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Background: According to a WHO report, the prevalence of anemia is the highest in children less than five years of age (40%) and pregnant women of the global population (37%). The prevalence of hypertensive disorders of pregnancy was 7.8% in India. 14% of maternal deaths are attributed to hypertensive disorders of pregnancy, according to a WHO report. Our study aimed to evaluate the variation of serum ferritin (SF) levels in four different groups: (1) normal pregnancy, (2) pregnancy with anemia, (3) pregnancy with hypertensive disorders, and (4) pregnancy with hypertensive disorders and anemia, to derive an association of SF in patients of anemia and hypertensive disorders of pregnancy. Methods: Thirty diagnosed cases of each predefined group of similar gestation were enrolled. A venous blood sample was collected from all subjects of all four groups for estimation of SF levels and hemoglobin levels. Results: SF level was found to be significantly around twofold higher in groups 3 and 4 with hypertensive disorders of pregnancy (60.6 ± 27.5 μg/dL and 54.4 ± 26 μg/dL, respectively) compared to normal pregnancy and pregnancy with anemia (31.3 ± 25 μg/dL and 23.3 ± 21.6 μg/dL, respectively). Hence, the Kruskal–Wallis test was conducted for four groups, and it was statistically significant. Conclusions: In our study, pregnant women with anemia had lower SF levels than normal pregnancy cases. However, in group 4 with hypertensive disorders of pregnancy with anemia SF levels were higher than group 2.

Background: There can be a diagnostic challenge in differentiating giant cell tumor of bone (GCTB) from its mimics. Lately, histone H3F3A (Histone 3.3) G34W has been identified as a promising immunohistochemical marker. Aims: This study was aimed at evaluating H3.3 G34W immunostaining in 100 GCTBs, including its value in resolving diagnostic dilemmas. Materials and Methods: Immunohistochemical staining for H3.3 G34W was graded in terms of staining intensity (1+ to 3+) and the percentage of tumor cells showing crisp nuclear staining. Results: One hundred GCTBs occurred in 58 males and 42 females (M: F ratio = 1.3), of 7-66 years age (average = 31.3, median = 28), commonly in distal femur (26), followed by proximal tibia (17), distal radius (12), proximal humerus (7), metacarpals (7), sacrum (6), proximal fibula (6), and relatively unusual sites (19), including a single multicentric case. Out of 92 GCTBs, wherein H3.3 G34W immunostaining worked, 81 (88.1%) showed positive staining in the mononuclear cells, including tumors with fibrous histiocytoma-like areas, sparing osteoclast-like giant cells, with 3+ staining intensity in 65/81 (80%) tumors. All 7/7 (100%) malignant GCTBs showed positive staining, including the pleomorphic/sarcomatous cells. All 7/7 (100%) metastatic GCTBs showed positive immunostaining. Seven out of 10 post-denosumab treated GCTBs showed positive H3.3 G34W immunostaining in the residual mononuclear cells. None of the other 37 “giant cell-rich” lesions displayed H3.3 G34W immunostaining. Four of 9 GCTBs tested for H3.3 G34W mutation showed positive results. Conclusions: The diagnostic sensitivity and specificity of H3.3 G34W for GCTB were 88.1% and 100%, respectively. This constitutes one of the first reports from our country, further validating the diagnostic value of H3.3 G34W in differentiating GCTB, including metastatic and malignant forms from its mimics, including small biopsy samples. Its value in various diagnostic dilemmas is presented and utility in identifying residual tumor cells in post-denosumab treated GCTBs is worth exploring.

Traditional crowd counting (optical flow or feature matching) techniques have been upgraded to deep learning (DL) models due to their lack of automatic feature extraction and low-precision outcomes. Most of these models were tested on surveillance scene crowd datasets captured by stationary shooting equipment. It is very challenging to perform people counting from the videos shot with a head-mounted moving camera; this is mainly due to mixing the temporal information of the moving crowd with the induced camera motion. This study proposed a transfer learning-based PeopleNet model to tackle this significant problem. For this, we have made some significant changes to the standard VGG16 model, by disabling top convolutional blocks and replacing its standard fully connected layers with some new fully connected and dense layers. The strong transfer learning capability of the VGG16 network yields in-depth insights of the PeopleNet into the good quality of density maps resulting in highly accurate crowd estimation. The performance of the proposed model has been tested over a self-generated image database prepared from moving camera video clips, as there is no public and benchmark dataset for this work. The proposed framework has given promising results on various crowd categories such as dense, sparse, average, etc. To ensure versatility, we have done self and cross-evaluation on various crowd counting models and datasets, which proves the importance of the PeopleNet model in adverse defense of society.

Spermatocytic Seminoma is a rare yet distinct testicular germ cell tumor which represent less than 01% of testicular tumor. Here we presented a case of testicular swelling in young male. On histopathological examination Spermatocytic Seminoma was confirmed. However, Spermatocytic Seminoma is common is elderly age group. Since the prognosis for this tumor type is favourable, accurate diagnosis and differentiation from other malignant testicular neoplasm (classical seminoma) is must for therapeutic management with long term follow up.

This work presents a system design for extracting maximum power using the modified maximum power point tracking (MPPT) technique and a novel high-gain DC-DC converter, which was then used to supply a microgrid system with a conventional buck converter. We present a novel structure comprising the MPPT, voltage boosting, and voltage regulating components for a DC microgrid in a single system. The most important features of a photovoltaic (PV) system include a high-gain converter and maximum PV power extraction; considering these, we present a high-gain DC-DC converter that boosts the output voltage to ten times the input voltage. Furthermore, the MPPT technique extracts maximum power from the PV panel based on model predictive control through its better transient response than the conventional incremental conductance method. The MPPT approach was tested with both fixed- and variable-step operations, and the results were compared for load variations. Considering the economics of the system, the proposed approach attempts cost reduction by optimizing the number of sensors to two instead of three. Simulations were conducted under different environmental conditions using MATLAB-Simulink, and the performance differences between the conventional incremental conductance and proposed MPPT-based methods are shown. Next, DC voltage regulation was implemented for the proposed PV and existing systems by considering different load and irradiation conditions while maintaining constant temperature. The simulation results showed the latter system had better performance than the former under different environmental conditions, with persistent results for voltage regulation at different load and irradiation conditions.

Purpose Mediastinal staging in non-small-cell lung carcinoma (NSCLC) is essential for appropriate treatment. Invasive mediastinal staging is necessary and mediastinoscopy has been the gold standard, but it is associated with morbidity. The aim of this study is to evaluate the efficacy of endobronchial ultrasonography transbronchial needle aspiration (EBUS-TBNA), compare it with mediastinoscopy, and assess the endosonographic features of lymph nodes for prediction of metastasis.

Abstract Head and neck cancer is a major cause of morbidity and mortality worldwide. The identification of genetic alterations in head and neck cancer may improve diagnosis and treatment outcomes. In this study, we report the identification and functional characterization of UBE3C-LRP5 translocation in head and neck cancer. Our whole transcriptome sequencing and RT-PCR analysis of 151 head and neck cancer tumor samples identified the LRP5-UBE3C and UBE3C-LRP5 fusion transcripts in 5.3% of patients of Indian origin (n = 151), and UBE3C-LRP5 fusion transcripts in 1.2% of TCGA-HNSC patients (n = 502). Further, whole genome sequencing identified the breakpoint of UBE3C-LRP5 translocation. We demonstrate that UBE3C-LRP5 fusion is activating in vitro and in vivo, and promotes the proliferation, migration, and invasion of head and neck cancer cells. In contrast, depletion of UBE3C-LRP5 fusion suppresses the clonogenic, migratory, and invasive potential of the cells. The UBE3C-LRP5 fusion activates the Wnt/β-catenin signaling by promoting nuclear accumulation of β-catenin, leading to upregulation of Wnt/β-catenin target genes, MYC, CCND1, TCF4, and LEF1. Consistently, treatment with the FDA-approved drug, pyrvinium pamoate, significantly reduced the transforming ability of cells expressing the fusion protein and improved survival in mice bearing tumors of fusion-overexpressing cells. Interestingly, fusion-expressing cells upon knockdown of CTNNB1, or LEF1 show reduced proliferation, clonogenic abilities, and reduced sensitivity to pyrvinium pamoate. Overall, our study suggests that the UBE3C-LRP5 fusion is a promising therapeutic target for head and neck cancer and that pyrvinium pamoate may be a potential drug candidate for treating head and neck cancer harboring this translocation.

This study presents a method to limit the functioning of the differential relay during the different operating conditions of an Indirect Symmetrical Phase Shift Transformer (ISPST). The proposed method depends on two thresholds; phase angle shift (PAS) between two ends of an ISPST to discriminate internal faults and inrush conditions from normal, over-excitation, and external fault conditions and slope of differential current helps to discriminate the situation of internal fault from inrush. In the first step of the algorithm, the PAS-based threshold discriminates normal, over-excitation, and external fault conditions from magnetizing inrush and internal fault conditions. In the second step, the slope-based threshold discriminates magnetizing inrush from internal fault conditions. The reliability of the proposed method has also been examined under the condition of current transformer saturation due to heavy external faults. Additionally, the comparison of the suggested and conventional methods is discussed to check the superiority of the proposed method. The proposed method eliminates the need for phase angle shift correction in the suggested method. A variety of faults in the series and excitation unit are simulated using the PSCAD/EMTDC platform to verify the approach method.

Background: At least, 358,000 women worldwide die annually from pregnancy and childbirth-related problems. Obstetric hemorrhage is the single most significant cause of maternal mortality worldwide accounting for 25–30% of all maternal deaths. Aims and Objectives: The objective of the study is to see the usefulness/importance of shock index (SI) in obstetric hemorrhage (antepartum and post-partum hemorrhage) and to compare the performance of SI with conventional vital signs for prediction of maternal outcome. Materials and Methods: The descriptive study was conducted in 100 cases of hemorrhagic shock patients admitted in obstetrics and gynecology at Baba Raghav Das Medical College, Gorakhpur, between June 2020 and May 2021, on 100 subjects. Results: In our study, there were 100 patients. Patients with SI 0.6 to 1 were included in Group II which comprises 74% patients in which all patients required initial resuscitation with IV fluid and then blood transfusion, 21.62% patients require inotropic support, and 9.46% patients needed fresh frozen plasma transfusion. Maternal outcome in Group I patients is that only 15.38% patients required emergency lower segment cesarean section (LSCS). While in Group II, 28.95% patients required emergency LSCS, 5.26% patients required intensive care unit (ICU) admission for ventilator support, 3.95% went for cesarean hysterectomy, while 2.63% patients landed in end organ failure and expired. Conclusion: All patients with obstetric hemorrhage with SI>1 should receive immediate intervention such as blood transfusion need of ICU or surgical intervention. This is higher than the upper limit of normality in non-pregnant population. In low-resource settings, this simple parameter could improve outcomes because it has a significant ability to predict adverse maternal outcomes of hemorrhage.

Background and Objectives: The Goal of National Health Mission has been to enhance the availability and access of good quality health care for vulnerable population. The study evaluates the compliance of a neonatal intensive care unit (NICU) in a tertiary care government teaching hospital with national quality assurance standards (NQAS). Materials and Methods: A descriptive, observational, cross-sectional study was conducted using validated checklist adopted from NQAS. The data were collected by utilizing data collection techniques such as observation, staff interview, and record review. Results: The NICU has achieved a total score of 65% in service provision. Major gaps n = 126 (29%) were identified. The number of checkpoints which needed to be fulfilled at the departmental level was n = 137 (80%), to be fulfilled at the institutional level was n = 34 (19.2%), and those to be fulfilled at the top-level administration was n = 1 (0.8%); recommendations were made accordingly for improvement. Conclusion: The study concludes that there were n = 126 (29%) noncompliant checkpoints/major gaps, particularly with respect to the quality management and outcome. Based on the findings of the study, the author recommends the development of a dedicated checklist with new checkpoints that need to be incorporated for medical college hospitals and institutes in the country to ensure quality patient care, which will consecutively improve the medical education and research.

Climatotherapy is the planned medical application of climatic factors for the improvement of functioning and prevention or treatment of diseases. Various climatic factors affect the physical and psychosocial functioning in persons with various health conditions including neuromuscular conditions, rheumatic diseases, and chronic respiratory illness. This systematic review is an evidence-based overview of the efficacy of the application of various climatotherapy on rehabilitation outcomes. A comprehensive literature search was conducted using medical/health science databases: PubMed, EMBASE, CINAHL, and Cochrane Library (from inception till May 2022). Two reviewers independently performed study selection, data extraction, and appraised study quality. Due to heterogeneity amongst included trials, a qualitative analysis provided the best evidence synthesis. Overall, 11 randomized controlled trials and 7 observational studies, which evaluated the impact of different climatic factors/conditions (such as warm/cold climate and high altitudes) on patient outcomes postrehabilitation interventions, were included. Most studies scored “low” on quality assessment due to methodological limitations. The findings suggest evidence for the beneficial effect of a warm climate in reducing disability and improved participation in patients with rheumatological, neuromuscular, and chronic respiratory conditions. Rehabilitation interventions conducted in warmer climate tends to enhance physical activity in some of these conditions. No data was available for adverse effects or associated care costs. Although the impact of climatic factors on rehabilitation outcomes is widely documented, high-quality research is sparse in this area. More methodologically robust studies are needed to build evidence for the use of climatotherapy to enhance rehabilitative care.

With the increasing frequency of disasters and the significant upsurge of survivors with severe impairments and long-term disabling conditions, there is a greater focus on the importance of rehabilitation in disaster management. During disasters, rehabilitation services confront a greater load due to the influx of victims, management of persons with pre-existing disabilities and chronic conditions, and longer-term care continuum. Despite robust consensus amongst the international disaster response and management community for the rehabilitation-inclusive disaster management process, rehabilitation is still less prioritised. Evidence supports the early involvement of rehabilitation professionals in disaster response and management for minimising mortality and disability, and improving clinical outcomes and participation in disaster survivors. In the last two decades, there have been substantial developments in disaster response/management processes including the World Health Organization Emergency Medical Team (EMT) initiative, which provides a standardized structured plan to provide effective and coordinated care during disasters. However, rehabilitation-inclusive disaster management plans are yet to be developed and/or implemented in many disaster-prone countries. Strong leadership and effective action from national and international bodies are required to strengthen national rehabilitation capacity (services and skilled workforce) and empower international and local EMTs and health services for comprehensive disaster management in future calamities. This narrative review highlights the role of rehabilitation and current developments in disaster rehabilitation; challenges and key future perspectives in this area.

An Indirect Symmetrical Phase Shift Transformer (ISPST) represents both electrically connected and magnetically coupled circuits, which makes it unique compared to a power transformer. Effective differentiation between transformer inrush current and internal fault current is necessary to avoid incorrect differential relay tripping. This research proposes a system that uses a Chebyshev Neural Network (ChNN) as a core classifier to distinguish such internal faults. For simulations, we used PSCAD/EMTDC software. Internal faults and inrush have been simulated in various ways using various ISPST parameters. A large, simulated dataset is used, and performance is recorded against different sized ISPSTs. We observed an overall accuracy greater than 99%. The ChNN classifier generated exceptionally favorable results even in case of noisy signal, CT saturation, and different ISPST parameters.

Manufacturing titanium alloys with simultaneous enhancement in strength and ductility has motivated extensive research into various strategies for regulating the arrangement and texture of α and β phases. The present study explores a novel α + β titanium alloy, TIMETAL 639 (Ti-639), produced by replacing a portion of vanadium in Ti-64 with molybdenum. The low diffusivity and β-stabilizing effects of molybdenum help retain bimodal characteristics within solution heat-treated Ti-639 microstructures. EBSD and TEM were used to examine β-phase evolution after thermal processing and recrystallization of new globular α grains within pre-existing colonies in a depleted bimodal microstructure. These depleted bimodal colonies in solution heat-treated Ti-639 also led to lower misorientation spreads and dislocation densities within neighboring primary α grains. Quasi-static compression along the plate normal direction demonstrated the ability of the depleted bimodal microstructure to simultaneously enhance strength and ductility in Ti-639 (~90 MPa stronger, ~6% higher failure strain) versus identically processed Ti-64. Only one solution heat-treatment step (1 h at 900 °C) is needed to achieve these properties in Ti-639, whereas comparable properties in Ti-64 required prolonged aging heat treatment (24 h at 600 °C) after the same solution heat-treatment step, making Ti-639 a viable α + β alloy candidate.

Abstract Clinically relevant postoperative pancreatic fistula (CR-POPF) can significantly affect the treatment course and outcome in pancreatic cancer patients. Preoperative prediction of CR-POPF can aid the surgical decision-making process and lead to better perioperative management of patients. In this retrospective study of 108 pancreatic head resection patients, we present risk models for the prediction of CR-POPF that use combinations of preoperative computed tomography (CT)-based radiomic features, mesh-based volumes of annotated intra- and peripancreatic structures and preoperative clinical data. The risk signatures were evaluated and analysed in detail by visualising feature expression maps and by comparing significant features to the established CR-POPF risk measures. Out of the risk models that were developed in this study, the combined radiomic and clinical signature performed best with an average area under receiver operating characteristic curve (AUC) of 0.86 and a balanced accuracy score of 0.76 on validation data. The following pre-operative features showed significant correlation with outcome in this signature ( $$p < 0.05$$ p < 0.05 ) - texture and morphology of the healthy pancreatic segment, intensity volume histogram-based feature of the pancreatic duct segment, morphology of the combined segment, and BMI. The predictions of this pre-operative signature showed strong correlation (Spearman correlation co-efficient, $$\rho = 0.7$$ ρ = 0.7 ) with the intraoperative updated alternative fistula risk score (ua-FRS), which is the clinical gold standard for intraoperative CR-POPF risk stratification. These results indicate that the proposed combined radiomic and clinical signature developed solely based on preoperatively available clinical and routine imaging data can perform on par with the current state-of-the-art intraoperative models for CR-POPF risk stratification.

Abstract Many progressed information scientific strategies, particularly Artificial Intelligence (AI) and profound learning methods, have been proposed and tracked down wide applications in our general public. This proposition creates information driven arrangements by utilizing the most recent profound learning and AI innovation, including outfit learning, meta‐learning and move learning, for energy the executives framework issues. Genuine world datasets are tried on proposed models contrasted and best in class plans, which exhibit the predominant presentation of the proposed model. In this proposition, the engineering of the Smart Grid testbed is additionally planned and created by using ML calculations and true remote correspondence frameworks to such an extent that constant plan necessities of Smart Grid testbed is met by this reconfigurable system with stacking of full convention in medium access control (MAC) and physical layers (PHY). The proposed engineering has the reconfiguration property in view of the organization of remote correspondence and trend setting innovations of Information and communication technologies (ICT) which incorporates Artificial Intelligence (AI) calculation. The fundamental plan objectives of the Smart Grid testbed is to make it simple to construct, reconfigure and scale to address the framework level prerequisites and to address the ongoing necessities.

Climate change phenomena, such as droughts, floods, heat waves, hurricanes, and wildfires, have a deleterious effect on nature and the health of the people, especially on vulnerable population cohorts, such as persons with disabilities (PwD). PwD are disproportionately affected by the health effects of climate change and experience a greater burden due to various physiological, socio-economic and health-related factors. Rehabilitation professionals as trusted care providers/educators have an integral role in global efforts to educate, advocate and protect vulnerable people from the adverse impact of climate change. They are in a distinctive position as they are experts in understanding the complex medical, physiological and psychosocial needs of PwD. Although the impact of climate change on health is widely documented, the literature on the effect of climatic factors on PwD is sparse. Further, specific rehabilitation and disability-inclusive climate action plans are yet to be developed and/or implemented globally. As the climate-change-related health burdens continue to grow the critical importance of rehabilitation services is apparent. The challenge ahead is to build a structured people-centered approach to building rehabilitation-inclusive climate-resilient health systems to improve the adaptive capacity and resilience of the most susceptible people with distinct healthcare needs.

Objective To evaluate existing evidence from published systematic reviews for the effectiveness of rehabilitation interventions in patients with leukaemia towards physical, psychological and quality of life outcomes. Data sources A comprehensive literature search was conducted using medical and health science databases up to 1 December 2022. Bibliographies of pertinent articles, journals and grey literature were searched. Data extraction and synthesis Two reviewers assessed methodological quality and graded the quality of evidence for outcomes using validated tools. Any discrepancies were resolved by final group consensus. Results Fifteen systematic reviews (40 studies, 2,957 patients with leukaemia) evaluated 2 broad categories of rehabilitation interventions (physical exercise and coping skill/complementary interventions). Most reviews were of low methodological quality. The findings suggest: low-quality evidence for exercise interventions for improving physical and psychological functioning, fatigue and quality of life; very low-quality evidence for coping skill/complementary interventions for improved psychological symptoms and quality of life. Association between physical activity and the risk of leukaemia remains unclear. Conclusion Despite a range of rehabilitation interventions used for patients with leukaemia, high-quality evidence is limited for many. More robust research studies are required to determine the most effective rehabilitation approaches.