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This research examines the profound effects of integrating IoT-enabled predictive maintenance in sustainable transportation fleets. By using real-time sensor data, this implementation aims to enhance fleet dependability and operational efficiency. The fleet, including a variety of vehicles such as electric buses, hybrid cars, electric trucks, CNG-powered vans, and hybrid buses, is constantly monitored using IoT sensors that capture important characteristics like engine temperature, battery voltage, and brake wear percentages. The predictive maintenance algorithms adapt maintenance schedules in response to live sensor data, enabling a proactive strategy that tackles prospective problems before they result in major failures. The examination of the maintenance records reveals prompt actions, showcasing the system’s efficacy in reducing operational interruptions and improving the overall dependability of the fleet. Moreover, the examination of percentage change confirms the system’s flexibility, demonstrating its capacity to anticipate fluctuations in engine temperature, battery voltage, and brake wear. The findings highlight the system’s ability to adapt to various operating situations and its contribution to lowering maintenance expenses while enhancing operational effectiveness. The established approach incorporates ethical issues, such as data security and privacy, to ensure responsible adoption of IoT technology. This study has broader ramifications beyond the particular dataset, providing a detailed plan for incorporating IoTenabled predictive maintenance into contemporary transportation infrastructures. The study’s findings offer valuable insights into the potential of proactive maintenance strategies to transform the transportation industry towards sustainability. This contributes to a future where fleets operate with increased efficiency, reduced environmental impact, and improved reliability.

Malignant melanoma is most lethal skin malignancy accounting for 4% of all cutaneous cancers. It is usually seen in sun exposed areas but can occur anywhere in the body involving mucosal surfaces and internal organs as well. Rarely cases can present with metastases as the first manifestation of the disease, sometimes with unknown primary. Dermal melanomas are rarer which characteristically show lack of epidermotropism and thus enter as a close differential of metastatic melanomas that are exclusively dermal based. Amelanotic melanomas pose diagnostic difficulty clinically as well as on histopathology as the absence of pigments may simulate soft tissue tumors. In our study, we report a case of an elderly female presenting with a mass on the leg since 1 year, which on histopathology looked like a malignant soft tissue tumor with mixed epithelioid and spindle cells but on immunohistochemistry, it turned out to be an amelanotic melanoma that was completely based in the dermis. Following this, extensive serial sectioning of the remaining tissue specimen was done and two foci of lymphovascular invasion were detected favoring a diagnosis of a metastatic melanoma rather than a dermal melanoma. No obvious primary was found even after thorough work up. We are presenting this case to throw light on the difficulties encountered by pathologists in diagnosing melanomas that show lack of melanin and epidermotropism, both are considered to be the most reliable features in clinching the diagnosis and how this tricky presentation should be worked up to render a correct report.

Syed Nawaz Ahmad,1 Duri Sameen,1 Mansoor Ahmad Dar,2 Romaan Jallu,3 Tajali Nazir Shora,4 Mansi Dhingra5 1Department of Obstetrics and Gynecology, Government Medical College Anantnag, Anantnag, Jammu and Kashmir, India; 2Department of Psychiatry, Government Medical College Anantnag, Anantnag, Jammu and Kashmir, India; 3Department of Microbiology, Government Medical College Srinagar, Srinagar, Jammu and Kashmir, India; 4Department of Community Medicine, Government Medical College Anantnag, Anantnag, Jammu and Kashmir, India; 5Department of Obstetrics and Gynecology, Vaga Hospital, Lucknow, IndiaCorrespondence: Mansoor Ahmad Dar, Department of Psychiatry, Government Medical College, Anantnag, Jammu and Kashmir, Tel +919596010111, Email gaashmansoor@gmail.com Romaan Jallu, Department of Microbiology, Government Medical College, Srinagar, Jammu and Kashmir, 190010, India, Tel +916006888061, Email romaanjallu763@gmail.comPurpose: To determine the feto-maternal outcome in pregnant women infected with SARS-CoV-2 in comparison to non-infected pregnant women and plan management strategies.Patients and Methods: A retrospective review of case records in the Department of Obstetrics and Gynecology for 1 year was conducted. A total of 6468 case files fulfilling the inclusion criteria were enrolled in the study. Patients who tested positive for SARS CoV-2 and fulfilled inclusion criteria were labeled as cases, whereas patients who tested negative were labeled as controls. Outcome measures including lower segment cesarean section (LSCS) rate, maternal and neonatal intensive care admission and feto-maternal mortality were compared between the two groups.Results: Our hospital was not an exclusive COVID-19 designated center, and 117 patients infected with SARS-CoV-2 fulfilling the inclusion criteria were enrolled in the study. Fever (67.52%), cough (56.41%), and altered smell (45.29%) were the frequently reported symptoms. Pneumonia affected 16.23% of the cases. LSCS rate was significantly higher in the COVID-19-infected patients (72.41%; OR 2.19; 95% CI 1.46– 3.34; p< 0.001). The rate of maternal ICU admission in COVID-19-infected pregnant women was 11.96% as compared to 0.8% in the non-infected women (OR 16.76; 95% CI 8.72– 30.77; p< 0.001). We observed a significantly higher maternal mortality in COVID-19-infected women (2.56%) [OR 41.61; 95% CI 7.65– 203.5; p< 0.001]. Viral RNA was detected in cord blood and nasopharyngeal swab of one neonate. The neonatal death ratio was high in infected mothers (2.6%) [OR 8.6; 95% CI 1.99– 27.23; p< 0.001].Conclusion: Significant maternal morbidity, mortality, and neonatal mortality were observed in COVID-19-positive patients.Keywords: COVID-19, ICU, cesarean, mortality, maternal, neonatal

Parag Shah,1 Sanjay Kalra,2 Yogesh Yadav,3 Nilakshi Deka,4 Tejal Lathia,5 Jubbin Jagan Jacob,6 Sunil Kumar Kota,7 Saptrishi Bhattacharya,8 Sharvil S Gadve,9 KAV Subramanium,10 Joe George,11 Vageesh Iyer,12 Sujit Chandratreya,13 Pankaj Kumar Aggrawal,14 Shailendra Kumar Singh,15 Ameya Joshi,16 Chitra Selvan,17 Gagan Priya,18 Atul Dhingra,19 Sambit Das20 1Department of Endocrinology, Gujarat Endocrine Centre, Ahmedabad, Gujarat, India; 2Department of Endocrinology, Bharti Hospital & B.R.I.D.E, Karnal, Haryana, India; 3Department of Endocrinology, MAX Super Specialty Hospital, Dehradun, Uttarakhand, India; 4Department of Endocrinology, Apollo Hospital & Dispur Polyclinic and Nursing Home, Guwahati, West Bengal, India; 5Department of Endocrinology, Apollo Hospital, Mumbai, Maharashtra, India; 6Department of Endocrinology, CMC Hospital, Ludhiana, Punjab, India; 7Department of Endocrinology, Diabetes and Endocrine Clinic, Berhampur, Orissa, India; 8Department of Endocrinology, OeHealth Diabates & Endocrinology Centre, Delhi, Delhi, India; 9Department of Endocrinology, Excel Endocrine Centre, Kolhapur, Maharashtra, India; 10Department of Endocrinology, Visakha Diabates & Endocrine Centre, Vishakhapatnam, Andhra Pradesh, India; 11Department of Endocrinology, Endodiab Clinic, Calicut, Kerala, India; 12Department of Endocrinology, St.John’s Medical College & Hospital, Bangalore, Karnataka, India; 13Department of Endocrinology, Endocare Clinic, Nashik, Maharashtra, India; 14Department of Endocrinology, Hormone Care & Research Centre, Ghaziabad, Uttar Pradesh, India; 15Department of Endocrinology, Endocrine Clinic, Varanasi, Uttar Pradesh, India; 16Department of Endocrinology, Endocrine and Diabetes Clinic, Mumbai, Maharashtra, India; 17Department of Endocrinology, Ramaiah Memorial Hospital, Bangalore, Karnataka, India; 18Department of Endocrinology, IVY Hospital, Chandigarh, Punjab, India; 19Department of Endocrinology, Bansal Hospital, Sri Ganganagar, Rajasthan, India; 20Department of Endocrinology, Endeavour Clinic, Bhubaneshwar, Orissa, IndiaCorrespondence: Sanjay Kalra, Kunjpura Road, Model Town, Near State Bank of India, Sector 12, Karnal, Haryana, 132001, India, Tel +9215848555, Email brideknl@gmail.comAbstract: Glucocorticoids are potent immunosuppressive and anti-inflammatory drugs used for various systemic and localized conditions. The use of glucocorticoids needs to be weighed against their adverse effect of aggravating hyperglycemia in persons with diabetes mellitus, unmask undiagnosed diabetes mellitus, or precipitate glucocorticoid-induced diabetes mellitus appearance. Hyperglycemia is associated with poor clinical outcomes, including infection, disability after hospital discharge, prolonged hospital stay, and death. Furthermore, clear guidelines for managing glucocorticoid-induced hyperglycemia are lacking. Therefore, this consensus document aims to develop guidance on the management of glucocorticoid-induced hyperglycemia. Twenty expert endocrinologists, in a virtual meeting, discussed the evidence and practical experience of real-life management of glucocorticoid-induced hyperglycemia. The expert group concluded that we should be proactive in terms of diagnosis, management, and post-steroid care. Since every patient has different severity of underlying disease, clinical stratification would help understand patient profiles and determine the treatment course. Patients at home with pre-existing diabetes who are already on oral or injectable therapy can continue the same as long as they are clinically stable and eating adequately. However, depending on the degree of hyperglycemia, modification of doses may be required. Initiating basal bolus with correction regimen is recommended for patients in non-intensive care unit settings. For patients in intensive care unit, variable rate intravenous insulin infusion could be temporarily used, but under supervision of diabetes inpatient team, and patients can be transitioned to subcutaneous insulin once stable baseline assessment and continual evaluation are crucial for day-to-day decisions concerning insulin doses. Glycemic variability should be carefully monitored, and interventions to treat patients should also aim at achieving and maintaining euglycemia. Rational use of glucose-lowering drugs is recommended and treatment regimen should ensure maximum safety for both patient and provider. Glucovigilance is required as the steroids taper during transition, and insulin dosage should be reduced subsequently. Increased clinical and economic burden resulting from corticosteroid-related adverse events highlights the need for effective management. Therefore, these recommendations would help successfully manage GC-induced hyperglycemia and judiciously allocate resources.Keywords: corticosteroids, insulin, steroid-induced hyperglycemia, steroid-induced diabetes, stress hyperglycemia, diabetes