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Background: Currently, either Hem-o-lok (HOL) clip or stapler is being used to control the renal vein in laparoscopic right living donor nephrectomy. The study aims to compare the quality of renal vein retrieved using either HOL clip or Endo TA 30 stapler (TAS) in laparoscopic right living donor nephrectomies. Materials and Methods: We retrospectively analyzed the perioperative data of right-living donor nephrectomies performed at our institute. For the venous control, either two HOL clips (15 mm) or an Endo TA-30 stapler (30 mm–2.5 mm, 3 rows of staples) were used. Perioperative variables from both the donor group and corresponding recipients were recorded and analyzed. A Student’s t-test was used to compare. Results: HOL was applied in 48 (n1) and TAS in 78 (n2) donors, for the control of renal vein. The retrieved length of right renal vein was significantly longer in TAS than in HOL (2.28 ± 0.24 vs. 1.76 ± 0.12 cm, P < 0.001). There was no statistically significant difference in warm ischemia time (5.82 ± 0.89 vs. 5.86 ± 0.91 min, P = 0.84), blood loss (103.65 ± 33.00 vs. 103.64 ± 33.62 mL, P = 0.87), and total surgery duration (139.74 ± 25.83 vs. 140.41 ± 26.33 min, P = 0.86) in both the group. Furthermore, there was no statistically significant difference in postoperative diuresis, acute tubular necrosis, and serum creatinine at 3 months (1.01 ± 0.20 vs. 0.97 ± 0.19 mg/dL, P = 0.67) in corresponding recipients. Conclusion: Endo TAS provides a comparatively longer allograft vein along with an edge of the inferior vena cava than the HOL clip.

Purpose: The COVID-19 pandemic was caused by severe acute respiratory syndrome coronavirus-2 (SARS-COV2). The impact of the pandemic is becoming more apparent now on various tissues and body organs. Limited knowledge is present about the characteristics, duration, and long-term sequelae of ocular problems post-COVID-19 infection. The purpose of the present study was to evaluate and analyze the ocular problems occurring in healthcare workers after COVID-19 infection. Material and Method: This was a cross-sectional survey study conducted in the Department of Ophthalmology, Patna Medical College and Hospital, Patna. The participants were healthcare workers who were exposed to COVID-19 infection ≥6 months back. A questionnaire was prepared. Responses were evaluated and analyzed. Patient consent and institutional committee permission were taken as per norms. Result: A total of 210 healthcare workers who were infected with COVID-19 >6 months back responded with complete answers. The maximum number of respondents was between the ages of 31 and 60 (73.3%). The pre-covid ocular problems were present in 25% of the participants, especially in those having chronic diseases (such as diabetes, hypertension, or both). Post-ocular problems were faced by 60% of the participants, which was significant (P < 0.01). Dry eye, itching, and foreign body sensations were present in 60% of those facing ocular problems (P < 0.01). Ocular surface manifestations were more common. Conclusion: A knowledge, understanding, and awareness about ocular problems and their long-term sequelae in post-COVID-19-infected patients will help in early diagnosis and better management of such patients.

Background: This survey delved into the diverse practices regarding the placement and removal of temporary restorations in the field of endodontics. Employing a Google Forms questionnaire containing 16 inquiries, the study sought to capture varied trends prevalent among practitioners. The survey was conducted for 2 months, engaging 250 participants through social media platforms by sharing a generated link for the Google survey. Materials and Methods: The questionnaire covered a spectrum of aspects related to temporary restoration procedures, aiming to gather insights into the methodologies, techniques, and protocols adopted by practitioners during these processes. By employing an Internet-based survey tool, the researchers efficiently collated responses from a diverse pool of professionals. Results: The study’s focus encompassed understanding the nuances in temporary restoration practices, emphasizing the significance of structured guidelines or protocols in ensuring efficient and standardized procedures. Through the collected responses, the survey aimed to identify prevalent trends, disparities, and potentially innovative approaches in the placement and removal of temporary restorations within the domain of endodontics. Conclusion: Ultimately, the survey results are anticipated to provide valuable insights into the varied methodologies employed in temporary restoration procedures, potentially paving the way for standardization or enhancement of protocols in this critical aspect of endodontic therapy.

Introduction: Root canal irrigants combat endodontic microbial flora, effectively targeting resilient microbes like Enterococcus faecalis, which persist despite treatment. Chlorhexidine (CHX), as an irrigant, boasts broad-spectrum antibacterial activity, notable substantivity in dentine, and favorable biocompatibility. In the realm of nanotechnology, the use of silver nanoparticle (AgNP) solutions appears promising, given their strong antibacterial and antimicrobial properties. Objective: The objective of the study was to compare the antimicrobial effectiveness of varying concentrations (1%, 0.75%, and 0.5%) of AgNPs and 2% CHX against E. faecalis. Materials and Methods: Four irrigant solutions, including 1%, 0.75%, and 0.5% AgNPs and 2% CHX with gentamicin as the control, will be assessed. The ATCC 29212 strain of E. faecalis will be cultivated at 37°C on brain–heart infusion Broth plates. After 48 h, the bacterial population will be quantified by counting colony-forming units on agar plates. Each irrigant will be applied to the plates, and the resulting bacterial inhibition zone will be measured. Results: Our study demonstrates the antimicrobial effects of 1%, 0.75%, and 0.5% AgNPs and 2% CHX against E. faecalis. While 2% CHX exhibited superior activity, AgNPs at various concentrations also displayed inhibitory effects against E. faecalis. Conclusion: In conclusion, this study highlights the antimicrobial properties of 1%, 0.75%, and 0.5% AgNPs and 2% CHX against E. faecalis. The results indicate that 2% CHX exhibits superior activity, while AgNPs at various concentrations also demonstrate inhibitory zones against E. faecalis.

Background: “Domestic violence” is defined as “a pattern of behavior in any relationship that is used to gain or maintain power and control over an intimate partner.” Intimate partner violence during the phase of pregnancy enhances the risk of abortion, preterm birth, low birth weight babies, and intrauterine death. Aim & Objective: To assess the prevalence of intimate partner violence among antenatal women and its association with various sociodemographic and obstetric factors. Materials & Method: This was a cross sectional community based study which was carried out in the rural area of district Jabalpur (M. P.) among 230 pregnant women for period of 1 year (March 2021–February 2022) Intimate partner violence was assessed by using HURT, INSULT, THREATEN, and SCREAM scale. Results: Prevalence of intimate partner violence was 29 (12.6%) among antenatal women. Strong correlation was found between age of respondents with intimate partner violence (P = 0.026). Physically hurt, insult or talk down, threaten with physical harm, and scream or curse were reported by 29.6%, 51.3%, 33.9%, and 54.8% antenatal women, respectively. Conclusion: Health care workers at ground level are most important personnel to screen out antenatal women for intimate partner violence due to multiple contacts during the course of pregnancy and it should be included in routine antenatal care.

Immunotherapy has ushered in a new era of cancer treatment, yet cancer remains a leading cause of global mortality. Among various therapeutic strategies, cancer vaccines have shown promise by activating the immune system to specifically target cancer cells. While current cancer vaccines are primarily prophylactic, advancements in targeting tumor-associated antigens (TAAs) and neoantigens have paved the way for therapeutic vaccines. The integration of artificial intelligence (AI) into cancer vaccine development is revolutionizing the field by enhancing various aspect of design and delivery. This review explores how AI facilitates precise epitope design, optimizes mRNA and DNA vaccine instructions, and enables personalized vaccine strategies by predicting patient responses. By utilizing AI technologies, researchers can navigate complex biological datasets and uncover novel therapeutic targets, thereby improving the precision and efficacy of cancer vaccines. Despite the promise of AI-powered cancer vaccines, significant challenges remain, such as tumor heterogeneity and genetic variability, which can limit the effectiveness of neoantigen prediction. Moreover, ethical and regulatory concerns surrounding data privacy and algorithmic bias must be addressed to ensure responsible AI deployment. The future of cancer vaccine development lies in the seamless integration of AI to create personalized immunotherapies that offer targeted and effective cancer treatments. This review underscores the importance of interdisciplinary collaboration and innovation in overcoming these challenges and advancing cancer vaccine development.

Introduction: There is an unmet need for high-quality data for Robot-assisted partial nephrectomy (RAPN) in the Indian population. Indian study group on partial nephrectomy (ISGPN) is a consortium of Indian centers contributing to the partial nephrectomy (PN) database. The current study is a descriptive analysis of perioperative and functional outcomes following RAPN. Methods: For this study, the retrospective ISGPN database was reviewed, which included patients who underwent RAPN for renal masses at 14 centers across India from September 2010 to September 2022. Demographic, clinical, radiological, perioperative, and functional data were collected and analyzed. Ethics approval was obtained from each of the participating centers. Results: In this study, 782 patients were included, and 69.7% were male. The median age was 53 years (interquartile range [IQR 44–62]), median operative time was 180 min (IQR 133–240), median estimated blood loss was 100 mL (IQR 50–200), mean warm ischemia time was 22.7 min and positive surgical margin rates were 2.5%. The complication rate was 16.2%, and most of them were of minor grade. Trifecta and pentafecta outcomes were attained in 61.4% and 60% of patients, respectively. Conclusions: This is the largest Indian multi-centric study using the Indian Robotic PN Collaborative database to evaluate the outcomes of robot-assisted PN, and has proven its safety and efficacy in the management of renal masses.

Abstract Background The Indian Swachh Bharat Mission (SBM) was launched in 2014 with the goal to make India open defecation (OD) free by October 2019. Although it is known that the ambitious goal was not achieved, the nature of the sanitation change brought about by the SBM in different parts of India is poorly understood. One reason is a dearth of case studies that would shed light on the performance of the SBM simultaneously across its different domains. This article provides an example of such study. Employing a Process, Outcomes, Context approach, the objective is to understand the process and outcomes of the SBM-induced sanitation change in a specific context of rural Jharkhand. Methods The study utilizes data collected through field research conducted in the rural areas of Ranchi district, Jharkhand, a state in east-central India. This data was obtained via repeated cross-sectional household surveys conducted at the beginning and at the end of the SBM, supplemented by key informant interviews with SBM stakeholders. Findings We identified political support of SBM implementation and its acceptance amongst the population. Female community workers became key agents of SBM implementation at local level. The SBM increased toilet coverage in the study area from 15% to 85% and lowered the OD rate from 93% to 26%. It substantially reduced structural inequalities in access to toilets, furthered social sanitation norms, improved some of the attitudes towards toilet use, but impacted less on hygiene and sanitation knowledge. The implementation mainly concentrated on the construction of subsidized toilets but less on improving public understanding of safe sanitation practices. Conclusions Although the SBM reduced sanitation inequalities in access to toilets in the study area, the behaviour change component was underplayed, focusing more on spreading normative sanitation messages and less on public education. Sustainability of the observed sanitation change remains a key question for the future. This article calls for more systematic production of geographically situated knowledge on the performance of sanitation interventions.

The present study aims to examine the influence of pillar widths on the stability of caverns. Case study considering two caverns viz. Powerhouse Cavern (PHC) and Transformerhall Cavern (TC), in a major hydro-electric project in the eastern Himalayas is considered. 2D and 3D numerical analysis was carried out for w/B ratios 1.5 and 3.0 respectively. Primary aspects like major principal stress and development of plastic zone were investigated for the two pillar widths. An optimum pillar width was observed that resulted in reduced stress acting along the cavern periphery, a better stress distribution, and no overlap of plastic zones between the caverns. Further, the optimum pillar width resulted in a better stress-redistribution with progress of excavation and the in-situ stress became constant at an earlier stage of excavation. Observations from comparative analysis revealed that a pillar width nearly equal to the largest dimension or twice the width of the larger of the caverns in the group resulted in a better stability and hence can be considered as the optimum width. Furthermore, the analysis suggests that along the pillar width, maximum stress was observed at mid-height, and it is more in the vicinity of the face of the caverns.

The performance enhancement of an inverter-based grid-connected system necessitates a fast and accurate dynamic response in terms of estimating three-phase grid voltage attributes. The synchronous reference frame phase-locked loop (PLL) and/or the frequency-locking (i.e., frequency-locked loop) approaches are widely used in practical applications. However, due to the phase/frequency feedback loops, the aforementioned parameter estimation schemes may experience instability and provide a slow dynamic response. This work presents a PLL-less grid synchronization solution for three-phase applications to counter the slower dynamic response and demonstrate better immunity against the nonideality of a three-phase grid. In order to remove even and odd-order harmonics and extract the fundamental frequency positive sequence (FFPS), the proposed method employs a combination of band pass filters (CBPFs). Additionally, a novel frequency estimation algorithm is developed, which accurately estimates the angular three-phase grid frequency. Furthermore, the phase angle and amplitude are adaptively estimated using an off-line error-resolving approach, which is derived from the transfer function of the proposed prefiltering solution. Finally, the experimental findings validate the robustness of the current proposal.

During the operation of a reversible pump-turbine, a hump area can easily appear under the pump condition, which will greatly affect the performance of a storage unit, with pressure pulsation being the key factor for the stable operation of a pump-turbine. Therefore, in order to explore the pressure pulsation characteristics of each flow component in the hump area, this paper first compared the full characteristics of the model test under different working conditions, and then it analyzed the pressure pulsation characteristics. By analyzing the pressure pulsation characteristics in the unit’s flow component under different flow rates in the hump area, the pulsation rule of a pump-turbine running in the hump area was revealed. It was found that the peak-to-peak value of the draft tube in the hump area was the smallest under the optimal flow condition, and the peak-to-peak value increased along the flow direction, with the rotor and stator interaction (RSI) effects being continuously enhanced. When away from the runner basin, the influence of RSI gradually weakened after leaving the runner. No low frequency was found in the optimal traffic. The peak-to-peak value of the low flow condition increased compared with the optimal flow condition, and the distribution was not uniform. The main frequency of the whole basin was relatively complex, indicating that the flow of water was unstable in the condition of partial load, resulting in the hump area during the unit operation. The research results can provide a theoretical reference for improving the stability of pump-turbines.

Clustered regularly interspaced short palindromic repeat (CRISPR)-based genome editing (GED) technologies have unlocked exciting possibilities for understanding genes and improving medical treatments. On the other hand, Artificial intelligence (AI) helps genome editing achieve more precision, efficiency, and affordability in tackling various diseases, like Sickle cell anemia or Thalassemia. AI models have been in use for designing guide RNAs (gRNAs) for CRISPR-Cas systems. Tools like DeepCRISPR, CRISTA, and DeepHF have the capability to predict optimal guide RNAs (gRNAs) for a specified target sequence. These predictions take into account multiple factors, including genomic context, Cas protein type, desired mutation type, on-target/off-target scores, potential off-target sites, and the potential impacts of genome editing on gene function and cell phenotype. These models aid in optimizing different genome editing technologies, such as base, prime, and epigenome editing, which are advanced techniques to introduce precise and programmable changes to DNA sequences without relying on the homology-directed repair pathway or donor DNA templates. Furthermore, AI, in collaboration with genome editing and precision medicine, enables personalized treatments based on genetic profiles. AI analyzes patients’ genomic data to identify mutations, variations, and biomarkers associated with different diseases like Cancer, Diabetes, Alzheimer’s, etc. However, several challenges persist, including high costs, off-target editing, suitable delivery methods for CRISPR cargoes, improving editing efficiency, and ensuring safety in clinical applications. This review explores AI’s contribution to improving CRISPR-based genome editing technologies and addresses existing challenges. It also discusses potential areas for future research in AI-driven CRISPR-based genome editing technologies. The integration of AI and genome editing opens up new possibilities for genetics, biomedicine, and healthcare, with significant implications for human health.

Background: Right living donor nephrectomy is technically more demanding because of the anatomical differences. Patient safety is the utmost priority because it is performed on healthy donors. We hereby describe our experiences with surgical modifications to minimize donor morbidity and overcome surgical challenges in the cases of right living donor nephrectomy. Materials and Methods: In this retrospective comparative study, we analyzed the prospectively maintained perioperative and follow-up data of standard and modified right living donor nephrectomies performed in the recent past 10 years at our institute. We also compared the significant events in corresponding recipients. Student's t-tests were used to define statistical significance. Results: A total of 1530 laparoscopic living donor nephrectomies were performed between 2012 and 2021, of which 117 were on the right side. Of them, 62 donors underwent modified right laparoscopic donor nephrectomy (MRLDN) and 55 underwent standard right laparoscopic donor nephrectomy. The mean duration of surgery (103.44 ± 14.59 vs. 139.45 ± 25.99 min), warm ischemia time (4.30 ± 0.59 vs. 5.89 ± 0.91 min), and blood loss (90.24 ± 24.75 vs. 103.72 ± 33.37 mL) were significantly lower in modified as compared to standard donor nephrectomy (P < 0.05). There was no significant difference in postoperative diuresis, acute tubular necrosis, and serum creatinine at 3 months in the corresponding recipient group. Conclusion: MRLDN is a safe, reliable, and reproducible technique of right laparoscopic donor nephrectomy.

Abstract Background Primary testicular leiomyosarcoma has a rare occurrence and the diagnosis is uncertain on pre-operative assessment. It is often seen in the background of chronic inflammation, radiotherapy, and the use of high-dose anabolic steroids. Case presentation We report a case of a painless testicular lump in a septuagenarian with pre-existing diabetes mellitus and hypertension but without any oncological risk factors. The primary workup did not reveal any elevation of serum tumour markers or any signs of metastatic disease on contrast imaging. The patient underwent a high inguinal orchiectomy due to a suspicion of germ cell tumor, and histopathology and immunohistochemistry confirmed the diagnosis of leiomyosarcoma. Conclusion Testicular leiomyosarcoma in the elderly is a rare malignancy and usually occur without any pre-existing risk factors. Early treatment provides long-term curative oncological control.

Corrosion implies to the irreparable damage or demolition of living tissues or materials due to electrochemical reactions. The automotive sector is rather bellicose and gives rise to metal corrosion in automotive parts due to high amount of pollution generated and due to de-icing salts. In power plants, corrosion is the principal agent leading to costly and critical downtimes. The water-steam circuits in fossil and nuclear power plants are inherently prone to corrosion, as metal components are constantly in contact with water. This review paper provides the overview of distinct types of corrosion in automotive and thermal power plant, their causes and measures to prevent them.

Synchronization is a crucial process in the operation of grid-connected distributed energy sources. Synchronization techniques are classified in closed-loop (CLS) and open-loop synchronization (OLS) techniques. Unlike the CLS technique, OLS techniques are recent and less known. This paper discusses a comparative analysis of the three prominent state-of-the-art OLS techniques. Accordingly, a benchmark model is proposed to systematically evaluate the performance of the OLS techniques under grid voltage disturbances such as harmonic distortions, voltage unbalance, DC offset, and low voltage ride through operation. Given the hardware resource utilization, the computational complexity and the execution time are also presented to judge the efficacy of the proposed model. Thus, engineers/or researchers can better understand the choice of hardware resources and the preferred dynamic performance of a synchronization scheme applied to control and protect a grid-tied power converter. Simulation and experimental results are presented and discussed to demonstrate the purpose of the proposed model.

Context: Optimum main renal artery (RA) length before first branching needed to achieve single lumen during laparoscopic donor nephrectomy (LDN) is not known. Aims: The aim of the study is to identify optimal minimum length of RA before first branching which can be safely harvested as a single lumen in LDN. Settings and Design: This is a single institutional, retrospective study. Materials and Methods: Records of consecutive left LDNs performed at our institute from January 2016 to June 2019 were reviewed. RA length was measured from preoperative computed tomography angiogram. We clipped RA using two Hem-o-lok® and one titanium clip while maintaining constant mild upward traction. Primary outcome was to identify lowest RA length at which chances of achieving a single lumen were maximum. Secondary outcomes included minimum RA length below which single lumen could not be achieved and incidence of intraoperative vascular complications. Statistical Analyses: Receiver operator characteristic curve was plotted according to donor RA length. Likelihood ratio positive (LR+) was used to identify optimum length of RA above which chances of achieving single lumen were maximum. Results: Four hundred and eighty-eight donors with single RA underwent left LDN during study period. LR +of achieving single lumen after clipping was maximum at 10mm cutoff. Single lumen could not be achieved below 6–7 mm cutoff. There were no vascular complications or re-explorations. Conclusions: Main left RA length ≥10 mm before first branching is most likely to yield single lumen for implantation with our technique.

Abstract Background With increased penetration of the internet and social media, there are concerns regarding its negative role in influencing parents’ decisions regarding vaccination for their children. It is perceived that a mix of religious reasons and propaganda by anti-vaccination groups on social media are lowering the vaccination coverage in Malappuram district of Kerala. We undertook a qualitative study to understand the factors responsible for generating and perpetuating vaccine hesitancy, the pathways of trust deficit in immunization programs and the interaction between various social media actors. Methods In-depth interviews and focus group discussions were conducted among parents/caregivers, physicians, public sector health staff, alternative system medical practitioners, field healthcare workers and teachers in areas with highest and lowest vaccination coverage in the district, as well as with communication experts. Results The trust deficit between parents/caregivers and healthcare providers is created by multiple factors, such as providers’ lack of technical knowledge, existing patriarchal societal norms and critical views of vaccine by naturopaths and homeopaths. Anti-vaccine groups use social media to influence caregivers' perceptions and beliefs. Religion does not appear to play a major role in creating vaccine resistance in this setting. Conclusions A long-term, multipronged strategy should be adopted to address the trust deficit. In the short to medium term, the health sector can focus on appropriate and targeted vaccine-related communication strategies, including the use of infographics, soft skills training for healthcare workers, technical competency improvement through a mobile application-based repository of information and creation of a media cell to monitor vaccine-related conversations in social media and to intervene if needed.

Penile fracture with an associated urethral injury is a rare urological emergency resulting from trauma to the erect penis during vigorous sexual intercourse. The patient often presents with swelling of the penis, discoloration of the penile skin, localized pain, and hematuria with a typical history of sudden detumescence during intercourse. Subcoronal penile degloving incision has been conventionally described and is frequently used by many clinicians for the management of penile fracture-urethral injury. Here, we describe a case of complex penile fracture managed through the vertical penoscrotal incision. The penoscrotal approach confers excellent exposure to both the ruptured corpus cavernosum and urethra. This approach ensures successful outcomes in such an emergency procedure without having disadvantages of the degloving incision.

Cancer is a problematic global health issue with an extremely high fatality rate throughout the world. The application of various machine learning techniques that have appeared in the field of cancer diagnosis in recent years has provided meaningful insights into efficient and precise treatment decision-making. Due to rapid advancements in sequencing technologies, the detection of cancer based on gene expression data has improved over the years. Different types of cancer affect different parts of the body in different ways. Cancer that affects the mouth, lip, and upper throat is known as oral cancer, which is the sixth most prevalent form of cancer worldwide. India, Bangladesh, China, the United States, and Pakistan are the top five countries with the highest rates of oral cavity disease and lip cancer. The major causes of oral cancer are excessive use of tobacco and cigarette smoking. Many people’s lives can be saved if oral cancer (OC) can be detected early. Early identification and diagnosis could assist doctors in providing better patient care and effective treatment. OC screening may advance with the implementation of artificial intelligence (AI) techniques. AI can provide assistance to the oncology sector by accurately analyzing a large dataset from several imaging modalities. This review deals with the implementation of AI during the early stages of cancer for the proper detection and treatment of OC. Furthermore, performance evaluations of several DL and ML models have been carried out to show that the DL model can overcome the difficult challenges associated with early cancerous lesions in the mouth. For this review, we have followed the rules recommended for the extension of scoping reviews and meta-analyses (PRISMA-ScR). Examining the reference lists for the chosen articles helped us gather more details on the subject. Additionally, we discussed AI’s drawbacks and its potential use in research on oral cancer. There are methods for reducing risk factors, such as reducing the use of tobacco and alcohol, as well as immunization against HPV infection to avoid oral cancer, or to lessen the burden of the disease. Additionally, officious methods for preventing oral diseases include training programs for doctors and patients as well as facilitating early diagnosis via screening high-risk populations for the disease.

With the rapid expansion of robotic platforms in urology, there is an urgent and unmet need to review its cost and benefits in comparison to the traditional laparoscopy, especially in reference to a developing country. A nonsystematic review of the literature was conducted to compare the outcomes of pure laparoscopic and robot-assisted urologic procedures. Available literature over the past 30 years was reviewed. Robot-assisted surgery and laparoscopy were found to have similar outcomes in the areas of radical prostatectomy, partial and radical nephrectomy, radical cystectomy, retroperitoneal lymph node (LN) dissection, inguinal LN dissection, donor nephrectomy, and kidney transplantation. Robot-assisted surgery was found to be significantly costlier than pure laparoscopy. In the absence of a clear advantage of robot-assisted surgery over pure laparoscopy, lack of widespread availability and the currently prohibitive cost of robotic technology, laparoscopic urological surgery has a definite role in the developing world.

Background: Personnel deployed at an altitude ranging from 9000 ft to 23,000 ft are exposed to sub-zero temperatures up to −40°C. These conditions lead to the development of various cold injuries which presents in varying grades and severity. Aim: The aim of this study is to study the epidemiological trends and assess risk factors/conditions those are contributing to the development of cold weather injuries (CWI) at extreme cold climate in high altitude areas. Methodology: This is a retrospective, observational study on cold injury cases evacuated from the northern glaciers of India. The data were collected and tabulated in MS-Excel sheets, and analysis was done using percentage, mean, median, linear regression, and P value calculation. SPSS statistical analysis software version 23 was employed for generating the results. P < 0.05 was considered for statistically significant. Results: The annual incidence of cold injuries calculated for troops deployed at high altitude (>9000 feet) with extreme cold climate is 6.4/1000/year. The average duration of exposure for the development of CWI was found to be 4.85 h with a standard deviation = 2.88 h. Statistically significant association was found between the median temperatures and number of cold injury cases evacuated monthly with a strong negative coefficient of correlation (Pearson's) value r = −0.8214, and P = 0.001063. No correlation was found between the severity of frostbites and duration of exposure as the coefficient of correlation r (Pearson's) was weakly positive with a value of 0.19 and statistically not significant with P = 0.127. Conclusion: This study highlights the magnitude of problem, high risk zones, and predisposing activities. Statistical association has been drawn between altitude, temperature and duration of exposure with burden of cold injury. This study provides an insight with respect to associations and risk factors for the development of CWI, in Indian perspective and may be beneficial for better planning and preventive measures to reduce burden of CWI.

Background: The literature on the impact of comorbidities on the severity and outcome of COVID-19 in kidney transplant patients is limited. We aimed to review the same. Methods: We conducted this review as per Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. PUBMED, Embase, Scopus, and Science Direct were searched for studies, available online till May 31, 2020. Studies reporting comorbidities, clinical course, and outcome of each kidney transplant patient with COVID-19 were included. Studies on any other organ transplant, recommendations, or review articles were excluded. The impact of comorbidities on severity and outcome was assessed. The study appraisal was done using Joanna Briggs Institute Critical Appraisal Checklist. Continuous variables were compared using Mann–Whitney U-test. Categorical variables were compared using Fisher's exact test. A univariate and multivariate logistic regression for predictors of severity and outcome, was done. P < 0.05 was considered statistically significant. The study protocol was registered with PROSPERO (CRD42020190114). Results: We analyzed 19 studies (56 patients) out of the 355 identified. The most common comorbidity was hypertension (83.92%). Nearly 30.35% of the patients had severe clinical course. The mortality rate was 19.64%. Advanced age was statistically significantly associated with severe course (P = 0.0173) and death (P = 0.0005). Men were more likely to have nonsevere course (P < 0.0001). No comorbidity had any impact on the severity or outcome. Patients with severe disease had higher odds of dying (P = 0.002). Conclusions: Comorbidities were not found to have any significant impact, hence the contribution of immunosuppression toward the severity of COVID-19 needs to be studied. Ours is the first review to assess the impact of comorbidities in kidney transplant patients with COVID-19 but limited by the number of patients.

Liquid crystals are molecular systems that exhibit partial ordering of molecules similar to solids while maintaining the ability to flow like liquids. Depending upon the amount of ordering in the material, there are many types of liquid crystalline phases. The nematic phase is the most common and technologically most important one due to its use in display applications. In the nematic phase, the molecules tend to have the same alignment, but their positions are not correlated. In part due to fundamental scientific interest and driven by new technological motivations apart from displays, the existence of new stable nematics has been continuously searched. The continuing search led to a recent discovery of a new type of nematic phase,1,2 known as the twist-bend nematic (Ntb), in certain bent-shaped liquid crystal dimers that have been supported by various independent experimental studies. Since the Ntb phase has been discovered recently, its properties have not been fully explored and a detailed description and understanding at the molecular level are still far from complete.3 The Ntb phase’s formation is highly sensitive to any slight changes in the molecular shape arising from the chemical makeup of the linking spacer, terminal moieties and mesogenic units.4, Such structural features are not accessible directly through experiments. Thus, in this work, we present a set of DFT calculations on a series of liquid crystal dimers. This work aims to probe the role of certain structural features in driving the formation of the Ntb phase. This study also reveals why this phase occurs in certain bent molecules, but not in all. Since the constituent molecules are flexible and exist in a range of conformers, comparing the conformational landscapes of the dimers-exhibiting-the-Ntb-phase against those-do-not would identify the molecular conformations promoting the formation of the Ntb phase. Overall, this study evaluates ideal molecular structural features and conformational ensembles potentially responsible for the appearance of the Ntb phase.

Three generations of the Miniature X-ray Solar Spectrometer (MinXSS) have flown on small satellites with the goal “to explore the energy distribution of soft X-ray (SXR) emissions from the quiescent Sun, active regions, and during solar flares, and to model the impact on Earth’s ionosphere and thermosphere.” The primary science instrument is the Amptek X123 X-ray spectrometer that has improved with each generation of the MinXSS experiment. This third-generation MinXSS-3 has a higher energy resolution and larger effective area than its predecessors and is also known as the Dual-zone Aperture X-ray Solar Spectrometer (DAXSS). It was launched on the INSPIRESat-1 satellite on 2022 February 14, and INSPIRESat-1 has successfully completed its 6 month prime mission. The INSPIRESat-1 is in a dawn–dusk, Sun-synchronous orbit and therefore has had 24 hr coverage of the Sun during most of its mission so far. The rise of Solar Cycle 25 has been observed by DAXSS. This paper introduces the INSPIRESat-1 DAXSS solar SXR observations, and we focus the science results here on a solar occultation experiment and multiple flares on 2022 April 24. One key flare result is that the reduction of elemental abundances appears greatest during the flare impulsive phase, thus highlighting the important role of chromospheric evaporation during flares to inject warmer plasma into the coronal loops. Furthermore, these results are suggestive that the amount of chromospheric evaporation is related to flare temperature and intensity.

Grid faults are found to be one of the major issues in renewable energy systems, particularly in wind energy conversion systems (WECS) connected to the grid via back-to-back (BTB) converters. Under such faulty grid conditions, the system requires an effective regulation of the active (P) and reactive (Q) power to accomplish low voltage ride through (LVRT) operation in accordance with the grid codes. In this paper, an improved finite-control-set model predictive control (FCS-MPC) scheme is proposed for a PMSG based WECS to achieve LVRT ability under symmetrical and asymmetrical grid faults, including mitigation of DC-link voltage fluctuation. With proposed predictive control, optimized switching states for cost function minimization with weighing factor (WF) selection guidelines are established for robust BTB converter control and reduced cross-coupling amid P and Q during transient conditions. Besides, grid voltage support is provided by grid side inverter control to inject reactive power during voltage dips. The effectiveness of the FCS-MPC method is compared with the conventional proportional-integral (PI) controller in case of symmetrical and asymmetrical grid faults. The simulation and experimental results endorse the superiority of the developed FCS-MPC scheme to diminish the fault effect quickly with lower overshoot and better damping performance than the traditional controller.

Study Design: Open level experimental design. Purpose: Ceramics are effective, safe, and good alternatives of iliac crest autograft for spinal fusion. There were not enough study available to compare among ceramics for fusion in spinal surgery. Our aim was comparative assessment of posterolateral spinal arthrodesis radiologically and clinically in dorsolumbar spine trauma using hydroxyapatite (HA), tricalcium phosphate (TCP), and 60% HA + 40% TCP. Overview of Literature: Surgical management of thoracolumbar spine injury has encouraged early rehabilitation and avoided adverse effects of prolonged recumbency. Instrumentation enhanced spinal fusion which was the main technique of spinal stabilization. Although iliac crest autograft is the gold standard for spinal fusion,the procedure is not devoid of major and minor complications. A variety of ceramics are available as good alternatives for spinal arthrodesis. There are not any studies in the literature comparing spinal fusion rate among commonly used ceramics. Materials and Methods: Patients having Thoraco Lumbar Injury Classification and Severity score ≥4 underwent pedicle screw fixation and decompression (if required). We applied chips of HA, TCP, or 60% HA + 40% TCP for fusion. At 12-month follow-up, computed tomography scan of involved spine was done to assess posterolateral fusion by Lenke classification. Clinical follow-up was done evaluating pain status (visual analog scale). Mean follow-up duration was 27.8 months. Radiological and clinical parameters were compared among three groups. Results: A total of 45 patients (16 received HA, 15 received TCP, and 14 received [60%HA + 40%TCP]) were analyzed. About 28.88% of total patients had Lenke Grade A fusion and 51.11% had Grade B, but no statistically significant difference (P = 0.09) among three groups. Although reduction of pain score occurred individually in all three groups,no significant difference (P = 0.3)was noted among three groups. Conclusions: There was no statistically significant difference in fusion rate and change in pain perception with applied ceramics (HA/TCP/[60%HA + 40%TCP]).

Inward foreign tourism in India is on the rise and the tourists are equally at risk of fatal road accidents and stroke leading to brain death. This provides an opportunity for organ donation; however, no guidelines are available on how to proceed in such cases. The Transplantation of Human Organs Act 1994 is also silent on this aspect. This paper seeks to lay down recommendations and guidelines for hospitals, healthcare professionals, Transplant Coordinators and the state machinery allocating such organs on how to proceed with such cases. Three such donations by foreign nationals in India were examined and based on the experience of coordinating them, guidelines have been drawn up. It was seen that families agreed readily where the individual had expressed the desire to be an organ donor (by opting the same on the driving licence or coming from a country that follows presumed consent). Effective counselling also encouraged consent in case of no prior wish. However, absence of guidelines and standard protocols creates confusion. In order to increase the donor pool, donations from foreign nationals in India should be streamlined. Also, from a human rights perspective, India needs to enable the choice of organ donation for every person who is declared dead within its territory.

This commentary highlights the potential consequences of the COVID-19 pandemic for India’s rural population. The rural health care system in India is not adequate or prepared to contain COVID-19 transmission, especially in many densely populated northern Indian States because of the shortage of doctors, hospital beds, and equipment. The COVID-19 pandemic creates a special challenge due to the paucity of testing services, weak surveillance system and above all poor medical care. The impacts of this pandemic, and especially the lockdown strategy, are multi-dimensional. The authors argue for the need to take immediate steps to control the spread and its aftereffects and to use this opportunity to strengthen and improve its primary health care system in rural India.

BACKGROUND: There are no studies pertaining to resilience related to novel coronavirus focusing primarily on doctors and undergraduate medical students in India. The objectives of this survey were to assess the resilience and its various domains that are needed for dealing with novel coronavirus among doctors, interns, and undergraduate students and to see its correlation with various sociodemographic factors. MATERIALS AND METHOD: An online cross-sectional survey was done among doctors and undergraduate medical students during the first COVID-19 wave from May 19, 2020 to June 8, 2020. A total of 434 responses were recorded during the study period. All the recorded full responses were considered for data analysis. Snowball sampling was used for this study. Resilience was assessed using three items, which were taken from the Brief Resilience Scale (BRS). RESULT: Out of 434 responses, 51.7% (224/433) of the respondents were non-resilient. The presence of the elderly at home was significantly associated with poor resilience (P = 0.02). Resilience was not significantly associated with other socio-demographic factors. Younger respondents (P = 0.019) and females (P =0.0004) were of the opinion that they recovered late from stressful events. Elderly respondents (P = 0.003) and those with chronic illness (P = 0.008) reported that it is hard for them to snap back if something bad happens (P = 0.003). CONCLUSIONS: More than half of the doctors and undergraduate medical students were found to be non-resilient, underscoring the urgent need to take steps to improve the resilience of this group of frontline workers.

Background: Fifteen percent of adults and 20%–30% of pediatric patients develop renal failure, results from structural urological abnormalities. Successful renal transplantation depends partly on a bladder which has adequate capacity, good compliance, and efficient voluntary emptying. Urinary bladder rehabilitation with augmentation or diversion is necessary before transplant in these patients to achieve good graft outcome. We, hereby report our last 10 years' experience of such patients undergoing kidney transplant in abnormal bladder. Materials and Methods: A total of 14 patients underwent renal transplantation in rehabilitated bladder from 2006 to 2016. Demographic details, prereconstruction bladder and urodynamic findings, and type of pretransplant reconstruction were recorded. Posttransplant creatinine levels, graft survival at 7 days, 3 months, 1 year, and 3 years were recorded. Results: Mean (± standard deviation) serum creatinine posttransplant at 7 days, 3 months, 1 year, and 3 years was 0.9 (±0.20), 1.58 (±0.65), 1.92 (±1.02), and 2.47 (1.17) mg/dl, respectively. Four patients developed rejection within 6 months of transplant. Kidney biopsy was suggestive of acute cellular rejection in all cases, which was treated successfully. At three years follow-up, four patients who had rejection-have rising creatinine levels and diminishing renal functions. No patient needed dialysis support till last follow-up. All these four patients had rejection, urinary tract infection (UTI) episodes and pyelonephritis in the past. Conclusion: Native bladder is the best reservoir for urinary storage and drainage. The main cause of graft dysfunction in rehabilitated bladder is UTI as a result of poor hygiene, contamination during clean intermittent self-catheterization (CISC) and noncompliance for CISC leading to high residual urine. Controlling frequent attacks of UTI posttransplant is essential, otherwise long-term graft survival and function will deteriorate faster and might trigger rejection.

Rothmund–Thomson syndrome is a rare, autosomal recessive genodermatosis characterized by an early-onset poikiloderma, skeletal abnormalities, short stature, premature aging, and increased susceptibility to malignancy. We report a case of a 1-year-old male child with bullous lesions and pigmentary changes over the face and extremities. Strict photoprotection and careful surveillance for malignancy forms the mainstay of treatment. The case is being reported due to its rarity and the diagnostic dilemmas associated with it.

Adenocarcinoma prostate treated with hormone deprivation may evolve into a neuroendocrine differentiated tumor. Usually visceral metastasis are seen in neuroendocrine tumors. We present a case of neuroendocrine differentiated urethral metastasis from a hormone deprived prostate cancer.

Introduction: Renal transplantation is the treatment of choice for children with end-stage renal disease (ESRD). We evaluated the outcome of renal transplantation in the pediatric and adolescent age groups in the perspective of a developing country as compared with developed nations while highlighting the challenges we have faced in a pediatric transplant programme. Materials and Methods: Seventy live related pediatric and adolescent renal transplantations were reviewed retrospectively. Variables analyzed were etiology of ESRD, pre-transplant renal replacement modality, donor relationship, surgical complications, rejection episodes, immuno-suppression regimens, compliance to immunosuppression, graft survival and overall survival. Results: The cohort consisted of 13 (18%) female and 57 male (82%) recipients. The mean age was 14 ± 1.4 years. The etiology of ESRD was chronic glomerulonephritis (n = 43), chronic interstitial nephritis (n = 26) and Alport′s syndrome (n = 1). Fifty-six (80%) children were on hemo-dialysis and 10 (14%) on peritoneal dialysis prior to transplantation. 80.5% and 61% patients were strictly compliant to immunosuppresant medications at 1 and 5 years. The 1, 3 and 5 year graft survival rates were 94.3%, 89.2% and 66.8%, respectively. The overall survival rates were 95.7%, 96.4% and 94.1% for 1, 3 and 5 years, respectively. Conclusions: The spectrum of etiology of ESRD differs in our patients from the west, with chronic glomerulonephritis being the most common etiology. Early graft survival is comparable, but the 5-year graft survival is clearly inferior as compared with developed countries.

Genitourinary tuberculosis (TB) is a common form of extrapulmonary tuberculosis. The kidneys are usually affected by hematogenous seeding at the time of primary pulmonary infection. Genitourinary TB has non-specific clinical presentations and variable radiographic appearances. We are reporting a case of genitourinary TB presenting as bilateral renal mass. The patient underwent computed tomography-guided kidney biopsy that showed a granulomatous lesion. Then, the patient was put on anti-tuberculous treatment with a good response. We feel that patients having multiple bilateral kidney lesions should undergo biopsy to determine the nature of the lesion before any surgical intervention.

Adrenocortical carcinoma with tumor thrombus extending via an adrenal vein into the inferior vena cava is uncommon. We describe a left side kidney-preserving surgery in such a patient where, after transection of the main renal vein at the point of insertion of the adrenal vein, the left kidney was being drained by lumbar and gonadal veins.

Tuberculous osteomyelitis affecting long bones is a rare form of tuberculosis. Among infants born in endemic region, often it is difficult to diagnose owing to its subtle clinical features. Here, a case of tuberculous osteomyelitis affecting the distal radial metaphysis is reported, presenting as a cystic lesion in a nine-month-old male infant. Open biopsy with curettage was performed followed by filling of the cavity with synthetic bone substitute (beta tricalcium phosphate granules). The diagnosis was confirmed by histopathological examination and demonstration of acid fast bacilli. Further treatment with anti-tubercular drugs led to clinical and radiological improvement. This case report highlights the importance of keeping tuberculosis as a differential diagnosis while dealing with cases with similar presentation in an endemic region.

Background: Evaluation of result of anterior cervical approach with manubriotomy and anterior instrumentation in tuberculosis of cervicothoracic spine in terms of the neurological recovery, reconstruction of spine and prevention of deformity along with relief of pain. Materials and Methods: All five patients with cervicothoracic caries spine had surgery through anterior cervical approach with manubriotomy in our hospital and underwent excision of the involved vertebrae and intervertebral discs followed by anterior spinal reconstruction with titanium spacer cage filled with cancellous iliac crest bone graft and Orion plate with locking screw. Antitubercular drugs were administered for 12 months. The follow-up period ranged from 12 to 36 months. Results: Analysis of result was done on the basis of clinical and radiological criteria. Clinical assessment based on Frankel grade and modified JOA score showed significant improvement from preoperative findings. Radiological assessment showed osteointegration, no spinal instability and no progression of the deformity. The pain control, based on visual analog scale changed from a pre-operative average of 7.5 to 2 at the last follow-up thereby indicating significant improvement and all patients returned to preoperative functional status. One patient had transient hoarseness of voice. No other complication had been encountered in the immediate post operative and during the follow-up period. Conclusions: Our study showed that anterior cervical approach with manubriotomy and anterior insertion of titanium cage, filled with autogenous bone graft, secured with locking plate instrumentation has a successful role in the eradication of infection, neurological recovery, segmental spinal reconstruction and it also reduces surgical time, blood loss, and surgical complications and approach related comorbidity in follow up period. Level of Evidence- Level 4, Case series