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Context : Graves’ disease is the commonest cause of hyperthyroidism. Other common causes include toxic multinodular goiter, thyroiditis etc. Clinical manifestations of thyrotoxicosis in cases of thyroiditis and early or mild Graves' disease may be difficult to differentiate. Although persistence of symptoms and signs in Graves' disease can distinguish it from other etiologies, it is prudent to distinguish between various etiologies of hyperthyroidism because of disease- specific management. Aims : To evaluate role of ultrasound in differential diagnosis of hyperthyroidism and propose a cut-off value of Inferior thyroid artery for differentiation of Graves Disease and destructive thyroiditis. Settings and Design: A cross-sectional study done in a tertiary care hospital. Methods and Material: Ultrasound evaluation of thyroid gland was performed in 100 patients of hyperthyroidism for the possible etiology of hyperthyroidism. Statistical analysis used: IBM Statistical Package for the Social Sciences (SPSS) software for Windows, Version 26.0. Armonk, NY: IBM Corp was used for analysis. Chi-square test was used for the comparison of categorical variables. P-values < 0.05 was considered statistically significant. Results: Ultrasound was found to be highly sensitive and specific in diagnosing the various etiologies of hyperthyroidism. A cut-off value of 40 cm/sec of peak systolic velocity of inferior thyroid artery was found to be statistically significant to differentiate between Graves’ disease and destructive thyroiditis (p- value 0.000). Conclusion: In order to optimize diagnostic workup of hyperthyroidism, thyroid ultrasound being readily available, inexpensive and radiation free modality, can act as an effective diagnostic tool in differential diagnosis of hyperthyroidism

Anticoagulation-related nephropathy (ARN) is a rare form of acute kidney injury where the use of anticoagulation causes hemorrhage in various compartments of nephron including glomerulus, renal tubules, and interstitial compartment. Also, warfarin-induced vasculitis is an extremely rare condition characterized by the appearance of purpuric lesions on the skin which on biopsy are suggestive of leukocytoclastic vasculitis (LV). We hereby report a case presenting with coexistent warfarin-induced nephropathy and cutaneous vasculitis. A 64-year-old male, on warfarin for 10 years, presented with complaints of palpable purpuric rashes over lower limbs, hematuria, and decrease urine output. INR was in the supratherapeutic range (INR-6.3). Skin biopsy of the lesion was suggestive of LV and kidney biopsy showed RBCs in Bowman’s capsule, RBCs and RBC casts in tubules suggestive of ARN. All vasculitic markers were negative. Thus, a diagnosis of warfarin-induced nephropathy and cutaneous vasculitis was made. Warfarin was discontinued and oral steroids were started. Gradually, his skin lesions improved, and he became dialysis independent. He was then discharged on apixaban. On follow-up after 3 months, his skin lesions had disappeared with partial recovery of kidney function (cr-5.49).

Early-start peritoneal dialysis (PD) (use of PD catheter within 48 hours of insertion) is an innovative approach for prompt initiation of PD.This study was conducted to analyze the outcomes of early-start PD.A total of 100 patients on PD were retrospectively analyzed. Patients were grouped according to the "break-in period":48 hours (PD1) and ≥ 14 days (PD2). PD was initiated with low dwell volumes (500 mL) in a recumbent position within 48 hours of surgery. PD prescription was gradually incremented over 10 days to minimize any complications.In our study, there were 48 patients in the PD1 group and 52 in the PD2 group. The most common cause of end-stage kidney disease (ESKD) was diabetes mellitus in both groups. Incidence of early mechanical complications (within 30 days of catheter insertion), such as catheter obstruction, early catheter leakage, catheter malposition, tip migration, and infectious complications, were not found to be higher in the PD1 group. 1- and 4-year catheter patency rates were 97.0% and 96.2% in the PD1 group, respectively. These rates were comparable with those in the PD2 group. Early-start PD was not associated with an increased incidence of catheter failure (HR = 1.0, 95% CI 0.28 - 3.47).An early break-in period of48 hours is a feasible option for ESKD patients without any significantly increased risk of mechanical or infectious complications. It offers a safe and efficacious option for renal replacement therapy.

The most common glomerulonephritis seen in the world is immunoglobulin A nephropathy (IgAN). It can be primary or secondary associated with various conditions like Chronic Liver disease, Crohn's disease, neoplasms, etc. However, IgAN secondary to Wilson's disease is very rare. A 9 year old boy presented with gross hematuria and proteinuria. He had a history of recurrent jaundice in the past. Ultrasonography (USG) whole abdomen showed altered echotexture of the liver with normal-sized kidneys. An extended workup for liver disease was done, and the diagnosis of Wilson's disease was confirmed with decreased serum ceruloplasmin levels, increased urinary copper, and the Kayser–Fleischer ring. Urine routine microscopy showed numerous red blood cells, few red blood cell casts, and mild proteinuria. Renal biopsy showed IgAN. The patient was started on D-penicillamine. On follow-up at 3 months, he showed complete resolution of proteinuria and hematuria. Thus, we suggest that Wilson's disease should be considered as one of the causes of secondary IgAN in pediatric patients with hematuria, proteinuria with liver dysfunction.

We investigated 60 patients undergoing Total hip arthropasty in a prospective, interventional and randomized study. Here, patients were divided alternatively into two groups of 30 patients each, in group A and group B. Group A will receive intravenous infusion of tranexamic acid at dose of 15mg/kg and same will be given 3hrs after the first dose, while in group B no drug will be given. Direct and Indirect blood loss is calculated. Hence, direct blood loss is less (p value=0.000) in tranexamic group compared to control group i.e988 vs 1295 ml. Indirect blood loss, is also significantly lower in patients receiving drug as compared to placebo group. i.e (1018.87±160.76 vs 1335.2±194.4 ml)None of the patient in our study in either group developed any complication. In conclusion, we found Tranexamic acid, administrated before surgical incision, to be efficient in reducing Direct and Indirect blood loss during Total hip arthroplasty.Thus, we conclude that Tranexamic acid administration is an effective, safe and cheap method for reducing total blood loss, drain output, and hemoglobin drop without any increase in thromboembolic complications.

Workers on Electronic Manufacturing Service (EMS) assembly lines are exposed to a high degree of occupational stress and fatigue. There is a need for assistive technologies to limit worker stress/fatigue. Electro Dermal Activity (EDA) (Skin Conductance) is a known indicator of a worker’s stress/fatigue level. We propose a novel Electrostatic Discharge (ESD) wrist strap-based EDA sensor. Our sensor seamlessly integrates with the dual-wire grounded ESD wrist strap that EMS operators are mandated to wear. Our approach for EDA measurement is non-intrusive, considering that the operators are accustomed to continuous usage of ESD wrist straps. Besides EDA measurement, our front-end circuit also monitors the integrity of the ESD wrist strap and alerts the wearer in the event of an intermittent or open ground. We present the circuit design and stress-test-based experimental results.

Background: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder of premenopausal (1) women affecting approximately 5-10% of female population in their reproductive years . The clinical, biochemical as well as the radiological spectrum of PCOS and their correlations have gained importance over the years owing to complex pathophysiology of this syndrome, which still remains partially understood. Aims & Objectives: To study hemodynamic changes in ovarian and uterine arteries in PCOS patients using color doppler ultrasound, along with their clinical and biochemical parameters. A total of 60 patients with clinical history of infertility Methods: (30 obese & 30 non-obese) and 30 control (fertile women) were taken, who underwent transvaginal ultrasound and color doppler scan, and were correlated clinically and hormonally. Results: The ovarian artery mean pulsatility index (PI) was observed to be 4.05 in control group and 2.58 among PCOS cases, which is signicantly decreased in cases. Comparing non-obese and obese PCOS cases, the mean ovarian artery PI was found to be 2.65 and 2.51 respectively. The difference was not signicant. In our study, the resistive index (RI) of ovarian artery also showed a signicant decrease among PCOS cases with mean value of 0.62, compared to 0.9 in the control group. The PI and RI of uterine artery in both obese and non-obese cases were signicantly increased in comparison to control group. Transvaginal colour doppler helps in adequate evaluation of haemodynami Conclusion: c changes in small vessels of utero-ovarian circulation. It can aid in diagnosis as well as serve as prognostic indicator in patients suffering from PCOS.

Background: Epidemiological surveillance is the cornerstone for the prevention and control of any pandemic. The purpose of the study was using clinical and radiological data of COVID-19 positive patients to describe the clinical features, risk factors, grading of severity on the basis of chest X-ray and their survival outcome. Methods: A retrospective observational study comprising 9100 COVID-19 positive patients was done in the Department of Radiodiagnosis, M.G.M. Medical College and M.Y. Hospital, Indore. Patients' data including demography, clinical findings, vaccination status and imaging findings was collected and assessed in between March 2020 and March 2022. In the descriptive statistical analysis, continuous variables were noted in terms of the mean and standard deviation and nominal variables were noted in terms of percentage.Results: In our study, there were 9100 patients proven with positive COVID-19 disease had abnormal CXRs were detected in 7553 of 9100 patients (83%). In our study, B/L lung involvement (69%) was found to be more with lower lung zone predominance (86.5%) and peripheral predominance opacities (83.7%). The most common finding of chest X-ray pattern is consolidation (65.7%), followed by ground glass opacity (29.0%). Most of the vaccinated patients were found to be in mild category and majority of mild cases didn’t require oxygen support. The chi-square statistic is 79.3372. The result is significant at p

CMV infection is one of the most common opportunistic infection in kidney transplant patients. If not treated, it is associated with increased mortality and graft loss. It can present as viremia or CMV disease in the form of CMV syndrome or tissue invasive CMV disease. The cutaneous presentation of CMV disease is a rare finding. Its identification is vital as cutaneous CMV infection can signal systemic infection and poor prognosis. In our case, 46-year-old male who was a post renal allograft recipient (RAR) presented as a protuberant growth over the medial side of the left ankle. On skin biopsy, nucleomegaly and inclusion bodies were seen in the epithelial cells. Immunohistochemistry was positive for CMV infection. Patient was treated with Ganciclovir, however, he succumbed to death because of severe sepsis due to secondary bacterial infection. Thus, CMV disease should always be kept in mind in immunocompromised patients like post RAR patients who present with cutaneous features like ulcerative lesions or fungating growth.

Industry 4.0 is the latest trend in the manufacturing sector that focuses on intelligent manufacturing and smart factories. This leads to opportunities in automation, optimization, asset management and predictive maintenance, which helps reduce downtime and increase revenue. In this paper, we propose the solution that was created for a particular SMT PCB manufacturing facility in Mysuru (Vinyas IT), the features it has to offer and the methodologies that were implemented in order to achieve our goals. We will also highlight the important aspects of the solution that will be showcased during the demonstration and the impact of our solution.

Background: The high mortality associated with ovarian cancer is due to delayed detection. Novel agents are being developed for more targeted therapy. Hence, a more accurate interpretation of the lesion is required. DW-MRI forms a promising tool in the same. Aims & Objectives: To assess the diagnostic potential of DW-MRI in the evaluation of ovarian mass lesions. Methods: 103 women with ovarian lesions were evaluated with DW-MRI. The characteristics were recorded, analysed and compared with histopathology reports wherever possible. Results: With a sensitivity of 93.94%, a specicity of 98.08% and accuracy of 96.47%, DW-MRI is a promising tool to be considered in the evaluation protocol of ovarian mass lesions, for a more accurate interpretation. Conclusion: With advancements like diffusion-weighted, in conventional MRI, the diagnostic performance has been improved and needs to be utilised in the evaluation of ovarian mass lesions

Background: Ovarian cancer is highly lethal due to delayed detection. Ovarian lesions display a myriad of findings on imaging. Knowledge of these is essential to make a diagnosis or list the differentials. USG remains the mainstay imaging modality in this war on cancer. Aims & Objectives: To assess the diagnostic accuracy of USG B-mode and doppler in characterisation of ovarian mass lesions. Methods: 103 women with ovarian lesions were evaluated with USG B-mode and doppler. The interpretation was compared with histopathology reports wherever possible. Results: With sensitivity and NPV of 81.82% and 84.62% of USG B-mode, it is a good primary imaging modality. By showing an increase in specificity to 94.23%, PPV to 89.29% and accuracy to 87.06%, the addition of doppler in the evaluation acts as a tool in confirmation of malignancy. Conclusion: With good diagnostic performance, USG proves to be a good primary imaging modality. Also, doppler evaluation forms a promising add-on that can be considered.

Chylous ascites refers to the accumulation of chyle in the abdominal cavity. Postoperative chylous ascites is most commonly associated with abdominal aortic surgeries. However, it is a rare complication following laparoscopic nephrectomy. It causes loss of fat, protein, and antibodies causing malnutrition and immunodeficiency. Thus, it is important to treat it as early as possible. We hereby report a case of chylous ascites following laparoscopic donor nephrectomy. A 55-year-old female was admitted at our center 2 weeks after undergoing left laparoscopic donor nephrectomy with abdominal distension and constipation. USG abdomen revealed free fluid in the abdomen. Paracentesis revealed chylous ascites. The patient was started on conservative treatment, including a diet rich in proteins and low in fats; conservative treatment, however, was unsuccessful. Lymphangiography and subsequent embolization of the defect were done, and she made a full recovery.

This paper illustrates the implementation of a character feature extraction, classifier and an effective mapping algorithm applied on images of vehicle license plates, using nonlinear feature extraction and spatial mapping. A novel algorithm for low-level visual feature extraction has been presented, highlighting non-linear morphological operations with structuring, filtering, erosion and dilation techniques. Filtering and enhancement of raw image for key feature extraction and recognition by edges by sobel, canny and Fuzzy logic, convolution, median filtering and scaling image for boosting visual spatial features has been performed. Template matching using thresholding by effective feature mapping and semantic feature matching methods with pre-fed datasets has been accomplished as an application to image computing. The results obtained are tabulated and an accuracy of 79.30% using the above mentioned algorithm is reported. The images henceforth have been exposed to standard channel noises and thereafter compared for loss of information and overall structure. Comparison methodologies used are MSE and PSNR values and Structured Similarity Index (SSIM). The accuracy of results thus obtained are reported, suggesting the robustness and effectiveness of the algorithm. Image acquisition is accomplished by a remotely controlled android platform based device integrated with the MATLAB platform in real-time. The acquired number-plate data is transferred into a text file for creating a vehicle index log, critical for security systems.

This paper looks at the attitude of people toward mutual funds as an investment vehicle in Nepal. Mutual funds is a relatively new industry in Nepal. How people perceive mutual funds is important because this affects their intention to buy and ultimately their behaviour. As such, this paper examines key variables that are likely to affect people's evaluations toward mutual funds as an investment vehicle from a Nepalese perspective.

The antenatal magnetic resonance imaging (MRI) of a third-trimester primipara patient showed a fetus in a vertical position with two separate heads, a common thorax, abdomen, and pelvis with a single pair of upper and lower limbs [Figure 1]. Both heads appeared equal and symmetric with normal brain development [Figure 2]. Two separate upper cervical spinal cords fused to form a single spinal cord in the mid/lower cervical spine level. There was a single heart present in the thoracic cavity. The intra-abdominal organs appeared normal in position, structure, and number [Figure 1]. The findings were confirmed at delivery [Figure 3]. Figure 1 Coronal T2-weighted turbo spin echo (TSE) showed the fetus in a vertical position with two separate heads, two cervical spinal cords fusing at the mid-cervical spine level, a common thorax, abdomen, and pelvis, and a single pair of upper and lower limbs ... Figure 2 Coronal T2-weighted turbo spin echo (TSE) the posterior half of the fetal heads showed normally and bilaterally symmetric development of the fetal brains on both sides. Normal appearing cerebral and cerebellar hemispheres, with normal sulci and gyri, ... Figure 3 Postnatal photograph of the baby delivered at 28 gestational weeks by cesarean section. (Informed consent was taken from the parents of this baby for use of this image).