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Computer vision is nowadays is one of the promising & evolving areas in information technology. Image processing is increasingly used in several applications such as automotive, medical or aerospace. Every computer vision application involves capturing several images with the help of camera. Image acquisition, image transmission & image security are the three important aspects of image processing system. This paper includes development of complete image processing system including improved median filtering with better PSNR & operating frequency, Image compression module with better PSNR & compression ratio, Image Encryption module using Advanced Encryption Standard. more...

With the development of Internet of Vehicles (IoV), the integration of Internet of Things (IoT) and manual vehicles becomes inevitable in Intelligent Transportation Systems (ITS). In ITS, the IoVs communicate wirelessly with other IoVs, Road Side Unit (RSU) and Cloud Server using an open channel Internet. The openness of above participating entities and their communication technologies brings challenges such as security vulnerabilities, data privacy, transparency, verifiability, scalability, and data integrity among participating entities. To address these challenges, we present a Privacy-Preserving based Secured Framework for Internet of Vehicles (P2SF-IoV). P2SF-IoV integrates blockchain and deep learning technique to overcome aforementioned challenges, and works on two modules. First, a blockchain module is developed to securely transmit the data between IoV-RSU-Cloud. Second, a deep learning module is designed that uses the data from blockchain module to detect intrusion and its performance is assessed using two network datasets IoT-Botnet and ToN-IoT. In contrast with other peer privacy-preserving intrusion detection strategies, the P2SF-IoV approach is compared, and the experimental results reveal that in both blockchain and non-blockchain based solutions, the proposed P2SF-IoV framework outperforms. more...

Objective Vesical Imaging Reporting and Data System (VIRADS) score was developed to standardize the reporting and staging of bladder tumors on pre-operative multiparametric magnetic resonance imaging (mpMRI). It helps in avoiding unnecessary repeat transurethral resection of bladder tumor (Re-TURBT) in high-risk non-muscle-invasive bladder cancer (NMIBC) patients. This study was done to determine the validity of VIRADS score prospectively for the diagnosis of muscle-invasive bladder cancer. Methods This study was conducted from March 2019 to March 2020 at Sawai Mansingh Medical College and Hospital, Jaipur, Rajasthan, India. Patients admitted with the provisional diagnosis of bladder tumor were included as participants. All these patients underwent a 3 T mpMRI to obtain a VIRADS score before they underwent a TURBT and these data were analysed to evaluate the correlation of pre-operative VIRADS score with muscle invasiveness of the tumor in final biopsy report. Results A cut off of VIRADS ≥4 for prediction of detrusor muscle invasion yielded a sensitivity of 79.4%, specificity of 94.2%, positive predictive value (PPV) of 90%, negative predictive value (NPV) of 87.5%, and diagnostic accuracy of 86.37%. A cut off of VIRADS ≥3 for prediction of detrusor muscle invasion yielded a sensitivity of 91.2%, specificity of 78.8%, PPV of 73.8%, NPV of 93.2%, and accuracy of 83.7%. The receiver operating curve (ROC) showed the area under the curve (AUC) to be 0.922 (95% confidence interval: 0.862–0.983). Conclusions VIRADS score appears to be an excellent and effective preoperative radiological tool for the prediction of detrusor muscle invasion in bladder cancer. more...

Cooperative Intelligent Transport System (C-ITS) is a promising technology that aims to improve the traditional transport management systems. In C-ITS infrastructure Autonomous Vehicles (AVs) communicate wirelessly with other AVs, Road Side Units (RSUs) and Traffic Command Centres (TCCs) using an open channel Internet. However, the use of the Internet brings inherent vulnerabilities related to privacy (e.g., adversary performing inference and data poisoning attacks), and security (e.g., AVs can be compromised using advanced hacking techniques) issues and prevents the faster realization of C-ITS applications. To address these challenges, this paper presents a privacy-preserving-based secure framework to provide both privacy and security in C-ITS infrastructure. The proposed framework provides two level of security and privacy using blockchain and deep learning modules. First, a blockchain module is designed to securely transmit the C-ITS data between AVs-RSUs-TCCs, and a smart contract-based enhanced Proof of Work (ePoW) technique is designed to verify data integrity and mitigate data poisoning attacks. Second, a deep-learning module is designed that includes Long-Short Term Memory-AutoEncoder (LSTM-AE) technique for encoding C-ITS data into a new format to prevent inference attacks. The encoded data is used by the proposed Attention-based Recurrent Neural Network (A-RNN), for intrusive events recognition in C-ITS infrastructure. The proposed A-RNN is trained using Truncated Backpropagation Through Time (BPTT) algorithm. The framework is further validated and tested using two publicly available ToN-IoT and CICIDS-2017 datasets. The proposed framework is compared with peer privacy-preserving intrusion detection techniques, and the result shows the effectiveness of the proposed framework over several state-of-the-art techniques in both blockchain and non-blockchain systems. more...

Background/Aims: Intestinal tuberculosis (ITB) is difficult to diagnose due to poor sensitivity of definitive diagnostic tests. ITB may be associated with concomitant pulmonary tuberculosis (PTB) which may remain undetected on chest X-ray. We assessed the role of contrast enhanced computed tomography (CECT) chest in detecting the prevalence of active PTB, and increasing the diagnostic yield in patients with suspected ITB. Methods: Consecutive treatment naïve patients with suspected ITB (n=200) who underwent CECT chest (n=88) and had follow-up duration>1 year were recruited in this retrospective study (February 2016 to October 2018). ITB was diagnosed in the presence of caseating granuloma, positive acid fast stain or culture for Mycobacterium tuberculosis on biopsy, presence of necrotic lymph nodes (LNs) on CT enterography or positive response to anti-tubercular therapy. Evidence of active tuberculosis on CECT-chest was defined as presence of centrilobular nodules with or without consolidation/miliary nodules/thick-walled cavity/enlarged necrotic mediastinal LNs. Results: Sixty-five of eighty-eight patients (mean age, 33.8±12.8 years; 47.7% of females) were finally diagnosed as ITB (4-caseating granuloma on biopsy, 12-necrotic LNs on CT enterography, 1-both, and 48-response to anti-tubercular therapy) and 23 were diagnosed as Crohn’s disease. Findings of active TB on CECT chest with or without necrotic abdominal LNs were demonstrated in 5 and 20 patients, respectively. No patient with Crohn’s disease had necrotic abdominal LNs or active PTB. Addition of CECT chest in the diagnostic algorithm improved the sensitivity of ITB diagnosis from 26.2% to 56.9%.Conclusions: Addition of CECT chest significantly improves the sensitivity for definite diagnosis in a patient with suspected ITB. more...

Smart Agriculture (SA) incorporates low cost and low energy consuming sensors and devices to enhance quantitative and qualitative agricultural production. However, these devices uses an open channel i.e., Internet and generates large amount of data in real-time and thus, has the potential to be misused. As a consequence, the major concern in the implementation of SA is minimizing the risk of security and data privacy violation (e.g., adversaries performing inference attacks). To address these challenges, we propose PEFL, a deep privacy-encoding based Federated Learning (FL) framework that adopts a perturbation-based encoding and Long-Short Term Memory-AutoEncoder (LSTM-AE) technique to achieve the target of privacy. Then a FL-based Gated Recurrent Unit Neural Network algorithm (FedGRU) is designed using the encoded data for intrusion detection. The experiment results based on ToN-IoT dataset reveals that the PEFL can efficiently identify normal and attack patterns after transformation over other non-FL and FL methods. more...

The majority of Ethiopia's population, primarily women, is susceptible to smoke inhalation during cooking, and they spend the majority of their time striving to collect firewood. Biomass deforestation for cooking harms the rural household economy and contributes to national and global environmental change, such as pollution and health issues. The effort should aim to integrate the Scheffler concentrator with a thermal storage system via the secondary solar cooking reflector in order to stimulate indoor cooking while avoiding concerns associated by carbon inhalation and deforestation. As a result, the Injera bakery system powered by solar thermal energy is born. There is a primary (Scheffler), secondary (reflective), and thermal storage device incorporated, as well as a cooking (pan) mounts. Solid works software was utilized for Scheffler focus and secondary reflector modeling and simulation. The thermal retention capacity of a storage device is determined using heating and cooling curves generated by software modeling and simulation. The findings gained would aid in the development of any comfortable indoor cooking system specifically for rural areas without a grid connection, and as a result of this study, carbon inhalation and deforestation difficulties would be mitigated. Through automation, the output rate would also increase the amount and efficiency of injera. This analysis focuses on the Injera baker concept for domestic applications. more...

In this review, the impact of the structure dimensionality and surface morphologies of WO3 for efficient detection of gases such as H2, NH3, H2S, CO, O3, VOCs etc. along with the influence of surface functionalization and doping has been discussed. more...

Inflammatory bowel disease (IBD), once considered a disease of the Western hemisphere, has emerged as a global disease. As the disease prevalence is on a steady rise, management of IBD has come under the spotlight. 5-Aminosalicylates, corticosteroids, immunosuppressive agents and biologics are the backbone of treatment of IBD. With the advent of biologics and small molecules, the need for surgery and hospitalization has decreased. However, economic viability and acceptability is an important determinant of local prescription patterns. Nearly one-third of the patients in West receive biologics as the first/initial therapy. The scenario is different in developing countries where biologics are used only in a small proportion of patients with IBD. Increased risk of reactivation of tuberculosis and high cost of the therapy are limitations to their use. Thiopurines hence become critical for optimal management of patients with IBD in these regions. However, approximately one-third of patients are intolerant or develop adverse effects with their use. This has led to suboptimal use of thiopurines in clinical practice. This review article discusses the clinical aspects of thiopurine use in patients with IBD with the aim of optimizing their use to full therapeutic potential. more...

In multiple sclerosis (MS), a subset of chronic active white matter lesions are identifiable on magnetic resonance imaging by their paramagnetic rims, and increasing evidence supports their association with severity of clinical disease. We studied their potential role in differential diagnosis, screening an international multicenter clinical research-based sample of 438 individuals affected by different neurological conditions (MS, other inflammatory, infectious, and non-inflammatory conditions). Paramagnetic rim lesions, rare in other neurological conditions (52% of MS vs 7% of non-MS cases), yielded high specificity (93%) in differentiating MS from non-MS. Future prospective multicenter studies should validate their role as a diagnostic biomarker. ANN NEUROL 2020;88:1034-1042. more...

BACKGROUND Dynamic contrast-enhanced magnetic resonance imaging (MRI) of the liver in pediatric Fontan patients often shows peripheral reticular areas of hypoenhancement, which has not been studied in detail. OBJECTIVE To semiquantitatively score the hepatic MR perfusion abnormality seen in pediatric Fontan patients, and to correlate the perfusion abnormality with functional clinical and hemodynamic parameters. MATERIALS AND METHODS All children ( more...

Erlotinib is a tyrosine kinase inhibitor and it can treat tumors, such as pancreatic and locally advanced lung cancer or metastatic cancer. The traditional formulation of erlotinib currently available is an oral delivery type that presents serious side effects such as hepatotoxicity, skin rashes, gastrointestinal disturbance, renal dysfunction, drug resistance and hematological symptoms. Besides this, other disadvantages of erlotinib provided mostly by oral administration are the comprehensive metabolism, low bioavailability, poor solubility and off-target impact. Overcoming such unfavorable attributes of the medication, innovative medication delivery mechanisms like nanocapsules, liposomes, microspheres, microparticles solid lipid nanoparticles, nanosponge, and nanoparticles have been studied that have really shown their lead over traditional formulations. This article summarizes the novel erlotinib drug delivery systems to boost its clinical efficacy and reduce systemic toxicity. Novel formulations of erlotinib will offer positive outcomes in cancer therapy and will play an important part in improving the drug's therapeutic potential. more...

Background: Long-term Arteriovenous Fistula (AVF) survival has been shown to be adversely impacted by the presence of previous Tunnelled Vascular Catheters (TVC). We analysed the effect of previous TVCs and their location (ipsilateral versus contralateral) on the successful function of upper limb AVFs in the first 12-months after creation. Methods: We retrospectively reviewed clinical data on patient9s first upper limb AVFs, created between January 2013 and December 2017. We analysed the rates of successful AVF function (successful cannulation using 2 needles for ≥50% sessions over a 2-week period) at 6- and 12- months post creation, time to AVF maturation, and rates of assisted maturation. Results: 287 patients with first AVFs were identified, of which 142 patients had a previous TVC (102 contralateral, 40 ipsilateral) and 145 had no previous TVC. The No TVC group had higher rate of AVF function at both 6-months (68.6% vs 54.3%, OR 1.84, 95% CI 1.00-3.39, p=0.05) and 12-months (84.3% vs 63.5%, OR 3.10, 95% CI 1.53-6.26, p=0.002) compared to the TVC group. The Contralateral TVC group had higher rate of AVF function at 6-months (59.6% vs 40%, OR 2.21, 95% CI 1.01-4.88, p=0.05), but not at 12-months (65.9% vs 57.6%, OR 1.42, 95% CI 0.62-3.25, p=0.40) compared to the Ipsilateral TVC group. The median time to AVF maturation in the Contralateral and Ipsilateral TVC groups were 121.5 and 146 days respectively (p=0.07). Assisted maturation rates were lower in No TVC group compared to the TVC group (12.4% vs 27.9%, p=0.007), but similar between the Contralateral and Ipsilateral TVC groups (28.7% vs 25.7 %, p= 0.74). Conclusions: Previous TVC use was associated with poorer AVF function at 6- and 12-months, with a higher rate of assisted maturation. The presence of an ipsilateral TVC was associated with lower successful AVF use at 6-months, compared to contralateral TVC. more...

Objectives This study aims to describe surgical graduation requirements in US dental schools in 2020, including changes made due to the COVID-19 pandemic. Methods Representatives of Commission on Dental Accreditation-approved predoctoral dental programs in the US (n = 66) received a 13-item questionnaire about operative and observational surgical requirements. Responses were assigned values to tabulate a surgical score (zero- to eight-point scale) as a proxy for required surgical experience, and statistical analyses were performed to explore for predictors. Results Surveys were returned by 97% (64/66) of programs with complete data from 62.5% of responding institutions. In periodontics, 6.8% of programs require students to perform periodontal surgery, 63.8% to assist, and none require a competency assessment in periodontal surgery. In oral and maxillofacial surgery, 23.3% of programs have numerical requirements in performance of surgical extractions, 35% require an operating room experience, and 51.9% have a competency assessment involving a surgical procedure. Modifications to surgical and nonsurgical graduation requirements due to COVID-19 were reported by 51.6% and 52.5% of programs, respectively. The mean surgical score was 1.73 ± 1.2 (range = 0-4) of eight possible points. This was not predicted by class size or the presence of postgraduate surgical programs. The presence of postgraduate surgical programs roughly doubled the likelihood of requiring an observational experience in surgery. Conclusions As of 2020, US dental programs require a small fraction of surgical experiences available to students. Class size is not a predictor of required surgical experience. The presence of postgraduate surgical programs increased the likelihood of required observational experiences. more...

Objective To describe the utility of wrist circumference in the identification of cardiometabolic risk in overweight and obese children. Methods A cross-sectional study was conducted in the obesity clinic of a tertiary care referral hospital over a two year period. All children and adolescents aged 5–17 years with nutritional overweight and obesity were recruited. Data pertaining to chronological age, sex, risk factors and family history were collected. Clinical assessment of anthropometry: Weight, height, body mass index (BMI), Tanner’s stage, wrist circumference, blood pressure, waist circumference and triceps skinfold thickness done as per standard criteria. Biochemical assessment of blood glucose, serum insulin, lipid profile, and Homeostatic Model for Insulin Resistance performed after 12 h of fasting. Results We recruited 118 subjects (mean age 10.9 years, 71.1% males, 87.3% obese and 12.7% overweight); 30 (25.4%) had metabolic syndrome. The mean z scores of wrist circumference of children who presented with and without metabolic syndrome was 2.7 ± 0.8 and 2.1 ± 0.7, respectively (p Conclusions Wrist circumference with 97th percentile as a cut-off is a useful tool to identify metabolic syndrome amongst overweight and obese children and adolescents. more...

Learning from past incidents is critical to achieving and maintaining high process safety performance. Accident and incident records provide one way for learning; however, these are usually in the form of unstructured texts, which makes analysis difficult. Recently, text mining methods based on supervised learning have been proposed for analyzing accident reports; however, they require an impractically large number of labeled records as training examples. This paper proposes an automated, semi-supervised, domain-independent approach for analyzing accident reports. Given a set of user-defined classification topics and domain literature such as handbooks, glossaries, and Wikipedia articles, the method can identify domain-specific keywords and group them into topics with minimal expert involvement. These keywords and topics can then be used for various data mining purposes, including classification. The proposed approach is demonstrated using two different case studies across domains: (1) in aviation to identify the stage of flight when an accident occurs, and (2) in the process industry domain to identify the cause of pipeline accidents. The average classification accuracy of the proposed method was 80% which is comparable to that of supervised learning methods. The key benefits of this approach are that it can generate domain-specific predictive models with limited manual intervention. more...

Semantic matching finds certain types of semantic relationships among schema/data constructs. Examples include entity matching, entity linking, coreference resolution, schema/ontology matching, semantic text similarity, textual entailment, question answering, tagging, etc. Semantic matching has received much attention in the database, AI, KDD, Web, and Semantic Web communities. Recently, many works have also applied deep learning (DL) to semantic matching. In this paper we survey this fast growing topic. We define the semantic matching problem, categorize its variations into a taxonomy, and describe important applications. We describe DL solutions for important variations of semantic matching. Finally, we discuss future R\&D directions. more...

Schools respond to the complex needs of students exposed to traumatic and adverse experiences as part of an interconnected system of care that includes health care, child welfare, juvenile justice, housing and a variety of other community services. As legislation increasingly mandates inter-organisational collaboration, attention has turned to consider the ways in which educators and professionals of other disciplines and services interact. This paper analyses the partnership between an educator and a psychologist in the development, delivery and evaluation of a trauma-informed practice program for schools. Using a case study methodology, the research used qualitative analysis of the authors’ reflections on their partnership to identify factors that have enabled and sustained interdisciplinary educational work. The findings highlight key elements of sustainable interdisciplinary joint work—including knowledge sharing, opportunities for expansive learning, adapting to changing working relationships and overcoming systemic barriers for collaboration. These themes are discussed in the context of implementing trauma-informed practices in schools. more...

We report a simple route to design highly sensitive triangular silver nanoplates (TSNPs)-based SERS substrate for the trace-level detection of explosive molecules. The size-dependent localized surface plasmon resonance (LSPR) tunability for the synthesis of TSNPs is achieved by controlling reaction kinetics and seed volume in a modified seed-mediated approach. The computed extinction spectra of TSNP, using the finite-difference time-domain (FDTD) method, are in excellent agreement with the experimental results, therefore assisting further in the investigation of the plasmonic properties of TSNP. The higher electric field enhancement offered by TSNP is systematically investigated by performing the FDTD simulations for various sizes and corner rounding of TSNP. The FDTD results show that the dipolar plasmon resonance wavelength, size, and corner rounding of TSNP are the principal contributing factors for designing the high-performance SERS substrate. Herein, we have used a portable Raman system for the SERS-based detection of three important explosive molecules: picric acid (PA), ammonium nitrate (AN), and 2, 4-dinitrotoluene (DNT). The TSNP-based SERS substrates display excellent intensity enhancement factors of ~ 107 for rhodamine 6G (R6G) and PA and ~ 105 for AN. The high sensitivity of SERS substrate with limit-of-detection (LOD) of value 2.3 × 10−11 M for PA and 3.1 × 10−8 M for AN and effective batch-to-batch reproducibility for DNT, thus offering its potentials for field detection of explosive molecules at trace-level. more...

Introduction Cytogenetic abnormalities are integral to the risk stratification of acute lymphoblastic leukemia (ALL). Objectives The present study aimed to highlight a rare, yet nonrandom cytogenetic abnormality notably dicentric (9;12), which was observed in ALL patients who presented to our institute. The study analyzed the frequency, clinicohematological features, and treatment response of these patients. Materials and Methods A single-group observational study was conducted from April 2014 to April 2020. Cytogenetic analysis was done on bone marrow aspirate samples of the patients referred to the cytogenetics laboratory with clinical diagnosis of acute leukemia. Cytogenetic, clinical, and hematological data were collected from respective departmental records, case files, and patients. Results Dic(9;12) was identified in 1.2% of ALL (19 out of 1,544 patients). They showed striking preponderance in teen and young adult males with characteristic precursor B cell immunophenotype. Majority of these patients displayed favorable risk profiles such as low total count, mild lymphadenopathy and splenomegaly, mild-to-moderate elevation of lactate dehydrogenase, and good response to first induction chemotherapy. Rare coexistence of dic(9;12) with well-established cytogenetic markers such as t(9;22) and t(1;19) was observed. Conclusion Dic(9;12) is one of the most specific cytogenetic markers of precursor B cell (pre-B) ALL. It defines a subgroup with favorable clinical and biological profile. We suggest inclusion of dic(9;12) in cytogenetic risk stratification of precursor B cell ALL. Long-term follow-up studies are recommended to establish the prognostic significance of this cytogenetic subgroup, which may benefit from less intensive chemotherapy. more...

Background/Aims: Predictors of short-term outcome of intravenous (IV) steroid therapy in acute severe ulcerative colitis (ASUC) have been well described, but the impact of cytomegalovirus (CMV) infection as a predictor of outcome remains debatable. We investigated the role of quantitative CMV polymerase chain reaction (PCR) as a predictor of short-term outcome in patients with ASUC.Methods: Consecutive patients with ASUC satisfying Truelove and Witts criteria hospitalized at All India Institute of Medical Sciences (AIIMS) from May 2016 to July 2019 were included; all received IV steroid. The primary outcome measure was steroid-failure defined as the need for rescue therapy (with ciclosporin or infliximab) or colectomy during admission. AIIMS’ index (ulcerative colitis index of severity > 6 at day 1+fecal calprotectin > 1,000 μg/g at day 3), with quantitative CMV PCR on biopsy samples obtained at initial sigmoidoscopy were correlated with the primary outcome.Results: Thirty of 76 patients (39%) failed IV corticosteroids and 12 (16%) underwent surgery. Patients with steroid failure had a significantly higher mucosal CMV DNA than responders (3,454 copies/mg [0–2,700,000] vs. 116 copies/mg [0–27,220]; P< 0.01). On multivariable analysis, mucosal CMV DNA load > 2,000 copies/mg (odds ratio [OR], 10.2; 95% confidence interval [CI], 2.6–39.7; P< 0.01) and AIIMS’ index (OR, 39.8; 95% CI, 4.4–364.4; P< 0.01) were independent predictors of steroid-failure and need for colectomy. The combination correctly predicted outcomes in 84% of patients with ASUC.Conclusions: High mucosal CMV DNA ( > 2,000 copies/mg) independently predicts failure of IV corticosteroids and short-term risk of colectomy and it has an additional value to the established markers of disease severity in patients with ASUC. more...

Objective It is recognised that advanced maternal age is associated with adverse pregnancy outcomes. It is less known what the psychological impact of having a pregnancy in later maternal age is. This study aimed to establish whether women having children over 50 experience challenges with regards to their mental well-being during the pregnancy and thereafter. Study design 17 women delivered aged ≥ 50 at our maternity unit in a central London hospital between 2014 and 2020. Of these, one had died of metastatic ampullary carcinoma two years following delivery, one declined taking part, and two we were unable to get hold of, leaving 13 women in the study. Two validated questionnaires were used to survey the women: (i) Warwick-Edinburgh Mental Well-being Scale (WEMWBS), (ii) Parenting Daily Hassles Scale (PDHS). We analysed the questionnaire data using their individual scoring systems. Results The WEMWBS showed a median score of 60 out of a possible 70 (range: 45–70), indicating a high level of mental well-being among these women. The PDHS results indicated that reported hassles were overall low in both frequency and intensity for the mothers. Conclusion Women giving birth over 50 have often experienced long, emotional and financially-burdensome journeys in order to fall pregnant, usually involving assisted reproductive techniques (ART), with multiple antenatal and delivery complications thereafter. As a result, they are extremely happy and grateful to have the child, and are often in better socioeconomic positions that can help with the stress that comes with child-caring. more...

Aim: We conducted this network meta-analysis to compare the efficacy and safety of targeted pharmacotherapies and fecal microbial transplantation (FMT). Patients & methods: Nineteen studies were included and there was only one head-to-head randomized controlled trial (adalimumab vs vedolizumab). Results: All interventions, including FMT, were superior to a placebo in inducing clinical remission (except adalimumab – odds ratio 1.66; 95% CI: 0.97–2.85), clinical response and endoscopic remission. FMT was comparable with other agents in achieving all efficacy outcomes. Infliximab was ranked highest in inducing clinical remission (surface under the cumulative ranking, 0.8). There was no difference in safety outcomes between FMT and other targeted therapies. Conclusion: FMT is as efficacious and as safe as other targeted therapies in inducing clinical remission, clinical response and endoscopic remission. Further studies to assess the long-term benefits are needed in order to reach a definitive conclusion. more...

Background: The single file reciprocating system prepares the canal quickly with a better centric ability and has increased resistance to cyclic fatigue compared to the continuous rotary file system. However, the former file system was associated with more postoperative pain than the latter. The goal of the present study was to evaluate and compare the clinical efficacy and safety between continuous rotary and reciprocating instrumentation systems. Methods: Fifty patients who fulfilled specific inclusion criteria were assigned into 2 groups according to the root canal instrumentation technique used, ProTaper Gold and WaveOne Gold. Endodontic treatment was performed in a single visit. Patients were instructed to rate the intensity of postoperative pain on Visual Analog Scale and to record the quantity of prescribed analgesic medication taken after 24 hours, 48 hours, 72 hours, and 7 days. Time of root canal preparation, duration of pain, and incidence of procedural errors such as ledging, transportation, root perforation, and instrument separation were recorded. The data was collected from October 2018 to September 2019. SPSS version 24 was used for data analysis. Results: This study revealed no statistically significant difference between instrumentation groups with relevance to postoperative pain and analgesic medication intake (P > 0.05). Canal preparation time was significantly shorter in reciprocating group compared to rotary group (P < 0.001). Further, the incidence of procedural errors in both instrumentation group was found statistically insignificant (P > 0.05). Conclusions: Continuous rotary and reciprocating systems were both found to have similar clinical efficacy and safety and hence can be used to instrument the root canals. more...

Sarcopenic dysphagia (SD) is swallowing difficulty associated with loss of generalized skeletal muscles and swallowing-related muscles. Diagnostic criteria for SD were suggested, yet there is a variability in instruments and cut-offs used. The aim of the current review is to critically evaluate tools used in diagnosis of sarcopenic dysphagia in the elderly. Comprehensive review of the literature was performed. Studies were qualitatively evaluated for the diagnostic tools used to make a diagnosis of "sarcopenic dysphagia" and compared to the known diagnostic criteria for SD and other accepted measures. Fourteen studies (N = 10,282) were selected from a search yield of 331 de-duplicated studies. Ninety-three percent of studies (13/14) were conducted in Japan. All subjects included were over the age of 65 years old (mean, 76.5 years). Various tools were used to assess sarcopenia including handgrip strength (14/14 of studies), followed by skeletal muscle mass/index (7/14), tongue pressure, gait speed, and calf circumference in 5/14 studies. The most commonly tool used for dysphagia and/or swallowing dysfunction was the food level intake scale (5/14 of studies) followed by the functional oral intake scale (3/14). The 100-mL water swallow test was used in 2 of the 14 included SD studies. Fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallowing study, EAT-10 questionnaire, and standardized swallow assessment were each used in only one SD study. Further research is required to validate SD diagnostic tools, establish cut-offs in different populations, and investigate their role in screening of dysphagia and swallowing dysfunction in the elderly. more...

While celiac disease (CeD) is considered to affect primarily the small intestine, pathological changes in other parts of the gastrointestinal tract (GIT) are also known to occur. IgA anti-tissue transglutaminase-2 antibody (anti-TG2 Ab) deposits at the site of involvement is one of the methods to establish CeD-related tissue pathology. To explore the utility of IgA anti-TG2 Ab deposits in pan-gastrointestinal mucosal biopsies as evidence of CeD-related pathologies. Forty-two treatment-naive patients with CeD and 45 patients with irritable bowel syndrome were included as cases and controls, respectively. Mucosal biopsies were collected from the esophagus, stomach, duodenum, and rectosigmoid regions at baseline from cases and controls, and additionally after 6-months of gluten-free diet in cases. All biopsies were evaluated for histological changes and subjected to dual-color immunohistochemical staining for identifying IgA anti-TG2 Ab deposits. Significantly higher number of patients with CeD had lymphocytic esophagitis (9.7% vs. 0%, P = 0.05), lymphocytic gastritis (35% vs. 8.8%, P more...

Introduction and Aim: The prevalence of thyroid disorders all over the world is on the rise. However, the diagnosis is complicated among the elderlies due to factors such as non-specific clinical manifestations and interacting medications. The aim of the study is to estimate the prevalence and type of thyroid dysfunction among the elderly. Materials and Methods: The cross-sectional study was undertaken in the Department of General Medicine of a tertiary care teachinghospital. The study included 100 subjects aged above 60 years, of both genders. Data for clinical examination and biochemical tests such as T3, T4, TSH and lipid profile were collected. Reports of USG/FNAC, performed in cases of thyroid nodule, were also checked.Results:The prevalence of thyroid disorders was 22% of the study population. Overt and subclinical hypothyroidism were observed among 4% and 17% respectively, with 1% having hyperthyroidism. Subclinical hypothyroidism was more common among women. No specific trend was observed with increasing age.TPO antibodies were positive among 73% of the cases. Patients with thyroid dysfunction had higher values of triglycerides, total cholesterol and LDL. The proportion of dyslipidemia was significantly higher among elderly with thyroid dysfunction as compared to people with no thyroid dysfunction (90.90% Vs 24.35%, P value < 0.001). Conclusion: Thyroid dysfunction in the elderly is common. Strong clinical suspicion of thyroid diseases in elderly patients presenting with non-specific symptoms is needed. This would aid in the diagnosis of thyroid disorders among the elderly. more...

OBJECTIVE To noninvasively assess myelin status in chronic white matter lesions of multiple sclerosis (MS), we developed and evaluated a simple classification scheme based on T1 relaxation time maps derived from 7-tesla postmortem and in vivo MRI. METHODS Using the MP2RAGE MRI sequence, we classified 36 lesions from 4 postmortem MS brains as "long-T1," "short-T1," and "mixed-T1" by visual comparison to neocortex. Within these groups, we compared T1 times to histologically derived measures of myelin and axons. We performed similar analysis of 235 chronic lesions with known date of onset in 25 MS cases in vivo and in a validation cohort of 222 lesions from 66 MS cases, investigating associations with clinical and radiological outcomes. RESULTS Postmortem, lesions classified qualitatively as long-T1, short-T1, and mixed-T1 corresponded to fully demyelinated, fully remyelinated, and mixed demyelinated/remyelinated lesions, respectively (p ≤ 0.001). Demyelination (rather than axon loss) dominantly contributed to initial T1 prolongation. We observed lesions with similar characteristics in vivo, allowing manual classification with substantial interrater and excellent intrarater reliability. Short-T1 lesions were most common in the deep white matter, whereas long-T1 and mixed-T1 lesions were prevalent in the juxtacortical and periventricular white matter (p = 0.02) and were much more likely to have paramagnetic rims suggesting chronic inflammation (p more...

Clinicians always face a challenge in selecting the appropriate material for clinical use. Presently, the term bioactive is being used judiciously and unquestionably in the field of dental materials. The introduction of nanotechnology brought about a revolution in material science leading to the development of bioactive materials for caries prevention and management. This review comprehensively evaluates the use of bioactive materials for modification of the oral biome, prevention of dental caries, and the management of dental caries as restorative materials. Six online database (PubMed, Scopus, Science Direct, Embase, Web of Science, and Cochrane library) were systematically searched using broad keywords. Published articles were scrutinized, analyzed and the full-text articles were selected. Data reveals relatively limited application of tissue engineering and regeneration for enamel and dentin due to their limited ability to remodel. However, many steps are being taken in biomimetic approach for the modification of dentin. The path to overcoming any challenges will require active collaboration among clinicians, a material scientist and pulp biologist. more...

Objectives The aim of this study was to review the clinical profile, management, and outcome of solid tumors in the head-and-neck region in children at our institute. Methods We retrospectively reviewed children with head-and-neck solid tumors who were treated jointly under the departments of Pediatric Surgery and Otorhinolaryngology at our institute between 2016 and 2019. Results In the study period, 10 children (6 males, 4 females) with a median age of 9.5 years (range 5 days-16 years) were treated by our unit. The patients had four tumors arising from the parotid, 2 from nose/naso-pharynx, 1 each from the tongue, submandibular gland, para-pharyngeal space, and infratemporal fossa. A majority (90%) of the patients underwent complete surgical excision of the tumor, preserving the loco-regional neurovascular structures to minimize postoperative morbidity. Malignant lesions were seen in 4 patients (2 rhabdomyosarcoma, 1 primitive neuro-ectodermal tumor, 1 mucoepidermoid carcinoma) and 6 patients had benign pathology (3 pleomorphic adenoma, 2 mature teratoma, 1 schwanomma). Additional therapy with chemotherapy and local radiotherapy was required in 3 out of 4 patients with malignant pathology. The median follow-up duration is 15 months. At last follow-up, all patients are alive and 9 out of 10 patients (90%) are disease-free. Conclusion Our experience highlights rare and difficult tumors in the head-and-neck region in children. These tumors are not commonly managed by the pediatric surgeon in routine practice. The paper outlines the multi-modality management of these tumors, which is essential for an optimal outcome. more...

Technological advancements and volatile customer demand over the globe have forced manufacturing industries to adopt smart and sustainable manufacturing practices. Now the industries are moving towards the Industry 4.0 to satisfy the mass customization demands as well as to create sustainable value creation. Indian industries are considered as one of major manufacturing hub for the automobile components in world and plays an important role in development of Indian economy. However, the adoption level of Smart manufacturing practices in India is limited due to technological, economical and other challenges. Industries are still struggling with the adoption of smart and sustainable manufacturing practices in the developing economies like India. Therefore, this study aims to find the relationship between sustainable and smart manufacturing practices in the emerging economies. In the present study we have used the hypothesis modelling approach to link the manufacturing competitiveness and top management commitment with the sustainable and smart manufacturing practices. The data is collected with the help of questionnaire survey from the Indian manufacturing industries. Further, Structural equation modelling approach (SEM) is used. The results of this study highlights how manufacturing industries can adopt the smart and sustainable manufacturing practices in the developing economies like India. more...

BACKGROUND Exposure of various tropical infections and infestations like tuberculosis, filariasis, malaria, anemia, kala-azar and poor sanitation are major health concerns in Bihar and it’s neighboring state. Spleen size increases in several other diseases e.g., metabolism or storage disorder, malignancies and hematological disorders. Determining the normal parameters of spleen is essential for assessment of splenomegaly in routine ultrasonography (USG) or in the computed tomography (CT) scan. In this study, we wanted to estimate the CT based measurement of splenic dimensions in various planes, splenic index (linear dimension) and splenic volume and also to estimate the relationship of splenic index and splenic volume with age, gender and other splenic dimensions. METHODS It was a retrospective study and data was collected from January 2019 to December 2019. A total of 154 cases (including both genders) of age range 18 - 60 years were collected from the vitrea system (Vitrea software used for the 3-D assessment of splenic volume) and clinical data was collected from the medical record section. CT scan data of only those patients were included who had the clinical history of pain in abdomen, abdominal trauma or other diseases not affecting the spleen. Various measurements including splenic length and thickness at hilum and maximum thickness in axial view and height (maximum interpolar and true vertical height) in coronal views were recorded. RESULTS 154 cases including both gender and age range of 18 - 60 years were included in our study. There were 60 males and 94 females. The average age of the male and female patients was 45.93 +/- 15.19 years and 45.87 +/- 15.12 years respectively. The mean splenic dimensions were 9.03 +/- 1.49 cm in length (axial view), 3.69 +/- 0.05 cm thickness at hilum (axial view) and 9.05 +/- 2.23 cm maximum craniocaudal length and 7.9 +/- 2.96 cm true vertical length (coronal view). Mean splenic index and mean splenic volume were 340.30 +/- 107.39 cm3 and 227.02 +/- 62.22 cm3 respectively. There was statistically significant correlation between splenic volume and maximum craniocaudal length (r2 = 0.4848, P = 0.001), maximum axial length (r2 = 0.4765, P < 0.001) and true vertical length (r2 = 0.3142, P = 0.001) with 95 % confidence interval. For all splenic measurements, there was stronger correlation with maximum craniocaudal length followed by maximum axial length. However, there was no statistically significant correlation either of splenic volume with age in either gender (r2 = 0.019, P = 0.043) or splenic index with age in either gender present (r2 = 0.016, P = 0.059). CONCLUSIONS Maximum splenic length both in coronal (craniocaudal) and axial sections are positively and strongly correlated with splenic volume and splenic index but age of the individuals doesn’t show any correlation either with the splenic volume or with splenic index. Hence, a regional reference of splenic parameters was established with a slightly different range of values reported previously. KEY WORDS Splenic Volume, Splenic Index, Computed Tomography more...

Coronavirus Infectious Disease (COVID-19) has taken heavy toll on human lives and world economy across the globe. Till date, there is no specific treatment and pathological effects in COVID-19 are continuously evolving. The governments and authorities have announced various measures for personal care with use of face masks, physical distancing and prohibition of mass gatherings. These measures have certainly helped to contain the disease but with substantial economic slowdown. Thus mass immunization by vaccination is the top priority. With knowledge of MERS-SARS (Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome) in hand, researchers are rushing to vaccine development against SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) with newer technological platforms. However, the challenge lies in proving safety, quality and efficacy of vaccine with its resilience to manufacture it in large scales within stipulated time frame. The time consuming nature of classical phased clinical trials are substituted by human volunteer challenge with vaccination of humans engaging undertrial vaccine. This review discusses about various technology platforms being used and tried, their types and challenges in development of vaccine for SARS-CoV-2. Briefly, Indian perspective is also discussed in the race of vaccine development. more...

We provide the South Asian Declaration, containing the consensus guidelines for coronavirus disease 2019 (COVID-19) vaccination in cancer patients.

Pancreatitis is as common in children as it is in adults, though causes and accepted imaging strategies differ in children. In this narrative review we discuss the epidemiology of childhood pancreatitis and key imaging features for pediatric acute, acute recurrent, and chronic pancreatitis. We rely heavily on our collective experience in discussing advantages and disadvantages of different imaging modalities; practical tips for optimization of ultrasound, CT, and MRI with MRCP in children; and image interpretation pearls. Challenges and considerations unique to imaging pediatric pancreatitis are discussed, including timing of imaging, role of secretin-enhanced MRCP, utility of urgent MRI, severity prediction, autoimmune pancreatitis, and best methods for serial imaging. We suggest a methodical approach to pancreatic MRI interpretation in children and have included a sample structured report, and we provide consensus statements according to our experience imaging children with pancreatitis. more...

Celiac disease (CeD) is a systemic, immune-mediated enteropathy, which is triggered by gluten protein in genetically susceptible individuals. CeD, once thought to be an uncommon disease, is now recognized to affect approximately 40-60 million people globally. While CeD is now well reported from a few Asian countries such as India, China, Pakistan, and Middle Eastern countries; it is still believed to be uncommon in the rest of Asia. Gluten-related diseases other than CeD, like non-celiac gluten sensitivity (NCGS) are also emerging globally. CeD and NCGS may present with either intestinal or extra-intestinal symptoms, and a proportion of them have overlapping symptoms with irritable bowel syndrome. Hence, many of them are misdiagnosed as having irritable bowel syndrome in clinical practice. In this review, we discuss the emergence of CeD and other gluten-related disorders, both globally and in Asia, the overlapping manifestations between gluten-related disorders and irritable bowel syndrome, and the challenges associated with diagnosis and management of CeD in Asia. more...

Children’s robotics skills can be assessed in various ways, one being examining the unique projects that they create. This paper discusses the multi-phase development and testing of a robotics project rubric. The rubric considers both the programming concepts and the aesthetic design elements of a project, which enables researchers and practitioners to determine the overall level of complexity exhibited in the robotics project. This paper presents the background literature and theoretical framework that contributed to the rubric design and summarizes findings from iteratively developing and testing the rubric with a total of 173 robotics projects. Implications for future research and practice are also discussed. more...

Patients with celiac disease (CeD) can commonly present with symptoms of dyspepsia. We conducted a systematic review and meta-analysis of the present literature to assess the prevalence of CeD in patients diagnosed with dyspepsia. We searched MEDLINE and EMBASE databases for the keywords: celiac disease, coeliac disease, anti-gliadin, tissue transglutaminase antibody, anti-endomysial antibody, dyspepsia and functional gastrointestinal disorder. All the studies published from January 1991 till May 2021 were included. Diagnosis of CeD was based on the European Society of Pediatric Gastroenterology, Hepatology and Nutrition guidelines. A random-effects model was used to pool the data. Twenty-one studies screening 10,275 patients with dyspepsia were included. The pooled seroprevalence of CeD based on a positive anti-tissue transglutaminase antibody and/or anti-endomysial antibody was 4.8% (95% CI [2.8, 6.7%], I2 = 87.7%). The pooled biopsy-confirmed CeD prevalence was 1.5% (95% CI [1.0, 1.9%]; I2 = 59.8%) in these patients. Both seroprevalence (Odds ratio: 1.8; 95% CI [0.8, 4.0%]; I2 = 0%) and prevalence of biopsy-confirmed CeD (Odds ratio: 1.4; 95% CI [0.8, 2.4]; I2 = 0%) were not higher in patients with dyspepsia compared to controls. There was a moderate risk of selection bias and significant heterogeneity in the pooled results. The pooled prevalence of CeD in patients with dyspepsia was 1.5% and it was not significantly higher than the general population. These results do not support screening of patients with dyspepsia for CeD. more...

While the small intestine is the main site of disease, many other organs are affected by celiac disease (CeD). Dental enamel defects (DED) are common in patients with CeD, and these are one of the indicators of CeD, even when no other symptom of CeD is present. Data on dental and oral cavity manifestations in Asian patients with CeD are scanty. The purpose of the current study was to evaluate dental and oral manifestations in Asian patients with CeD. We recruited 118 patients with biopsy-confirmed CeD (36 treatment naive and 82 on follow-up for at least 1 year on gluten-free diet [GFD]) and 40 controls. Diagnosis was made as per the standard criteria. Oral and dental manifestations were evaluated by a dental surgeon. The DED were evaluated according to Aine’s criteria. Overall higher number of patients with CeD (66.9%), both treatment naive (69.4%) and those on GFD (65.8%) had DED in comparison to controls (20%) (odds ratio, 8.1, 95% confidence interval [CI] 3.4–19.2; p more...

BACKGROUND Cutaneous involvement by classic Hodgkin lymphoma (CHL) is an extraordinarily rare phenomenon in the current era. To date, no single large case series of cutaneous involvement by Hodgkin lymphoma has ever been reported in the literature. METHODS A comprehensive search for cases designated "skin" and "Hodgkin" was performed at different institutions between 1990 and 2020. Twenty-five cases were identified, and each case was independently reviewed by at least three board-certified dermatopathologists and/or hematopathologists. RESULTS All cases represented examples of systemic CHL with secondary skin dissemination. A single lesion, usually a tumor, nodule or infiltrative plaque was observed in 56% of cases and multiple lesions were present in 28% of cases. Most patients (86%-12/14) had a diagnosis of stage IV disease at first diagnosis. The interval between the clinical (first) diagnosis of HL and the development of skin lesions ranged between 6 and 108 months (average 33.75 months). Comprehensive histopathologic evaluation of these cases (at the initial diagnosis) revealed a diagnosis of classic HL not otherwise specified (NOS) in 60% of cases (15/25), nodular sclerosis type in 24% (6/25), mixed cellularity in 12% (3/25), and lymphocyte depleted in 4% (1/25). CONCLUSIONS We provide documentation of a large series of CHL with secondary skin involvement in association with CHL with additional clinical, morphologic, and immunophenotypic features. more...

The Indian Society of Gastroenterology (ISG) felt the need to organize a consensus on Helicobacter pylori (H. pylori) infection and to update the current management of H. pylori infection; hence, ISG constituted the ISG's Task Force on Helicobacter pylori. The Task Force on H. pylori undertook an exercise to produce consensus statements on H. pylori infection. Twenty-five experts from different parts of India, including gastroenterologists, pathologists, surgeons, epidemiologists, pediatricians, and microbiologists participated in the meeting. The participants were allocated to one of following sections for the meeting: Epidemiology of H. pylori infection in India and H. pylori associated conditions; diagnosis; treatment and retreatment; H. pylori and gastric cancer, and H. pylori prevention/public health. Each group reviewed all published literature on H. pylori infection with special reference to the Indian scenario and prepared appropriate statements on different aspects for voting and consensus development. This consensus, which was produced through a modified Delphi process including two rounds of face-to-face meetings, reflects our current understanding and recommendations for the diagnosis and management of H. pylori infection. These consensus should serve as a reference for not only guiding treatment of H. pylori infection but also to guide future research on the subject. more...

Tibial plateau fracture have been a challenge to treat as these fractures are associated with severe damage to the soft tissue envelope and significant communition and bone loss. This may be due to high speed velocity accidents or fall from height. There exist no gold standard approach in treating these fractures, each case may vary in terms of soft tissue injury, communition and association of neurovascular status. This study was conducted by department of orthopaedics at Government Medical College Ernakulam from February 2018 to January 2020, during this period 30 patients managed by internal fixation was evaluated for their functional outcome. The patients were assigned into two groups; those treated with locking plate and another being the Non locking group. Follow up range was 10-24 months, average being 17.4.This study revealed locking plates to be superior in terms of knee scores, radiological outcomes and post-operative pain. more...