators’ tendency to engage in information control. To test our hypotheses, we obtain data from a large SBC platform. Our panel data contains monthly observations of 92,850 creators from August 2016 to December 2017. The results of our empirical analyses provide evidence for the benefits of the two information control strategies in SBC and demonstrate the reinforcing relationships between information control and SBC outcomes. We discuss theoretical and practical implications of our findings.

Background Hand hygiene is the simplest and most effective method to prevent hospital acquired infections (HAI). Compliance with hand hygiene among health providers is, however, widely variable due to significant knowledge gaps and behavioral issues. The knowledge and practices of hand hygiene among medical undergraduate students, the future health workforce in the current COVID-19 pandemic will enable a reality check and ensure course correction at an early stage of their learning. Methods An online questionnaire-based survey based on a standard, validated WHO 25-point (multiple-choice question and Yes/No answers) hand hygiene survey was undertaken among medical undergraduate students in an urban city from April to June 2020. Each correct response was awarded 1 point, and an incorrect response was awarded 0 points. The maximum achievable score was 25, and the minimum score was 0. Results A total of 457 students with a mean age 20.24 ± 1.27 years completed the survey. A total of 415 (90.8%) students received hand hygiene training in the past three years. Overall 27.6% (n = 126) students had good knowledge, 65.4% (n = 299) had moderate and 7% (n = 32) had poor knowledge of hand hygiene practices. Conclusions There were significant knowledge gaps regarding hand hygiene among medical undergraduate students in the midst of the COVID-19 pandemic. There is a need to strengthen existing teaching methods to positively impact behavioral change and potentially translate into better hand hygiene compliance among the future health workforce of the country.

A 9-month-old female baby was brought to the emergency room (ER) by her parents with reports of noisy breathing, poor feeding, inadequate weight gain and intermediate cyanotic spells noticed for the past month. She was a full-term baby weighing 2.8 kg at birth and had no other comorbidities. On

The vallecular cyst is formed due to an obstruction in the collecting duct of a submucosal gland, thereby causing the accumulation of mucus within it. It is also known as a ductal cyst, mucus-retention cyst. DeSanto et al [1][1] identified that these vallecular cysts are due to distended ducts and

Even in developing countries like Nepal, prevalence of ST-elevation myocardial infarction has been shown to be increased with rise in prevalence of conventional risk factors like diabetes, Hypertension, smoking, dyslipidemia and obesity. Our aim is to retrospectively analyze for various risk factors and angiographic patterns of coronary artery disease in patients with ST-elevation myocardial infarction undergoing Primary Percutaneous Intervention.During the period of 1 year (January 2019 to December 2019), 816 patients presented to our ER with acute STEMI, among them 437 (53.6%) patients underwent primary PCI strategy and among them 22 (5.3%) patients were died. Thirty-six (4.4%) patients received thrombolysis, among them 5 (13.9%) patients were died while remaining 343 (42.0%) patients were managed conservatively and among them 20 (5.8%) were died. The mean age of patient who underwent primary PCI was 58.5±12.7 years range from 25 years to 99 years. Among them 55-75 years old 217 (49.6%) were highest in number followed by55 years old 180 (41.2%). Males 318 (72.8%) were predominant. Among those who underwent primary PCI, hypertension 214 (49%) was the most common risk factor, followed by smoking 198 (45.3%), diabetes mellitus 123 (28.1%), dyslipidemia 53 (12.1%) and family history of premature coronary artery disease 18 (4.1%). Among those patients, 292 patients (66.8%) had single vessel disease, 99 patients (22.7%) had double vessel disease, 41 patients (9.3%) had triple vessel disease and 5 patients (1.1%) had non-significant coronary artery stenosis. Left anterior descending (53.3%) was the most frequently found culprit artery, followed by right coronary artery, left circumflex, ramus intermedius and left main artery.Fifty percent of patients presented with acute ST-elevation myocardial infarction and underwent primary PCI were between 55-75 years of age. Hypertension and smoking were the most common risk factors present in those patients. Single vessel disease was most prevalent with left anterior descending found to be the most commonly involved coronary artery followed by right coronary artery and left circumflex.

The purpose of this study was to determine whether a regular follow-up schedule with examination by clinicians results in a better detection rate of disease recurrence and eventual better clinical outcomes when compared to patients who present with symptoms to the clinic and are subsequently detected to have a recurrence of oral squamous cell carcinoma. Retrospective data from 642 patients who underwent treatment for oral squamous cell carcinoma at a tertiary level cancer centre were analysed. Of the 642 patients, 197 had recurrences of which 108 were detected on regular follow-up and 87 were detected in patients presenting out of schedule with symptoms; two patients were detected to have recurrence at another centre, but their mode of detection could not be ascertained. There was no difference in the loco-regional recurrence-free survival or disease-free survival between the two groups. A strict follow-up schedule in the first year followed by a more flexible symptom-based schedule in the subsequent years, with supplementation of imaging if clinically indicated, should be an adequate surveillance plan for oral cancer patients.

It is well-known that the HVAC (heating, ventilation and air conditioning) dominates electricity consumption in commercial buildings. In this paper, we focus on one of the core problems in building operation, namely chiller sequencing to reduce HVAC electricity consumption. Our contributions are threefold. First, we make a case for why it is important to quantify the performance profile of a chiller, namely coefficient of performance (COP), at run-time, by developing a data-driven COP estimation methodology. Second, we show that predicting COP accurately is a non-trivial problem, requiring considerable computation time. To overcome this barrier, we develop a data-driven COP prediction model and an edge-based chiller sequencing framework integrating the COP predictions, and show that they strike a good balance between electricity saving and ease of use for real-world deployment. Finally, we evaluate the performance of our scheme by applying it to real-world data, spanning 4 years, obtained from multiple chillers across 3 large commercial buildings in Hong Kong. The results show an electricity saving of over 30% compared to baselines. We offer our edge based data-driven chiller sequencing framework as a cost-effective and practical mechanism to reduce electricity consumption associated with HVAC operation in commercial buildings.

Testing of software is done with an intention to find faults. If a fault is there then it needs to be detected, located and then resolved. Fault detection and localization are adjoining activities and thus it is difficult to combine them. Fault detection requires test information that helps in detecting the faults early whereas fault localization requires information which helps in locating the faults accurately. But test information is one common thing that is required for both the activities. This pre-condition helps to effectively combine both fault detection and localization. In this research work, a code and mutant coverage based multi-objective approach has been proposed to produce a minimized test suite having the ability of both detecting and locating faults. For optimization of test cases, NSGA-II algorithm has been used. Results on the projects of Defects4j repository depicts that the proposed approach is able to produce minimized test suites having the capability of detecting 95.16% of faults and locating all detected faults with fault localization score almost equivalent to that of the complete test suite. The average percentage of reduction in test suite size is 78% which is a good reduction percentage with the given fault detection and localization scores.

Background Inflammatory bowel disease (IBD) is increasingly diagnosed in South Asia. This survey by the Tamil Nadu Chapter of the Indian Society of Gastroenterology (TNISG) documents the demography, clinical profile, and therapeutic practices related to IBD in Tamil Nadu. Methods TNISG members from 32 institutions completed an online cross‐sectional questionnaire on IBD patients from March 2020 to January 2021. Results Of 1295 adult IBD patients, 654 had Crohn's disease (CD), 499 ulcerative colitis (UC), and 42 IBD‐unclassified (IBD‐U). CD and UC showed a unimodal age distribution. A total of 55% were graduates or postgraduates. A positive family history was noted in 30, other risk factors were uncommon. In CD, the pattern of involvement was ileocolonic (42.8%), ileal (34.7%), colonic (18.9%), and upper gastrointestinal (3.5%); while in UC, disease was characterized as extensive (44.9%), left‐sided (41.7%), or proctitis (13.4%). Perineal disease, perianal fistulae, and bowel obstruction were noted in 4.3, 14.0, and 23.5%, respectively, of CD. The most widely used drugs were mesalamine, azathioprine, and corticosteroids. Surgery was undertaken in 141 patients with CD and 23 patients with UC. Of the 138 patients with pediatric IBD (≤16 years), 23 were characterized as very early onset IBD (VEO‐IBD), 27 as early‐onset, and 88 as adolescent IBD. VEO‐IBD were more likely to have a positive family history of IBD and were more likely to have perineal disease and to have the IBD‐U phenotype. Among pediatric IBD patients, corticosteroids, mesalamine, and azathioprine were the most commonly used medications, while 25 pediatric patients received biologics. Conclusion This study provides important information on demography, clinical profile, and treatment practices of IBD in India., Regional differences in inflammatory bowel disease (IBD) profile inform our understanding of the disease as well as prevention, and health planning. This study provides a snapshot of IBD presentation and practices in India at a time when the country is in the second of four phases of IBD transition. The apparently mild nature of IBD, the consequent widespread use of mesalamine, and the association of Crohn's disease with higher levels of education, compared to ulcerative colitis, are of notable interest.

Hypoglossal nerve schwannomas originating extracranially and mimicking a submandibular salivary gland tumour are extremely rare. A 55-year-old woman presented with a painless, gradually increasing swelling in the right submandibular region for the past 1 year. Fine-needle aspiration cytology and contrast-enhanced CT of the swelling showed features of submandibular gland malignant lesion. Intraoperatively, the right submandibular gland with a hypoglossal nerve swelling was noticed. Right submandibular gland along with the hypoglossal swelling were excised with adequate margins. However, the postoperative histopathology was reported as hypoglossal nerve schwannoma and a normal salivary gland. Accurate preoperative diagnosis of hypoglossal schwannomas may be challenging. A high level of suspicion must be sought for in cases with unusual clinical presentations and imaging characteristics. Herein, we report a rare presentation of submandibular hypoglossal schwannoma along with its clinical features and its management.

A 37-year-old man presented to the ENT outpatient clinic with progressive dysphagia and breathlessness on exertion for a year. The patient was tachypnoeic, with mild inspiratory stridor and orthopnoea. The neck had a generalised swelling, but no mass was clinically palpable. Indirect laryngoscopy

Vehicular ad hoc Networks (VANETs) can be designed in a way to organize road protection with no specific need for any fixed infrastructure. Accordingly, the movement of all vehicles can be planned according to perceived information, and Quality of Services Routing (QoSR) algorithms can be pressured according to its available options, paths, and links, and according to the criteria and reliability of the QoSR. Ensure that QoSR is aware of the environment of the network of vehicles, including location of vehicles, direction, and speed. This study is to reduce the effects of unpredictable problems on the best pathway to replace the broken path/link. A QoSR with Particle Swarm Optimization (QoSR-PSO) is used in this article for improving QoSs in vehicular ad hoc networks. By modeling the behavior of a group of particles, particle swarm optimization algorithms find the best possible solution to the problem. In order to perform simulation experiments, NS2 simulator and VanetMobisim have been used. The comparison results with benchmark studies show the improvement in packet delivery rate (PDR), delay, Packet Drop, and overload.

The recent developments in the wireless body area networks (WBAN) play a vital role in the modern remote healthcare monitoring system. In WBAN, the deployed intelligent, resource-limited body sensors will collect the patients' biological information (BI) and communicate the same to the doctor for further action through the internet. But, during the communication among the WBAN entities, the privacy, security of the BI, and user's personal data need to be protected against various security threats. To address these security shortcomings, we proposed a computationally efficient privacy-preserving anonymous authentication scheme for resource-limited WBAN. Also, it preserves the physical security of sensors, the confidentiality of BI, and provides conditional privacy to the WBAN users. The comprehensive security and performance analysis section ensure that the proposed scheme is secure and efficient in terms of computation and communication overhead compared to that of other existing schemes.

The management of dextro-transposition of the great arteries with left ventricular outflow tract obstruction continues to evolve. Even when large intracardiac shunts are present, it remains a lethal cyanotic congenital heart disease if it is not surgically corrected soon after birth. We present our experience with a 25-year-old lady who presented with transposition of great arteries with severe left ventricular outflow tract obstruction and underwent a successful single-stage arterial switch operation with preservation of aortic and pulmonary valves.

Background Postpneumopnectomy syndrome (PPS) is an extreme rotation and malposition of mediastinum causing dynamic and symptomatic central airway compression, arising after pneumonectomy or more uncommonly, in congenital single-lung physiology. Affected patients present with severe respiratory compromise. Intrathoracic prosthesis placement is an evolving technique in children that mitigate the effects of thoracic dead space. Research Question Assessment of clinical recovery and functional benefit in children undergoing placement of intrathoracic prosthesis following pneumonectomy or in congenital single lung situations. Study Design and Methods Retrospective chart review of patients at Great Ormond Street Hospital from 2010 and 2020 was performed of all patients who underwent intrathoracic tissue expander placement. We summarize the outcomes of twenty-four children, including those with both congenital and postpneumonectomy PPS etiology. Results 24 children who underwent placement of intrathoracic prosthesis for PPS in the study period with median age of 3.5 months and weight of 5 kg. Single lung etiology was congenital in 15 children (6 agenesis, 9 hypoplasia), and postpneumonectomy in 9 children. In seven patients, there was associated long segment tracheal stenosis. Pre-operative ECMO was required in 2 patients, and pre-operative ventilation was required in 12 patients – all of whom had congenital single lung. Intrathoracic prosthesis placement was concurrent with intracardiac repair in 5 patients. There were no operative deaths, but one early postoperative death related to septicaemia. Median follow up was 75 months with 10 patients on continued respiratory support and 3 on nocturnal support with good quality of life. Two children needed reoperations for replacement of prosthesis. Conclusion The use of tissue expanders is within the armamentarium of most plastic surgeons’ practice. We also therefore advocate for a collaborative team approach involving Plastic and Cardiothoracic Surgery for surgical treatment of these patients. This multidisciplinary strategy has improved management of this rare and debilitating condition of PPS, thereby offering significant improvements in general progress of these sick children having single lung physiology. Evidence is still lacking on functional outcomes in these children and further work is necessary to prove that this is indeed achievable.

Our aim was to determine the impact of a 3-month diabetes self-management education and support (DSME/DSMS) intervention involving both professional and peer support on glycemic control and diabetes distress in South Asian adults with type 2 diabetes (T2D) living in Metro Vancouver.We recruited 114 South Asian adults with T2D for a study conducted across 7 sites in Metro Vancouver. A previous DSME/DSMS intervention was modified using participant feedback. Participants attended the updated intervention involving 6 biweekly group-based DSME sessions co-led by a diabetes educator and peer leader and 6 biweekly DSMS sessions delivered by a peer leader. Assessments were conducted at baseline and 3 months. Primary outcomes were glycated hemoglobin (A1C) and diabetes distress. Secondary outcomes included apolipoprotein B, blood pressure (BP), height and weight, waist circumference, diabetes support and depressive symptoms.After the 3-month intervention, linear mixed-effects modelling demonstrated A1C decreased significantly from 8.2% (66 mmol/mol) to 7.8% (62 mmol/mol) (p0.0001), as did body mass index (from 30.02 to 29.7 kg/mParticipation in a professional plus peer-led intervention tailored by South Asian adults with T2D is associated with improved glycemic control and other favourable health outcomes.

This study examines how diversification in Indian business groups creates multiple forms of agency problems and has performance implications for group-affiliated firms. Departing from prior literature which emphasizes the principal–principal agency conflict in business groups, we argue that business group diversification leads to dual agency problems between controlling and minority shareholders (principal–principal) and shareholders and managers (principal–agent) in affiliated firms. Both these agency problems arise in diversified business groups through cross-subsidization of affiliated firms by inefficient capital investment, continuing presence of affiliated firms in declining industries, tunneling of resources from profitable affiliated firms, lack of attention by business group headquarters to affiliated firms, and affiliated firm managers' sense of perceived security, which negatively impacts affiliated firms’ performance. These agency issues are reduced with the increase in product market competition from exposure to international markets and through concentrated promoter ownership in the affiliated firms. Our hypothesized model finds empirical support in a sample of 828 business group–affiliated firms in India.

Background Even after 35 years of the National Leprosy Eradication Program (NLEP) and 15 years post-elimination, leprosy continues to be a public health challenge in India. This paper discusses the current awareness of leprosy among people living in urban slums of western Maharashtra. Methods The study was conducted in an urban slum of western Maharashtra with 400 participants. A closed-ended questionnaire regarding the knowledge, attitude, practices, and stigma existing among the people was administered, followed by a small awareness talk and screening for leprosy. Results Of the total 400 participants, 205 (51.25) were females and 195 (48.75) were males. Only 154/400 (38.5%) people were aware of leprosy. 130/400 (32.5%) people thought that it is treatable; however, 71/130 (54.6) of them thought that it would recur even after completing the treatment. Only 103/400 (25.75) said that they would marry a person with leprosy, denoting prevalent stigma in the society, and 79/400 (19.75) were aware of government services for leprosy and NLEP. Screening of all the participants surveyed did not reveal any new or doubtful cases of leprosy. Conclusion The present study shows a lack of awareness and knowledge of leprosy among the target population. With only 20% of them being aware of government services and the NLEP, combined with an extremely low knowledge about the disease; it shows the need to further augment the government programs. There is also an increasing need to educate people to accomplish a positive attitude of the community towards leprosy patients.