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Abstract Background Robotic-assisted technologies have been developed to increase surgical precision and reduce surgical variability in total knee arthroplasty (TKA). Several different robotic systems have been introduced in the last decade for TKA. The DePuy Synthes VELYS™ Robotic-Assisted Solution (VRAS) is an imageless system designed to eliminate the need for preoperative CT scans and is one of the latest entrants in the rapidly evolving field of robotic technology in TKA. This study compared the clinical and economic outcomes associated with VRAS and other robotic-assisted technologies for primary TKA. Methods A retrospective cohort study using the Premier Healthcare Database included patients who underwent primary TKA with VRAS or other robotic-assisted technologies from January 1, 2022, to April 30, 2023. The primary outcome for the study was hospital follow-up visits (revisits) within 90 days post-TKA. Secondary outcomes included readmission and revision rates within 90 days post-TKA, operating room time, length of stay, discharge status and hospital costs. Cohorts were balanced using propensity score fine stratification, and generalized linear models were constructed to evaluate outcomes. Results This study included 827 VRAS TKA patients and 16,428 TKA patients treated with other robotic-assisted technologies. The 90-day all-cause and knee-related revisit rates were significantly lower for VRAS than for other robotic-assisted technologies (all-cause 13.9% vs. 22.8% and knee-related 2.8% vs. 5.4%, respectively; p value

Urban drainage channels act as significant routers of microplastics (MPs) originating from terrestrial to aquatic systems. In the present study, contamination of MPs (250–5,000 μm size) has been investigated in an interlinked urban aquatic system comprising Najafgarh drain, corresponding secondary drains, and Yamuna River in Delhi, India. A range of 100–4,300 MPs/m3 (pre-monsoon) and 100–6,700 MPs/m3 (post-monsoon) were detected in secondary drains, which meet the Najafgarh drain through its course in the city. Najafgarh drain showed an average abundance of 771 and 343 MPs/m3 during pre- and post-monsoon season, respectively. The discharge of MP-laden wastewater from the Najafgarh drain into the Yamuna River created a rise in MP abundance in the river at the drain’s downstream location. Thus, revealing that secondary drains play a significant role in MP channelization to the Najafgarh drain and subsequently Yamuna River. White MP fragments were dominating in the study area. Chemical characterization revealed 11 types of MP polymers, with a predominance of polyethylene. Considering the knowledge gap in MP database of interconnected urban aquatic systems in India, this study might help in providing baseline information and encourage more studies addressing the magnitude of this problem for predicting long-term environmental risks. HIGHLIGHTS Najafgarh and its corresponding secondary drains transport microplastic (MP) contaminants to Yamuna River, Delhi.; Fragment-type MPs were most abundant across the study area.; Dominant MP colors were white followed by blue.; Blue-colored HDPE pellets were characteristic MPs found in Supplementary drain, NG drain, and Yamuna River.; The study would help in developing a baseline MP database for this interlinked urban aquatic system.;

Leachate formation is one of the most important factors taken into account during the operation and long-term management of municipal waste landfills. Systematic assessment of groundwater and leachate contamination may be useful in selecting the appropriate method of leachate management or treatment processes. The use of indicators to quantify the contamination potential of leachate and groundwater in the vicinity of MSW could help landfill managers assess their quality. Therefore, the aim of the study was to assess the representativeness of selected indicator methods for analyzing the temporal variability of leachate and groundwater properties in the vicinity of two municipal waste landfills in a Central European country (Poland). The leachate pollution index (LPI), sub-LPI and adjusted leachate pollution index (r-LPI) were used to assess the quality of leachate water, while the landfill water pollution index (LWPI) was used to assess the variability of groundwater quality. The results confirmed that LWPI is an effective method for assessing the quality of groundwater in the vicinity of municipal waste landfills. The obtained results confirm the negative impact of landfills, despite the insulation used. LWPI showed poor quality of groundwater and visible impact of the landfill (landfill W, average LWPI - 2.34) and moderately polluted waters and minor impact of the landfill (landfill S, average LWPI - 1.37). In most cases, it was observed that two parameters, EC and TOC, are the main factors contributing to the deterioration of groundwater quality. The sub-LPI analysis showed that leachates from both landfills have a very low content of heavy metals, so they should not have a negative impact on the biological treatment process. The obtained r-LPI values were in all cases higher than the calculated LPI values. For landfill S, the average r-LPI was 26.3 (Z-1) and 25.7 (Z-2). However, the average LPI was 13.5 (Z-1) and 13.2 (Z-2). For landfill W, the average r-LPI was 14.6 and the average LPI was 11.4. Analysis conducted on multi-year leachate and groundwater data using specific indicators can help managers better understand the impact of MSW on surrounding areas and help avoid potential operational problems in the future.

Introduction Infertility affects 13% to 15% of the couples worldwide. The problem of infertility can have varying effects, depending on the physical and mental health of the couple, ultimately influencing the environment and the overall growth of society. Analysis of a semen sample may lead to various defects in the semen quality and quantity like azoospermia, which means the absence of spermatozoa in the semen ejaculate. Conversely, in oligospermia, the sperm count in the semen ejaculate is low. Micro-organisms, pus cells etc indicate infection in semen and hence can point towards existing infection causing oligospermia. Hence, this study was done to highlight the importance of semen analysis in hospitals and to present a detailed audit of the semen analysed at the tertiary care centre. Materials and methods This is a cross – sectional study where data of 3 years from 2020-to 2023 was collected and tabulated under the reported headings - volume, appearance, motility, pus cells, and any other relevant findings at School of Medical Science and Research, Sharda University. A total of 299 semen samples were analysed. Results Total number of cases recorded were 299. Out of the total samples, 36.5% of the samples showed reduced motility. 1.7% samples had immotile sperms while reduced motility was seen in 8.4% cases. 24.7% cases showed some degree of abnormal forms (categorised by WHO criteria). 35% cases had pus cells above 5/hpf. Conclusion This study has demonstrated that abnormal semen analysis, especially, in terms of sperm quantity, quality, and bacterial infection is a major factor in infertile male having abnormal semen parameters.

Background: Extremely Low Birth Weight (ELBW) newborns, defined as those with a birth weight of 1000 grams or less, present challenging anesthetic scenarios. Emergency surgeries in these infants elevate their vulnerability to various complications. Case Presentation: We present a case series involving 5 ELBW neonates who underwent emergency surgery. Three of them were at a post-conceptual age (PCA) of ≥ 33 weeks and underwent procedures for congenital birth defects, including esophageal atresia, ileal atresia, and gastroschisis. The remaining two neonates, with a PCA of 29-30 weeks, underwent surgery for necrotizing enterocolitis (NEC). Conclusion: The compromised physiology resulting from distinct disease processes and the underdeveloped systems of ELBW preterm neonates necessitate focused care and strategic anesthesia. This approach is crucial to mitigate morbidity and mortality risks in such vulnerable patients.

Abstract Background Various formulae have been used to predict appropriate endotracheal tube (ETT) size in children, but there is no consensus regarding the best predictor. Recent use of ultrasonography (USG) to predict the ETT size may not always be feasible leaving the physical parameters as most useful and practical option. The present study was planned to compare age-, height- and weight-based formulae for ETT size prediction in children. Results The accuracy in predicting ETT size was found to be 88.67%, 73.33% and 32.67% for height-based formula (HBF), age-based formula (ABF) and weight-based formula (WBF), respectively. Pearson correlation coefficient was best for HBF (0.968 with 95% CI of 0.937–0.999), followed by ABF (0.942 with 95% CI of 0.887–0.996) and WBF (0.874 with 95% CI of 0.794–0.953). HBF was found to be best suited for children 1–3 years, ≤ 90 cm and weight < 15 kg with accuracy of > 98%, while WBF was unsatisfactory across all age, height and weight groups. Conclusions HBF is the best predictor of ETT size across all age groups with marginal superiority over ABF, especially in age group < 3 years. WBF was least effective in predicting ideal ETT size. It is recommended that HBF should be preferred over ABF and WBF for selection of ETT size in paediatric patients. This practice assumes greater importance especially in emergency situations where exact age and weight cannot be ascertained while height is easily obtainable.

Quality is essential in today’s competitive market to ensure customers are happy; recent research shows that about 90% of customers think quality is just as important as price when purchasing. Total quality management (TQM) has been a boon to the economies of many countries. Different tools and methods are used in TQM to give customers the best quality. However, there are some challenges that manufacturing organizations face when implementing these tools. Much research has been done on MSME sector, so far as label manufacturers are concerned, there has yet to be any research on a national or international level. In this study, we found 66 barriers to programs to improve quality in the label printing industry. We have used fuzzy MICMAC analysis and total interpretive modeling (TISM) to make a structural model. Our research paper provides an easy-to-use methodology and critically analyses the biggest obstacles to the successful application of TQM in the flexographic printing industry. Our research identified ten issues with the implementation of TQM in this industry. The paper has identified the interdependencies of the above variables. The findings of this research will aid in future planning, particularly in E-commerce and the pharmaceutical industry, where proper label printing is crucial.

INTRODUCTION Blood donation is an extremely important part of hospital work. One unit of blood donated can save a life hence hospitals lay stress on holding blood donation camps and encourage voluntary blood donation. Blood donation societies worldwide are encouraging 100% non-remunerated, voluntary blood donation to low-risk populations to fight the lack of blood components and prevent transfusion-transmitted diseases. The authors devised a survey with the intention of investigating awareness.

Burned-out testicular tumor is a very rare clinical entity. There are no clinical findings in the testicle because it regresses spontaneously without any treatment and generally presents with metastases. Burnt out testicle is often seen with Yolk sac tumour. The diagnosis of yolk sac tumours is usually a multimodality diagnosis including a biopsy of the lesion. We describe a case of metastatic yolk sac tumours that presented with deposits in inguinal lymph nodes. No testicular tumour was identified in our case.

The Yamuna River is a threatened resource of freshwater in Delhi, India. The present study is focused on investigating three important contaminants, namely microplastics (MPs), heavy metals, and fecal coliforms in the surface water of the river, with major emphasis on MPs occurrence and characterization. MPs showed an increase in abundance in the river from the Wazirabad barrage (n = 500 MPs/m3) to the Okhla barrage downstream (n = 3,900 MPs/m3) in Delhi, with a maximum abundance downstream to the Najafgarh and Shahdara drain outfalls. White color and fragmented shape were prevalent characteristics of the isolated MPs. Attenuated total reflectance–Fourier transform infrared (ATR-FTIR) spectroscopy revealed five types of polymers. Heavy metals (chromium, lead, manganese, and iron) and fecal coliforms were at unacceptable levels at most of the sampling sites. Due to the emergence of issues concerning the tendency of MPs to actively interact with heavy metals and pathogenic microorganisms, investigation of the co-occurrence of such harmful pollutants is very important. The present study is aimed at this issue and urges similar kinds of investigations in other riverine regions of our country, as well as globally, due to their scarcity in literature. This study can further provide a baseline database to help the Government of India's efforts to clean and revive the Delhi stretch of the Yamuna River. HIGHLIGHTS Microplastics (MPs) were prevalent across the Yamuna River stretch with a mean abundance of 1.78 × 103 MPs/m3.; MPs were most abundant near the wastewater discharge points of the Najafgarh and Shahdara drains.; In addition to MPs, the presence of co-contaminants like heavy metals and fecal coliforms in the study area was also a serious concern.; Co-contaminant interactions may disturb the balance of several biological systems.;

Schwannomas are benign nerve sheath tumors arising from differentiated Schwann cells. Common location is head & neck region, they are generally solitary. Retroperitoneal schwannomas are relatively rare accounting for 0.3 - 3.2% of benign schwannomas. Multiple schwannomas in the retroperitoneal region are extremely rare with only 4 cases reported till date. Pre-operative diagnosis of retroperitoneal schwannomas is difficult because they remain asymptomatic and also because they have a tendency to undergo cystic degeneration causing confusion in imaging studies. We present a case of 45 year old lady operated with provisional diagnosis of disseminated retroperitoneal hydatid cysts, which after histopathological examination was confirmed to be a case of multiple retroperitoneal schwannomas.

Abstract Electrostatic gating and light illumination are two widely used stimuli for semiconductor devices. Two‐dimensional electron gas (2DEG) at oxide heterostructures has shown potential in optoelectronics due to its high optical response and gate tuning property. The appearance of high photoconductivity and persistent photoconductivity at the oxide heterostructure of two insulators LaFeO3 and SrTiO3 is shown here. The photoconductivity has been further tuned using positive and negative back gating. A large change in conductivity has been achieved under the simultaneous application of light and electrostatic gating. A few measurement protocols that manifest possible applications of this interface as memory and switching devices are implemented.

We present the discovery of a unique Lyman-continuum (LyC) emitter at z = 3.088. The LyC emission was detected using the Hubble Space Telescope WFC3/UVIS F336W filter, covering a rest-frame wavelength range of 760–900 Å. The peak signal-to-noise ratio of LyC emission is 3.9 in an r = 0.″24 aperture and is spatially offset by 0.″29 ± 0.″04 (∼2.2 ± 0.3 kpc) from the peak of rest-UV emission (F606W). By combining imaging and spectroscopic data from the James Webb Space Telescope (JWST) JADES, FRESCO, and JEMS surveys, along with VLT/MUSE data from the MXDF survey, we estimate that the probability of random alignment with an interloper galaxy causing the LyC emission is less than 6 × 10 ^−5 . The interstellar medium (ISM) conditions in the galaxy are similar to those in other LyC emitters at high redshift ( $12+\mathrm{log}({\rm{O}}/{\rm{H}})={7.79}_{-0.05}^{+0.06}$ , $\mathrm{log}U=-{3.27}_{-0.12}^{+0.14}$ , O32 = 0.63 ± 0.03), although the single-peaked Ly α profile and lack of rest-UV emission lines suggest an optically thick ISM. Our observations indicate that LyC photons are leaking through a narrow cone of optically thin neutral ISM, most likely created by a past merger (as evidenced by medium-band F210M and F182M images). Using the constraints on escape fraction from individual leakers and a simple model, we estimate that the opening half-angle of ionization cones can be as small as 16° (2% ionized fraction) to reproduce some of the theoretical constraints on the average escape fraction for galaxies. The narrow opening angle required can explain the low number density of confirmed LyC leakers.

A Pediatric Endocrine Society (PES) Drugs and Therapeutics Committee workgroup sought to determine the prescribing practices of pediatric endocrinologists when treating children

The usual etiologies of giant abdominal cystic masses in infants are mesenteric cyst, enteric duplication cyst, ovarian cyst in females, cystic lymphangioma, however, the presentation of a choledochal cyst in a gigantic form, is unusual. The primary modality for diagnosis of this entity is ultrasound, followed by MRI. The characteristic ultrasound features of a choledochal cyst are a well-defined cystic lesion which may be found to replace any segment of the biliary tree and is distinctly separate from the gallbladder. The associated anomalies are biliary atresia, gallbladder atresia, hepatic fibrosis and those of the pancreatico-biliary ductal system. MRI with MRCP has a conclusive role in confirming the ultrasound diagnosis. Choledochal cysts are currently classified as proposed by Todani et al, into five types. Herein, we report the case study of a 4-month-old male infant afflicted with a gigantic, Type1 Choledochal cyst, complicated by perforation, which was diagnosed by us at the first instance itself, using ultrasound examination and confirmed by MRI. The diagnosis was further confirmed at surgery and histopathology. The recommended treatment of cyst resection accompanied by a hepatico-jejunostomy bypass procedure, was successfully performed in the reported infant.

Mucinous ovarian carcinoma is a less-prevalent subtype of epithelial tumors. We present a case of giant mucinous ovarian carcinoma weighing 41.1 kg in a 24-year-old Indian girl. Benign mucinous tumors have the potential to reach an enormous size but such a huge malignant mucinous tumor is very rare in literature and its occurrence in a young female is even rarer.

Extreme emission line galaxies (EELGs), where nebular emissions contribute 30%–40% of the flux in certain photometric bands, are ubiquitous in the early Universe ( z > 6). We utilize deep NIRCam imaging from the JWST Advanced Deep Extragalactic Survey ( JADES ) to investigate the properties of companion galaxies (projected distance 6.

Introduction: Medicolegal autopsies are performed to determine the cause and manner of death. Histopathological examination is reserved for only those cases where Cause Of Death (COD) is not readily apparent on autopsy. However, there are conflicting views regarding the utility of histopathological examination in medicolegal cases. Aim: To examine the role of histopathological examination in unravelling specific causes of mortality in two settings: 1) where collaborative clinical history and gross autopsy findings were available; 2) where definitive cause could be discovered only at the time of microscopic examination, thus altering its legal implications. Materials and Methods: This was a retrospective observational study including all medicolegal autopsy cases, in which histopathological examination was requested and sample was received at the Pathology Department, Dr Baba Saheb Ambedkar Medical College, New Delhi, India. Since this was a retrospective study, the data was compiled from medicolegal cases received by the department in two years i.e., from January 2018 to December 2019. Histopathological examination was performed in 96 cases out of which 10 were excluded due to autolysis (n=86). Haemotoxilin and Eosin (H&E)-stained slides were examined and special stains and Immunohistochemistry (IHC) applied wherever required. Gross and histopathological findings were recorded along with autopsy findings and clinical history. The results were tabulated and statistical analysis was done using the Chi-square and Fischer’s test to look for any significance and association between gross and microscopic findings in various organs. The p-value of

Abstract Background Coronavirus‐19 (COVID‐19) is a disease caused by the SARS‐CoV‐2 virus, the seventh coronavirus identified as causing disease in humans. The SARS‐CoV‐2 virus has multiple potential pathophysiologic interconnections with endocrine systems, potentially causing disturbances in glucose metabolism, hypothalamic and pituitary function, adrenal function and mineral metabolism. A growing body of data is revealing both the effects of underlying endocrine disorders on COVID‐19 disease outcome and the effects of the SARS‐CoV‐2 virus on endocrine systems. However, comprehensive assessment of the relationship to endocrine disorders in children has been lacking. Content In this review, we present the effects of SARS‐CoV‐2 infection on endocrine systems and review the current literature on complications of COVID‐19 disease in underlying paediatric endocrine disorders. We provide recommendations on management of endocrinopathies related to SARS‐CoV‐2 infection in this population. Summary and outlook With the surge in COVID‐19 cases worldwide, it is important for paediatric endocrinologists to be aware of the interaction of SARS‐CoV‐2 with the endocrine system and management considerations for patients with underlying disorders who develop COVID‐19 disease. While children and adults share some risk factors that influence risk of complications in SARS‐CoV‐2 infection, it is becoming clear that responses in the paediatric population are distinct and outcomes from adult studies cannot be extrapolated. Evidence emerging from paediatric studies provides some guidance but highlights the need for more research in this area.

Background: Tuberculosis (TB) control is challenging due to failure of drug compliance and resistance. Mycobacterial antigen-induced cytokine secretions are helpful in detecting Mycobacterium tuberculosis infection and to determine prediction for the fate of TB infection and its cure. Considering immunological response to be a crucial factor in pathogenesis and cure of TB, it can be explored to determine clinical prospects in different categorical tubercular infections. This study was designed to compare serum levels of inflammatory (tumor necrosis factor [TNF]-alpha and interferon [IFN]-gamma) and anti-inflammatory cytokines/chemokines (interleukin [IL]-10 and IL-8) among different TB groups (freshly diagnosed, relapse, cases on antitubercular treatment [ATT], and healthy controls). Methods: This cross-sectional study included total 100 subjects. The study subjects were further divided into four study groups with 25 cases in each of freshly diagnosed TB, TB relapse cases, cases on ATT, and 25 healthy controls. Levels of serum cytokines/chemokines (TNF-alpha, IFN-gamma, IL-10, and IL-8) were measured by flow cytometry. Results: Data analysis observed statistically significant differences in serum levels of TNF-alpha and IFN-gamma among the studied groups with significantly low levels in subjects on ATT and markedly high levels in TB relapse subjects. No statistically significant difference was observed in IL-10 and IL-8 levels. However, subjects with relapse revealed low IL-8 and high IL-10 levels. Conclusion: TNF-alpha and IFN-gamma have important roles in immune response and might be considered as indicators for response to ATT. However, high levels of IL-10 with low IL-8 appear to be associated with poor outcome and possibility of relapse.

Background: Metastatic tumors are the most common central nervous system (CNS) tumors wherein the primary site remains unknown in most of the cases. Aim: The study was carried out to evaluate metastatic CNS tumors with unknown primary by using simplified diagnostic (clinico-histopathologic) approach. Material and Methods: A 2 years study was conducted on 32 cases of CNS metastases having unknown primary tumors in a neurosciences institute. Statistical Analysis: All the results were prepared using software version of SPSS 22. Results: The most common metastatic site found in brain was cerebrum (59.3%) [frontal > frontoparietal > parieto-occipital > temporal] [left cerebrum > right cerebrum], followed by cerebellum (12.5%), spinal cord (9.3%), and leptomeninges (3.12%). Most of the metastatic tumors presented as ill-defined (34%) rather than well-defined (22%) lesions with ring enhancement seen only in 16% of the cases on magnetic resonance imaging (MRI).On histopathology findings with targeted immunohistochemistry, most common histological tumor type identified irrespective of site was adenocarcinoma (68.7%), followed by squamous cell carcinoma (15.6%) and poorly differentiated carcinoma (12.5%). Only one case of lymphoma was reported. Corroborating all the above findings along with clinical history and other relevant investigations, primary sites could be detected in 23 cases (71.8%).The most common primary site deduced was lungs (39.1%), followed by thyroid (17.3%), breast in females (13.0%), gastrointestinal tract (8.6%), and prostate in males (4.3%). Only in nine cases (28.1%) with mainly poorly differentiated histopathological type, primary site remained unknown. Conclusion: Detection of the primary site in metastatic CNS tumors is possible by adopting this simple and effective diagnostic approach at centers/hospitals having cost and other constraints.

Introduction Differences in sex development (DSD) are a heterogenous group of conditions estimated to affect 1 in 4500 infants. A paradigm shift has occurred in societal and cultural acceptance of variant gender outcomes along with increased awareness around diagnostic uncertainty inherent to DSD. Lack of provider knowledge in evaluation of DSD and/or awareness of evolving paradigms relevant to care for patients with DSD can accentuate barriers to access optimal care for this already vulnerable population. Methods To address this unmet need, we used Kern's six-step framework and piloted a team-based learning (TBL) activity for pediatric residents and medical students (36 learners). This included preactivity reading, an 11-item self-efficacy survey around treatment of patients with DSD at the beginning of the TBL, and a seven-question individual readiness assurance test (RAT). Mixed teams of five to seven learners completed the RAT in small groups followed by large-group discussion. An application exercise followed with two cases focused on initial evaluation of a newborn/child with suspected DSD and an older child with suspected DSD. At the conclusion, learners repeated the self-efficacy measure and answered several evaluation questions. Results Individual RAT scores had a mean of 59%, while groups scored with a mean of 82%. Mean self-efficacy scores also increased significantly from 2.4 to 3.4 on a 5-point scale. Of learners, 80% agreed or strongly agreed that the activity was effective for improving DSD skills and knowledge. Discussion TBL is a valuable educational strategy to enhance knowledge and self-efficacy of DSD care for general pediatricians.

We present spectroscopic confirmation of candidate strong gravitational lenses using the Keck Observatory and Very Large Telescope as part of our ASTRO 3D Galaxy Evolution with Lenses ( AGEL ) survey. We confirm that (1) search methods using convolutional neural networks (CNNs) with visual inspection successfully identify strong gravitational lenses and (2) the lenses are at higher redshifts relative to existing surveys due to the combination of deeper and higher-resolution imaging from DECam and spectroscopy spanning optical to near-infrared wavelengths. We measure 104 redshifts in 77 systems selected from a catalog in the DES and DECaLS imaging fields ( r ≤ 22 mag). Combining our results with published redshifts, we present redshifts for 68 lenses and establish that CNN-based searches are highly effective for use in future imaging surveys with a success rate of at least 88% (defined as 68/77). We report 53 strong lenses with spectroscopic redshifts for both the deflector and source ( z _src > z _defl ), and 15 lenses with a spectroscopic redshift for either the deflector ( z _defl > 0.21) or source ( z _src ≥ 1.34). For the 68 lenses, the deflectors and sources have average redshifts and standard deviations of 0.58 ± 0.14 and 1.92 ± 0.59 respectively, and corresponding redshift ranges of z _defl = 0.21–0.89 and z _src = 0.88–3.55. The AGEL systems include 41 deflectors at z _defl ≥ 0.5 that are ideal for follow-up studies to track how mass density profiles evolve with redshift. Our goal with AGEL is to spectroscopically confirm ∼100 strong gravitational lenses that can be observed from both hemispheres throughout the year. The AGEL survey is a resource for refining automated all-sky searches and addressing a range of questions in astrophysics and cosmology.

Introduction: Premenstrual Syndrome (PMS) is the combination of physical, emotional, physiological and psychological symptoms felt by females after ovulation of each menstrual cycle which may affect the quality of life of the professionals. Aim: To assess the quality of life among Health Care Professionals (HCP) during PMS. Materials and Methods: This was a cross sectional descriptive study conducted at MMIMSR, Mullana to assess the quality of life among HCPs during premenstrual period. Total 493 subjects were enrolled out of 520 after excluding those who didn’t participate in the study. Subjects were assessed on three scalesSocio demographic Performa, Premenstrual Symptoms Scale (PMSS), Quality of Life (QoL-10). The results were computed with descriptive statistical methods (frequency tables, ANOVA) using SPSS 20 version (IBM Inc Chicago) software. Results: Out of 493 subjects 253 had PMS. The parameters which showed significant association with QoL were age (

Background Levobupivacaine is an attractive alternative to racemic bupivacaine for spinal anesthesia due to the lower potential for cardio-toxicity and faster recovery profile. This study was designed to compare isobaric levobupivacaine with hyperbaric racemic bupivacaine with respect to intraoperative quality of anesthesia and the postoperative recovery profile in patients undergoing inguinal hernia surgery. Methods A total of 100 American Society of Anesthesiologists 1 and 2 patients, aged 18–60 years, undergoing elective daycare unilateral inguinal hernia surgery, were randomized into two groups. Group L received spinal anesthesia with 3 ml of 0.5% plain levobupivacaine. Group B received 3 ml of 0.5% hyperbaric racemic bupivacaine. Quality of anesthesia, sensory and motor block characteristics, duration of effective analgesia, time to mobilization, and incidence of side effects were compared. Results The quality of anesthesia was comparable between the two groups. No difference was observed in the block onset time or maximum block height. The duration of anesthesia was significantly shorter in group L compared with that in group B (206.2 ± 18.9 min vs. 224.1 ± 15.6 min, P < 0.001), as was duration of motor block (185.9 ± 20.3 min vs. 196.4 ± 21.2 min, P = 0.016) and time to walk unaided (321.9 ± 19.2 min vs. 356.7 ± 26.6 min, P < 0.001). The incidence of hypotension was less in group L (12%) compared to group B (32%) (P = 0.028). Conclusions Levobupivacaine is an effective alternative to bupivacaine for patients undergoing unilateral inguinal hernia surgery. It has a shorter duration of sensory and motor block, allowing earlier mobilization in daycare surgeries, and a lower incidence of intraoperative hypotension.

The objective of the present study is to investigate the current status of heavy metal pollution in River Yamuna, Delhi stretch. The concentrations of Nickel, Cadmium, Chromium, Copper, Iron, Lead, and Zinc in water samples have been studied during December 2013–August 2015. The overall mean concentration of heavy metals was observed in the following order Fe > Cu > Zn > Ni > Cr > Pb > Cd. Correlation analysis formed two distinct groups of heavy metals highlighting similar sources. This was further corroborated by results from principal components analysis that showed similar grouping of heavy metals (Ni, Zn, Fe, Pb, Cd) into PC1 having one common source for these heavy metals and PC2 (Cu, Cr) having another common source. Further, our study pointed out two sites i.e. Najafgarh drain and Shahdara drain outlet in river Yamuna as the two potential sources responsible for the heavy metal contamination. Based on heavy metal pollution index value (1491.15), we concluded that our study area as a whole is critically polluted with heavy metals under study due to pollutant load from various anthropogenic activities.

Introduction: The initial examination of cerebrospinal fluid (CSF) for proteins, glucose, and leukocytes, is still the gold standard investigation in some neurological conditions like meningitis. Aims and objective of the present study were to determine the accuracy of urinary reagent strip for semi-quantitative analysis of protein, glucose, leucocytes and erythrocytes in CSF along with its role in emergency for rapid diagnosis of neurological conditions. Materials and methods: 360 samples of CSF were received in emergency laboratory of a tertiary care hospital in a period of 6 months. All CSF samples were subjected to two types of tests-the definitive test and the index test. CSF microscopy for leucocyte and erythrocyte as well as biochemistry tests for protein and glucose on automated biochemistry analyser were considered as definitive test. The index test for protein, glucose, leucocyte and erythrocyte for the same sample was conducted by Combur-10 urinary reagent strip. Result: The strip test showed a sensitivity of 99% and a specificity of 54% for proteins. With respect to glucose, the strip was highly sensitive (98%) as well as highly specific (92%).It showed a high sensitivity and specificity for leukocytes ≥ 10 cells/cumm i.e.100% and 96% respectively. For CSF erythrocytes sensitivity and specificity was 100% Conclusion: Urinary reagent strip can be used routinely for rapid analysis of CSF. If implemented, this technique will be useful especially in emergency settings as well as in areas with limited resources. : Urinary reagent strip test: An alternative method for rapid analysis of CSF in neurological disorders in emergency settings lacking trained manpower and expensive equipments. Keywords: Cerebrospinal fluid analysis, Accuracy, Urinary reagent strips, Semi-quantitative, Emergency setting

Context: Certain quality indicators are mandatory in the maintenance and improvement of quality in blood transfusion. Monitoring of such indicators should be done regularly and deficiencies are to be corrected for effective blood transfusion services. Aims: To study the usefulness of monitoring of the National Accreditation Board for Hospitals and Healthcare Providers (NABH) core indicators in blood transfusion and in the maintenance of hemovigilance. Settings and Design: Hemovigilance is a "quality process" to improve quality and increase the safety of blood transfusion. It covers and surveys all activities of the blood transfusion chain from donors to recipients. Core indicators′ monitoring is a part of the hemovigilance process. Materials and Methods: A 2-year retrospective study was conducted in a blood storage unit of a NABH accredited tertiary care hospital of a metropolitan city. Four NABH core indicators in blood transfusion were observed and monitored by the clinical and blood storage unit staff of different levels. Results: It was observed that there was an improvement in quality by core indicators monitoring with decreased wastage of blood and blood components, decreased average turnaround time for issue of blood and blood components, and lesser number of transfusion reactions. Conclusion: This study demonstrated that monitoring of NABH core indicators results in the enhancement of quality and safety in blood transfusion services, reducing the incidence of transfusion reactions.

Background and Aims: India is a vast country with variable, nonuniform healthcare practices. A laryngoscope is an important tool during general anesthesia and resuscitation. The study aimed to determine the current practices of laryngoscope decontamination in India. Material and Methods: An online survey was conducted amongst 100 anesthesiologists to determine the common methods of laryngoscope decontamination adopted in their settings. The survey was done over 6 months after validating the questionnaire. Results: A total of 73 responses were received out of 100. The result of the survey revealed that there is no uniform technique of laryngoscope decontamination. There is marked variability in techniques followed not only among different institutions, but also within the same institution. Conclusion: There are no fixed protocols adopted for laryngoscope decontamination. Thus, there is a need to develop definitive guidelines on this subject, which can be implemented in India.

Judicious media planning decisions are crucial for successful advertising of products. Media planners extensively use mathematical models supplemented with market research and expert opinion to devise the media plans. Media planning models discussed in the literature largely focus on single products with limited studies related to the multi-product media planning. In this paper we propose a media planning model to allocate limited advertising budget among multiple products advertised in a segmented market and determine the number of advertisements to be given in different media. The proposed model is formulated considering both segment specific and mass media vehicles to maximize the total advertising reach for each product. The model also incorporates the cross product effect of advertising of one product on the other. The proposed formulation is a multi-objective linear integer programming model and interactive linear integer goal programming is discussed to solve the model. A real life case study is presented to illustrate the application of the proposed model.

Introduction: Patient's satisfaction is the need of the hour and one of the most important quality indicators in the laboratory medicine. Aim: To assess the patient’s satisfaction with phlebotomy services in a neuropsychiatric hospital by a structured questionnaire with grading scale. Also, identify the problems causing dissatisfactions and to undertake necessary Corrective and Preventative Action (CAPA). Materials and Methods: Total 1200 patients were randomly selected over a period of two months (June and July 2016). A structured self designed questionnaire (feedback form) was devised in both Hindi and English languages containing ten questions with a grading scale for each question. It also included suggestions from the users. All the selected patients or their attendants filled up this questionnaire. At the same time, they were also interviewed by phlebotomy staff. A statistical analysis was conducted using SPSS version 16.0 software and Likert scale. Results: A total of 94% of the patients were satisfied with the phlebotomy services. Almost 30.0% patients found the phlebotomy services to be very good, but the majority of them (40.5%) found it to be good and another 23.5% found it to be satisfactory while, 4% found the services to be poor and 2% found it to be very poor. The highest rate of satisfaction (4.21) was noted in case of parameter-ease to find collection sample room and lowest rate of satisfaction (3.92) was scored by the parameter-staff’s wearing proper uniform. Depending upon the deficient areas some corrective actions were suggested such as strict compliance of personal protective equipments, regular training to improve technical skill, knowledge and behaviour with emphasis on cleanliness of work area. Conclusion: Even though the overall patient’s satisfaction was high, there were areas which needed our attention such as waiting time for phlebotomy procedure, lack of proper sitting arrangement, techniques of sample collection, knowledge of universal precautions etc. Appropriate corrective and preventive actions were taken to solve the problems. Thereby, feedback proved effective in maintenance and improvement of phlebotomy services.

Introduction Type 1 diabetes mellitus (T1DM) is an autoimmune disease that impacts roughly 200,000 youths in the United States. Many patients have limited access to specialist care. Therefore, general pediatricians are expected to be skilled in the management of diabetes. Recent studies suggest that an educational gap exists for general practitioners regarding diabetes care. Team-based learning (TBL), an active, learner-centered method of teaching, has been shown to be an effective tool in adult learning and teaching. Here, we outline a TBL activity focused on the education of pediatric residents in the comprehensive management of T1DM. Methods Learners prepare in advance by reading through a review article on T1DM. They are formed into groups and work through the readiness assurance process first, followed by application exercises. The application exercises focus on choosing and applying an insulin regimen to a patient with a new diagnosis of T1DM, including modification of this regimen based on blood sugar trends, management of diabetes ketoacidosis, and recognition and management of hypoglycemia. Results Learners showed improvement in their readiness assurance testing, from 81.4% individually to 91% as a group. Eighty percent of learners agreed or strongly agreed this was an effective method for improving diabetes skills and knowledge, and the learning process engaged them. Discussion TBL may be a valuable educational strategy to enhance knowledge of T1DM care for general pediatricians. Future studies focusing on longitudinal educational outcomes would be beneficial.

Diabetes technology has continually evolved over the years to improve quality of life and ease of care for affected patients. Frequent blood glucose (BG) checks and multiple daily insulin injections have become standard of care in Type 1 diabetes (T1DM) management. Continuous glucose monitors (CGM) allow patients to observe and discern trends in their glycemic control. These devices improve quality of life for parents and caregivers with preset alerts for hypoglycemia. Insulin pumps have continued to improve and innovate since their emergence into the market. Hybrid closed-loop systems have harnessed the data gathered with CGM use to aid in basal insulin dosing and hypoglycemia prevention. As technology continues to progress, patients will likely have to enter less and less information into their pump system manually. In the future, we will likely see a system that requires no manual patient input and allows users to eat throughout the day without counting carbohydrates or entering in any blood sugars. As technology continues to advance, endocrinologists and diabetes providers need to stay current to better guide their patients in optimal use of emerging management tools.

Paragonimiasis is a food-borne parasitic zoonosis caused by the genus Paragonimus. Fresh water snails, crabs, and crayfish are the first and second intermediate hosts, respectively. Humans acquire this infection by ingesting uncooked/undercooked crustaceans. Laboratory diagnosis of Paragonimiasis is done by demonstration of ova in the sputum/feces/pleural fluid or by serology. A case of pulmonary Paragonimiasis is presented herewith; the patient having been diagnosed with pulmonary tuberculosis earlier. The aim of this presentation is to highlight this entity so that it is considered in the differential diagnosis in a case of hemoptysis.

Malignant pleural effusion is a leading cause of morbidity in lung cancer patients requiring repeated pleural aspirations or persistent intercostal drainage tube. Using an indigenous method of putting icd tube of smaller size with subcutaneous tunneling would allow draining fluid from lungs easily and painlessly when needed and avoid the need for repeated injections and chest tube insertion every time the fluid is to be drained.

Background: Fine needle aspiration cytology (FNAC) of the thyroid is an established first-line test for thyroid lesions. Marginal vacuoles (MVs) have been associated with hyperactivity of the thyroid, but some studies have pointed towards their nonspecific status. Aims: To assess the presence of MVs in diffuse thyroid enlargements and evaluate the strength of correlation between MVs, levels of thyroid hormone and cytological diagnosis. Materials and Methods: Ninety-seven cases of diffuse thyromegaly were studied. Cytomorphological features were examined with special attention to MVs. MVs were graded as scant, moderate and abundant. Hormonal status of the patients was recorded. The presence and grading of MVs was correlated with cytological diagnosis and hormonal status. The strength of association was studied by applying the Chi-square test and test of proportion; a P ? 0.05 was considered significant. ≤ 0.05 was considered significant. Results: Abundant MVs were not associated with hypothyroidism in this study; 79% of these cases were hyperthyroid. The correlation between moderate/insignificant MVs and functional status of the thyroid gland was inconclusive. Further, abundant MVs in thyroid FNACs were seen in cases of primary hyperplasia and Hashimoto′s thyroiditis. There was a significant correlation between the presence of abundant/moderate MVs and primary hyperplasia and their absence in colloid goiter (P = 0.01 and 0.004, respectively). Conclusions: A significant association was found between abundant MVs and a hyperthyroid state. Moderate/absent MVs in diffuse goiters were not found to correlate with thyroid function. Thus, all diffuse goiters with prominent MVs require hormonal evaluation to rule out hyperfunction of the thyroid.

Traumatized anterior teeth with sub-gingival crown fractures are a challenge to treat. The management of sub-gingival fractures includes exposing the cervical margin followed by appropriate coronal restoration. The treatment modalities, which involve exposing the cervical margin, are surgical crown lengthening and orthodontic extrusion. This paper reports a case of fractured maxillary anterior tooth at the sub-gingival level that was managed by forced orthodontic extrusion after endodontic treatment followed by esthetic rehabilitation, a much forgotten technique not utilized routinely yet conservative and cost-effective.

Diffuse Follicular Variant of Papillary Thyroid Carcinoma (DFVPTC) presents unique challenges to the pathologists with respect to its histological diagnosis, as it closely mimics nodular colloid goitre. Herein we present a case of FVPTCdiffuse follicular type initially diagnosed as adenomatous colloid goitre with cystic change on FNAC. The patient was a 35-year-old female with complaints of progressively increasing swelling in right anterior neck for two years. Clinical examination revealed thyroid swelling measuring 7x5cm, more on the right side. CT-scan showed multiple well defined heterogeneously enhancing masses with shifting of trachea and larynx to left side. Histopathological examination revealed follicles of varying sizes lined by cells showing typical papillary nuclear features, intrafollicular haemorrhage and multinucleated histiocytes in the lumen of follicles. In view of these microscopic findings especially presence of multinucleated histiocytes, final diagnosis of diffuse follicular variant of papillary thyroid carcinoma was rendered. The aim of this case report is to highlight and put forth distinctive histo morphological features that helps to distinguish between DFVPTC and nodular colloid goitre.

Introduction: The Rh blood group system is one of the most polymorphic and immunogenic blood group systems in humans. The expression of Rh blood group antigen is complex, among that Rh-D antigen is the most important antigen because of its immunogenicity. It is easy to detect D antigen in most of the cases. Sometimes, variable expression of Rh-D antigen leads to presence of weak forms. Weak D reacts variably with anti D sera and poses a problem in blood banking. Molecular genetics of Rh-D revealed that weak D antigen is a Rh-D phenotype that possesses less numbers of complete D antigens on the surface of red blood cells. Aim: Present study was carried out to study weak D positivity in a tertiary neuropsychiatry hospital of East Delhi for compatibility testing in blood transfusion, to assess the implications and need of weak D testing and for population genetics study. This study tried to observe pattern of weak D antigen in four broadly classified religious communities also (Hindus, Muslims, Sikhs and Christians). Materials and Methods: This was a two years prospective hospital based study including patients as well as donors. All patients were tested for Rh-D factor by commercially available monoclonal anti-D sera. The individuals who were found negative with anti-D were further investigated for weak D antigen by using indirect antiglobulin test (IAT) by tube as well as gel card technique. Results: The results were compiled by using SPSS software version 21.0 and Microsoft excel. Among 3619 cases, 3502 (96.7%) were Rh-D factor positive while 117(3.2%) were Rh D factor negative. Among these 117 Rh-D negative cases, 9 (7.6% out of total Rh-D negatives and 0.25% out of total samples) were weak D positive and 108(2.98%) were actually D negative individuals after IAT. Weak D positivity showed a slight predominance in females (55.5%). As per broad religious communities, weak D antigen was found in Hindus only and not observed in Muslims, Sikhs and Christians. In weak D positive individuals, B phenotype (0.43%) was found to be most common followed by A (0.26%) and O (0.2%). Conclusion: Considerably high frequency of weak D antigen was noticed in study samples of this hospital. With this data based information, it is felt worthwhile to perform weak D testing routinely of those individuals who are negative with saline anti-D to prevent possibility of haemolysis and for efficient blood transfusion practices by making compatible blood available.

Anesthetic management of superior vena cava syndrome carries a possible risk of life-threatening complications such as cardiovascular collapse and complete airway obstruction during anesthesia. Superior vena cava syndrome results from the enlargement of a mediastinal mass and consequent compression of mediastinal structures resulting in impaired blood flow from superior vena cava to the right atrium and venous congestion of face and upper extremity. We report the successful anesthetic management of a 42-year-old man with superior vena cava syndrome posted for cervical lymph node biopsy.

Background: H1N1 pandemic in 2009-2010 created a state of panic not only in India, but in the whole world. The clinical picture seen with H1N1 is different from the seasonal influenza involving healthy young adults. Critical care management of such patients imposes a challenge for anesthesiologist. Materials and Methods: A retrospective analysis of hospitalized positive H1N1 patients was performed from July 2009-June 2010. Those requiring the ventilatory support were included in the study. Result: 54 patients were admitted in the swine-flu ward during the study period out of which 19 required ventilatory support. The average day of presentation to the health care facility was 6 th day causing delay in initiation of antiviral therapy and increased severity of the disease. 65% of the ventilated patients were having associated comorbidities. Mortality was 74% among ventilated patients. Conclusion: Positive H1N1 with severe disease profile have a poor outcome. Early identification of high-risk factors and thus early intervention in the form of antiretroviral therapy and respiratory care will help in reducing the overall mortality.

One of the most important decisions related to the efficient management of testing phase of software development life cycle is to determine when to stop testing and release the software in the market. Most of the testing processes are imperfect once. In this paper first we have discussed an optimal release time problem for an imperfect faultdebugging model due to Kapur et al considering effect of perfect and imperfect debugging separately on the total expected software cost. Next, we proposed a SRGM incorporating the effect of imperfect fault debugging and error generation. The proposed model is validated on a data set cited in literature and a release time problem is formulated minimizing the expected cost subject to a minimum reliability level to be achieved by the release time using the proposed model. Solution method is discussed to solve such class of problem. A numerical illustration is given for both type of release problem and finally a sensitivity analysis is performed.

ABSTRACT Context: FNAC thyroid is more sensitive as well as specific in segregating neoplastic and non-neoplastic thyroid lesions. Identification of predominant cell pattern, cell morphology and background details in FNAC smears play an important role in categorisation of various thyroid lesions with accuracy. Marginal vacuoles (MVs) have been described as irregular cytoplasmic vacuoles with largely unstained central area. MVs, although suggestive of thyrotoxicosis, are non-specific, as they are also encountered in non- toxic goitre, Hashimoto’s thyroiditis and follicular carcinoma. This cytologic finding therefore deserves further study to precisely delineate its utility. Aims & Objective: To investigate whether MVs have a diagnostic role in FNAC of solitary thyroid nodule Setting & Design: This study was conducted on 40 patients who presented with solitary thyroid nodule. Methods & Material: Forty patients having solitary thyroid nodule were subjected to FNAC on an outpatient basis. Their cytomorphological features were studied with special attention to presence of MVs. MVs if present were then graded as no/ scant (gradeI ), moderate (gradeII) and abundant (gradeIII). Results and Conclusion: Majority (77.5%) of nodular goitres had insignificant MVs (gradeI) in their smears. Significant MVs (gradeII+III) were limited to autoimmune thyroiditis presenting as solitary nodule and follicular neoplasms. Abundant MVs/ gradeIII were seen in follicular neoplasm only. MVs were not present in rest of neoplastic goitres. This implies that MVs are a marker of follicular differentiation.

ABSTRACT Context: Renal transplantation is the definitive treatment in renal failure patients. Liver disease is a known problem in renal transplant recipients. They may be consequent to immunosuppression, drug toxicity, altered immune response to viruses and hemodialysis. Aims: The aim of this study was to analyze and correlate the biochemical parameters and histopathology of liver biopsy among renal transplant recipients with both HBV and HCV infection and to correlate them. Setting: The study group had thirty cases. Enrolment criteria included coinfection with HBV and HCV ; elevated liver enzymes and recipient of renal allograft. There was acontrol group of ten patients who were HBC and HCV positive but had not undergone renal transplant. Material & Methods: Liver function tests including alkaline phosphatase, SGOT, SGPT and serum bilirubin levels were donet. Percutaneous liver biopsies were carried out using Menghini’s needle.. Stains done included hematoxylin and eosin (H & E), vanGieson, reticulin and Perl’s stain. Histopathological grading was performed using Metavir scoring system. Immunohistochemistry (IHC) was done where required for ground glass hepatocytes. Correlation of SGOT, SGPT and Alkaline phosphatase of the study group and the controls was carried out with the grading. Statistical Analysis: Statistical tests done included paired “t” test at 5% and test of probability. Results: There was no statistically significant correlation between the controls and the transplanted patients. It was concluded that serum enzyme levels could be used to predict histological grade in the control group but not in the transplant recipients (p>0.05).

Virus associated hemophagocytic syndrome is a non-neoplastic, generalized histiocytic proliferation with prominent hemophagocytosis associated with a systemic viral infection. We report a case of cytomegalovirus (CMV) associated hemophagocytic syndrome in a 2 month old male child presenting with rashes, fever, hepatosplenomegaly, cervical lymphadenopathy and pancytopenia. Fine needle aspiration cytology and biopsy from cervical lymph nodes revealed prominent hemophagocytosis. Serology for CMV IgM was positive in both the mother and the child, suggesting recent infection. Possibly there was intrauterine transmission of the infection.

This study develops diffusion models for technological consumer products under the marketing environment when a product is marketed in a segmented market and observes two distinctive promotional strategies of mass and differentiated promotion; an under explored study area. Mass promotion strategy creates a spectrum effect in market with an aim to create wider product awareness and influence the market size. Whereas the differentiated promotion strategy plays major role in external influence component in the respective segment and target for adoption by the current potential segment. Previous studies on segmented diffusion models assumed only first time purchase and constant market size which may yield underestimated results and fail to give appropriate insight of the diffusion process. The study develops and validates generalized diffusion models for segmented market incorporating the repurchase behaviour of the adopter population and dynamic potential market size considerations. Performance of the proposed models is analysed on real life data for a new product marketed in four segments and compared with the previous study.