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Electric scooters are increasingly gaining popularity in India owing to rising global crude oil prices and rising levels of vehicular pollution. Most of them are currently powered by expensive in-wheel (IW) permanent magnet (PM) brushless DC motors. Owing to their simplicity, and ruggedness while being cost-effective (since they do not employ PMs), switched reluctance motors (SRMs) are a viable alternative. Despite these benefits, SRMs possess drawbacks such as low torque density and inferior efficiency. Recently, a multi-teeth (MT) SRM with an improved performance was reported. However, the design of MTSRM topologies and their electromagnetic performance have not been explored sufficiently. In this paper, a design formula governing the selection of the number of MT and rotor poles for MTSRMs has been proposed. Using this, a novel four-phase 8/18 IW-MTSRM is derived and proposed for an E-scooter. The characteristics of the proposed SRM are numerically compared with a conventional 8/10 SRM based on magnetic characteristics, efficiencies and steady-state operation for the complete torque-speed range. Results indicate that the proposed 8/18 MTSRM has a higher peak torque capacity, torque density, superior drive cycle efficiency and reduced torque ripple. Further, the FEA model is validated experimentally on a downsized 8/18 MTSRM prototype.

Background: The success of immunization depends highly on the level of cold chain maintenance. For effective implementation and success of the Universal Immunisation Programme, proper maintenance of Cold Chain needs a great focus. In 2010, WHO and UNICEF launched the Effective Vaccine Management (EVM) initiative. EVM is a tool which assesses immunization supply chain logistics management. Objectives: To evaluate the performance of Immunization supply chain in cold chain points of Government Health Facilities (HF) of Jammu district Methodology: A facility based cross-sectional study was conducted in Jammu district of UT of J&K. The assessment was done during November 2021– October 2022 using WHO-UNICEF EVM assessment standalone questionnaire generated on EVM assessor app. Sample size and site selection were done using the WHO EVM site selection tool(v1.7-March 2014). A total of 31 HFs were assessed including Divisional Vaccine Store (SN) Results: None of the health facilities reached the WHO recommended overall score of >80%. The criterion scores showed that Facility infrastructure and equipment (E4) and waste management (E9) for District Vaccine Store (LD) was 83% & 86%. Vaccine management (E8) score for SN level & Government Hospital was 88% & 82%. Rest of the CCPs scored less than 80% for all the criteria(E2-E9). The scores of distribution of vaccines and dry goods (E7) were very low for Primary Health Centres (PHC) and Health & Wellness Centres (H&WC) i.e., 39% and 25%. The scores for all the categories(C1-C6) for various CCPs were below 80%. Management criteria scores for supportive supervision(M3) was 0% for all CCP except LD &PHC Conclusion: The overall performance of cold chain in Jammu district was below the recommended level. Supportive supervision, provision of safe disposal pits, power backup, micro plan, training of Cold Chain Handlers and provision of vaccine transportation facility can help in effective vaccine management

Background: HIV/AIDS remains a significant global health challenge, affecting the well-being of millions around the world. While HIV treatments have demonstrated effectiveness, ongoing research indicates the persistence of various psychosocial challenges that tend to compromise the quality of life for individuals coping with HIV/AIDS. Notably, stigma associated with HIV/ AIDS remains widespread among affected individuals, exerting detrimental impacts on their overall quality of life Objective: To assess the quality of life in patients living with HIV/AIDS and to assess the relationship between perceived stigma and quality of life in patients living with HIV/AIDS attending an antiretroviral therapy centre in a tertiary care hospital in Jammu Methodology: This observational cross-sectional study was conducted among patients with HIV/AIDS over a period of 8 months who were attending an antiretroviral therapy centre in a tertiary care hospital of Jammu city of UT of J&K, using systematic random sampling. Patients were administered a questionnaire comprising socio-demographic data, (Pozqol scale) for quality of life and a short version (HSS-12) of the Berger HIV Stigma Scale. Data was analyzed using SPSS version 23.0 software Results: A total of 300 patients were included in the study. The mean age of patients was 42.13±10.48. Mean scores for psychological, social, health and functional domains of quality of life were 10.79±3.76, 10.18±3.70, 8.81±3.16 and 10.76±3.35 respectively. Overall quality of life was found to be significantly associated with marital status and HIV status of spouse/partner. There were significant negative correlations between various dimensions of stigma and different domains of quality of life Conclusion: Our findings indicated that higher HIV/AIDS-related perceived stigma decreases the quality of life in patients living with HIV/AIDS. “Prioritizing efforts to reduce stigma, enhance healthcare plans, and improve economic conditions is crucial for fostering improvements in the overall quality of life and its associated domains in the lives of patients living with HIV/AIDS.”

Background: Puerperium or Postpartum period is the period of first six weeks postpartum which begin immediately after parturition. During this time woman is adapting to multiple physical, social and psychological changes. Early identification of such symptoms is crucial for its prompt treatment. Many women develop depressive symptoms. Objective: is to find out the prevalence and factors associated with Postpartum Depression especially the social support. Methodology: this cross-sectional study was conducted for a period of one year among mothers who were in the period of 4-7 weeks postpartum. The participants were assessed using the scales -Edinburgh Postnatal Depression scale, Hamilton depression Rating scale and Multidimensional scale of perceived Social Support (MSPSS). Statistical analysis was done using spss version (20.0) info. Appropriate statistical tests were used. A p-value of < 0.05 was considered statistically significant. Results: Out of 750, 16.1% had postpartum depression, (a score of =10 on EPDS). The factors which were significantly associated included marital status, religion, residence, education of mother and her husband, history of domestic violence, history of mental illness in the past, family history of mental illness, duration of pregnancy, time since delivery, any complication during pregnancy, birthweight of baby and planned parenthood. Social support shows negative correlation with PPD which is statistically significant Conclusion: The prevalence of depression in postpartum mothers is high, various sociodemographic and obstetric factors are significantly associated with it. social support emerged to be protective in reducing the postpartum depression.

Background: Globally, the available literature indicates a disturbing and increasing trend of high levels of alcohol use, illicit drug use and misuse of prescription psychoactive drugs among the medical students. This interferes with the learning of medical students because of the cognitive and psychological impact the substance use can have on an individual and is also a cause of concern because of the direct negative impact substance use can have on the safety of patients, not to mention the conduct and efficiency of future doctors. Objectives: To estimate the prevalence of substance use and the association of various socio-demographic factors associated with substance use among Undergraduate Medical students. Methodology: This was a cross-sectional study conducted among 482 Undergraduate Medical students pursuing M.B.B.S. at GMC Jammu from September to mid-November 2023. First of all the socio-demographic data was collected, followed by an assessment of substance use. It was done using the WHO ASSIST questionnaire, which was distributed to the participants in electronic format (Google form). The participants were instructed to read and answer each question honestly and to the best of their knowledge. Proportions with 95% Confidence Interval were used to summarize the substance use. Results: A total of 482 Medical undergraduates participated in the study. The mean age of the study participants was 20 years (± 1.34). The substance with the most prevalent use was alcohol (12.2%). Tobacco, sedatives and cannabis consumption was reported to be 6%, 1.9% and 1.5% respectively among the respondents. Conclusion: Despite being aware of the potential hazards, medical students continue substance abuse, which is indicative of a lack of awareness about one’s health as well as increased peer and academic pressure and a lack of parental supervision. Proper counselling with well-planned policies should be implemented to address the evil of substance abuse among aspiring doctors.

In this paper, we consider Leavitt path algebras having coefficients in a k-semifield. Concentrating on the aspect of k-simplicity, we find a set of necessary and sufficient conditions for the k-simplicity of the Leavitt path algebra LS(Γ) of a directed graph Γ over a non-zeroid k-semifield S.

The high computational cost, complex external environment, and limited computing resources of embedded system are some major problems in traditional autonomous robot navigation methods. To overcome these problems, a mobile robot path planning navigation system based on panoramic vision was proposed. This method first describes the structure and functions of the navigation system. It explains how to use the environment to explore and map in order to create a panoramic vision sensor. Finally, it elaborates on the breadth-first search based on regression neural network (RNN) method, the Voronoi skeleton diagram method, the algorithm principle, and how to navigate by the planning path implementation of practical strategies. The simulation results illustrate that the breadth-first search method and the Voronoi skeleton graph method based on panoramic view have a high speed. The accessibility of RNN planning algorithm can effectively solve the difficult problems such as high computing overhead, complex navigation environment, and limited computing resources. In the actual robot navigation experiment, the difference in real-time performance and optimality performance that exists between the two algorithms is reflected in the length and duration of the course taken by the robot. When applied to a variety of site environments, the breadth-first search method requires between 23.2 and 45.3% more time to calculate the planned path than the Voronoi skeleton graph method, despite the fact that the planned path length is between 20.7 and 35.9% shorter using the breadth-first search method. It serves as a guide for choosing the appropriate algorithm to implement in practical applications.

These days, building sustainable infrastructure requires human endurance. In this sense, the idea of combining PET (polyethylene terephthalate) with pervious concrete is an intriguing field of study. On the one hand, by enabling water to percolate through voids and lowering surface runoff, pervious concrete helps to replenish groundwater levels. Conversely, waste PET plastic, which is produced more frequently these days, is recycled in building projects. Consequently, this leads to two main benefits: concrete’s mechanical and hydraulic qualities are changed, and plastic waste is effectively managed. This study looks at using leftover PET plastic fibres in varying amounts to create pervious concrete and assesses the mechanical properties (compressive strength, flexural strength, split. Porosity and permeability were also found to be correlated. Finally, an abrasion resistance test was conducted. Various percentages of PET plastic fibres, specifically 0%, 5%, 10%, 15%, and 20% by volume were used in place of natural coarse aggregates in this investigation while maintaining a constant water-to-cement ratio of 0.34. Compressive strength, flexural strength, and split tensile strength are all decreased when the amount of PET plastic in the concrete mix is increased. This decline in trend was notable for compressive strength at 20% replacement and for flexure strength at 10% replacement. Porosity, permeability, and abrasion resistance all indicated a progressive increase for different replacement percentages at the same time. The results of the experiment revealed that the porous concrete had an aggregate-to-binder ratio of 0.34 and a weight-to-cement ratio of 0.34.

Protection and control automation messages transfer between devices and the control center (CC) over IEC 61850 standard protocols in active distribution network (ADN) using Ethernet. Wireless communication network provides real-time monitoring and control of ADN. The proposed novel approach framework presentsline to ground (LG) faults protection and control method utilizing IEC 61850 standards at bay level between intelligent protection devices for fast and reliable protection. Moreover, this bay level peer to peer communication utilizes IEEE 802.11 wireless local area network (WLAN)to reduce the fault protection time and other messages transferring time instead of Ethernet communication by GOOSE multicast communication services. End to end time delay and throughput of data transmission between the coordination nodes are illustrated using NS2 simulation.

Power generation from Photovoltaic (PV) modules is the best way to utilize the renewable energy in many places. The output of the PV modules will depends on many factors including changes in solar irradiance, temperature, partial shading conditions, operating voltage across terminals of module etc. Apart from operating voltage of PV modules, remaining all factors are depending on nature which we cannot change easily. Hence obtaining an effective voltage regulation of terminals to achieve maximum power from PV module is very important for best utilization. There are many existing maximum power point tracking (MPPT) mechanisms on PV systems but an effective integrating mechanism is required to achieve the best operation under all possible conditions. Artificial neural network (ANN) can able to produce best reference signal corresponding to maximum power location under various random changes very quickly. In other hand, sliding mode controller (SMC) is able to force the boost converter to deliver the best output voltage with fewer ripples under variable input voltage. Fastest response with fewer ripples in dc voltage can help to harvest maximum energy from PV panels. Therefore, integration of ANN with SMC can prepare the MPPT converter to deliver more energy under random changes in irradiance and temperature. The performance of ANN associated SMC for boost converter based MPPT of the PV system is presented in this paper. In order to obtain more realistic response, Hardware-in the-Loop (HIL) is established for proposed system with the help of two OPAL-RT modules. Extensive results by using HIL are presented and discussed under various case studies to enhance the proposed method.

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with increased morbidity and mortality. We retrospectively analysed the perioperative anesthetic management in patients undergoing HIPEC surgery.

Introduction: The structural characteristics of unilaterally impacted maxillary canines and adjacent teeth were compared to the nonimpacted side. Three-dimensional (3D) cone-beam computed tomography (CBCT) was used to analyze and evaluate the various parameters. The aim of this study was a quantitative comparison of teeth adjacent to buccally and palatally impacted maxillary canines. Methods: CBCT records of 40 patients with unilateral impacted maxillary canine were allocated to this study. The morphological characteristics of teeth on the impaction and non-impaction sides of the same patient were examined. 3D reconstructed CBCT images were assessed using the OnDemand 3D program. Results: The dependent samples t test was used for data analysis with a level of statistical significance of 0.05. There was a significant increase in the size of the maxillary canine crown and a decrease in the maxillary lateral incisor root dimensions on the impacted side. No significant difference was observed in the morphology of the maxillary first premolar on either side. Conclusion: The impacted canine showed greater size compared to the eruption side. The decrease in root dimensions of the lateral incisor on the impacted side may indicate the possibility of root resorption.

Background: DNA is the main target for UV-B-irradiation-induced skin photodamage and accounts for 90 % of all the non-melanoma skin cancers. Purpose: In this study, we explored the mechanistic basis of photoprotective effect of Trigonelline, a naturally occurring alkaloid from the Trigonella foenum-graecum, against UV-B-induced oxidative DNA Damage Response using Primary Human Dermal Fibroblasts (HDFs) and BALB/C mice as models of skin photodamage. Methods: Primary HDFs were subjected to UV-B exposure (10 mJ/cm2) with or without TG for 24 h. Effect of UV-B exposure and TG treatment was evaluated by analyzing the cell survival, cellular morphology, oxidative stress & DNA damage response markers by performing biochemical studies, florescent microscopy & protein expression studies. In in-vivo study, TG pre-treated BALB/c mice were -irradiated with 180 mJ/cm2 of UV-B dose thrice a week on alternative days for four months, followed by topical application of different concentrations of TG. The photodamage caused by UV-B exposure and its ameleoriation by topical treatment of TG was studied by physical and morphological appearance and analyzing the oxidative stress & DNA damage response markers from skin. Results: We found that TG significantly alleviates UV-B–induced cell death effects in HDFs. TG protects HDF cells and BALB/c mice from UV-B-induced DNA damage by regulating the expression profile of key protein markers of DNA damage which include P53, ATM, ATR, ϒH2AX, Chk1 and Chk2. We found that TG offers geno-protection to UV-B–irradiated HDFs by alleviating CPD induction, reducing the number of TUNEL positive cells and by decreasing the expression levels of DNA damage marker protein ϒH2AX in immunocytochemistry. Further, we found that TG prevents the UVB induced oxidative stress by activating the PI3K-AKT-Nrf2 signalling pathway. On employing PI3K inhibitor, LY294002, we found the expression of ϒH2AX and p-P53 is significantly increased compared to UV-B treated only, indicating that TG mediates the geno-protection against UV-B irradiation via PI3K-AKT-Nrf2 signalling pathway. Conclusion: Current study presents for the first time the photo-protective role of TG against UV-B–induced oxidative DNA damage and provides its mechanistic insights also and provide strong evidence for TG to be carried forward as a potential remedial and cosmeceutical agent against UV-B–induced skin photodamage disorders.

Background: Retention in care is important for optimal treatment outcomes and effective positive prevention. Reports from India and other countries have mentioned various factors affecting retention but the data on 'opting out' from Antiretroviral Treatment (ART) under the National AIDS Control Programme are scanty. Aim and Objectives: To estimate prevalence and predictors for opting out from Antiretroviral Treatment among HIV infected individuals attending ART center at ICMR-National AIDS Research Institute, Pune. Material and Methods: In this retrospective study, records of individuals taking ART between January 2006 and May 2017 were reviewed. An individual who no longer wished to continue treatment with the national programme because of his/her personal choice and stopped visiting the centre was reported as being 'opted out' from the programme. Results: Of the total 3842 individuals ever initiated on ART, 115 (3%) individuals opted out. The possibility of opting out from ART was 4.9 [95% CI: 1.78-13.6, (p=0.002)] times more in individuals who showed declining trend in their CD4 counts and 8.8 [95% CI: 3.33-23.27,(p

This study examines the convergence patterns of prices across 50 U.S. states over the period 1960-2007, by applying the convergence algorithm developed by Peter C. B. Phillips and Donggyu Sul (2007). The empirical findings suggest the rejection of full convergence across the 50 U.S. states’ prices, and the presence of 11 subgroups, or convergence clubs. The main implications of this paper point to the low degree of market integration across the U.S. states, the limitations of using a unique national price deflator to calculate real U.S. state variables, and the different effects that national monetary policy decisions will have on U.S. state prices.

Weakly permeable micro-tubes are employed in many applications involving heat and/or mass transfer. During these processes, either solute concentration builds up (mass transfer) or steep change in temperature (heat transfer) takes place near the permeable wall causing a change in the viscosity of the fluid. Results of the present work suggest that such change in viscosity leads to a considerable alteration in the flow behavior, and the commonly assumed parabolic velocity profile no longer exists. To solve the problem numerically, the equation of motion was simplified to represent permeation of incompressible, Newtonian fluid with changing viscosity through a micro-tube. Even after considerable simplification, the accuracy of the results was the same as that obtained by previously reported results for some specific cases using rigorous formulation. The algorithm developed in the present work is found to be numerically robust and simple so that it can be easily integrated with other simulations.

Today, sustainable packaging has become an important way towards achieving the sustainable development by protecting the environment. This paper is an attempt to investigate the factors which affect the intention of Indian consumers towards green packaging, a packaging which is not harmful to the environment. This study considers three factors/ variables namely environmental concern, attitude towards green packaging and willingness to pay as independent variables and purchase intention of consumers towards green packaged products as dependent variable. The data have been collected from 111 respondents and have been analysed by using SPSS software. The correlation and regression analysis were performed to reach the conclusion that which factor affects how much towards consumers’ purchase intention of green packaged products. Findings of this study demonstrated that all the three variables (environmental concern, attitude towards green packaged products and willingness to pay) have a positive effect on the dependent variable (consumers’ intention towards green packaged products).

This article evaluates the predictability of the equity risk premium in the United States by comparing the individual and complementary predictive power of macroeconomic variables and technical indicators using a comprehensive set of 16 economic and 14 technical predictors over a monthly out-ofsample period of 1995:01 to 2012:12 and an in-sample period of 1986:01- 1994:12. In order to do so we consider, in addition to the set of variables used in Christopher J. Neely et al. (2013) and using a more recent dataset, the forecasting ability of two other important variables namely government shutdown and debt ceiling. Our results show that one of the newly added variables namely government shutdown provides statistically significant out-of-sample predictive power over the equity risk premium relative to the historical average. Most of the variables, including government shutdown, also show significant economic gains for a risk averse investor especially during recessions.

The detection of waterborne bacteria is crucial to prevent health risks. Current research uses soft computing techniques based on Artificial Neural Networks (ANN) for the detection of bacterial pollution in water. The limitation of only relying on sensor-based water quality analysis for detection can be prone to human errors. Hence, there is a need to automate the process of real-time bacterial monitoring for minimizing the error, as mentioned above. To address this issue, we implement an automated process of water-borne bacterial detection using a hybrid technique called Adaptive Neuro-fuzzy Inference System (ANFIS), that integrates the advantage of learning in an ANN and a set of fuzzy if-then rules with appropriate membership functions. The experimental data as the input to the ANFIS model is obtained from the open-sourced dataset of government of India data platform, having 1992 experimental laboratory results from the years 2003-2014. We have included the following water quality parameters: Temperature, Dissolved Oxygen (DO), pH, Electrical conductivity, Biochemical oxygen demand (BOD) as the significant factors in the detection and existence of bacteria. The membership function changes automatically with every iteration during training of the system. The goal of the study is to compare the results obtained from the three membership functions of ANFIS- Triangle, Trapezoidal, and Bell-shaped with 35 = 243 fuzzy set rules. The results show that ANFIS with generalized bell-shaped membership function is best with its average error 0.00619 at epoch 100.

Neem (Azadirachta indica A. Juss) is a multipurpose Indian tree important to local economy. Conservation of the genetic resources of neem is essential for the adaptability of this tree species to projected climate change impacts. Here, the effect of type and concentration of auxins in different rooting media on adventitious root formation (ARF) in mini-cuttings of Azadirachta indica is depicted. Three different rooting media (i.e., sand, vermiculite and soil) were used, and the experiment was established using three types of auxin (IBA, IAA and NAA) and 6 concentration treatment combinations (100, 250, 500, 750, 1000 and 1500 mg l-1), in a complete randomized block design (CRBD). Significant effects of different auxin types, concentration treatments and rooting media on adventitious root formation of neem mini-cuttings were observed. Mini-cuttings were assessed for rooting percentage, number of roots, root length and number of leaves. IBA resulted in higher rooting percentage (90%), number of roots (149.56), root length (14.83 cm) and number of leaves per rooted mini-cuttings (12.78), when growing in sand. The determination of proper rooting protocols and the use of mini-cuttings were proved important for improving mass propagation of A. indica.

The present paper deals with the study of reflection waves in an initially stressed transversely isotropic medium, in the context of Green and Naghdi (GN) thermoelasticity theory type II and III. The components of displacement, stresses and temperature distributions are determined through the solution of the wave equation by imposing the appropriate boundary conditions. Numerically simulated results are plotted graphically with respect to frequency in order to show the effect of anisotropy.

The present paper deals with the reflection of waves incident at the surface of a transversely isotropic micropolar medium under the theory of thermoelasticity of GN types II and III. The wave equations are solved by imposing proper conditions on the components of displacement, stresses, and temperature distribution. It is found that there exist four different waves, viz. quasi-longitudinal displacement (qLD) wave, quasi-transverse displacement (qTD) wave, quasi-transverse microrotational (qTM) wave, and quasi-thermal (qT) wave. The amplitude ratios of these reflected waves are presented, when different waves are incident. Numerically simulated results have been depicted graphically for the different angles of incidence with respect to the frequency. Some special cases of interest also have been deduced from the present investigation.

We present latest results of soft and small-x QCD measurements with the CMS experiment, such as minimum bias/underlying event physics, and studies on forward jet production.

AIM:To study the normal aerobic conjunctival flora in lower to mid Himalayan region of Shimla Hills.METHODS:Samples from normal conjunctiva of 200 individuals above the age of 13 years who visited Indira Gandhi Medical College Hospital Shimla for refraction or cataract surgery were taken by anaesthetising the conjunctival sac with sterile 4% Xylocaine solution. Samples were obtained by gently rubbing lower fornix with a sterile cotton wool swab moistened with normal saline and keeping the eye lids wide apart to avoid contamination from lid margins. It was immediately inoculated in Brain Heart infusion and subjected to standard aerobic culture and identification techniques.RESULTS:Totally, 72 eyes (36%) conjunctival sacs were sterile. Predominant aerobes isolated were Staphylococcus spp. in 120 (60%) followed by Haemophilus in 16 (8%), diphtheroids in 10 (5%), and Escherichia.coli (E. coli) in 4 (2%). A single aerobe was isolated from 98 eyes (49%) while 30 eyes (15%) yielded more than 1 aerobe. Staphylococcus epidermidis (S.epidermidis) was the most common bacterium, found alone in 58 eyes (29%) and in combination with another aerobe in 30 eyes (15%), followed by Staphylococcus aureus (S. aureus) in 18 (9%) and 10 eyes (5%) respectively.CONCLUSION:S. epidermidis is the most common commensal organism followed by Haemophilus species. diphtheroids occupied the third position which otherwise are found more abundantly in literature. Pathogens like S. aureus, Staphylococcus citreus and E. coli were also found. Therefore, preoperative administration of topical broad spectrum antibiotics is extremely important in prophylaxis against ocular infection. The variation in microflora of normal conjunctiva in this part of world can be attributed to geographical, climatic and ethnic characteristics of the population under study.

【Abstract】Objective: The treatment of multi-fragmentary, intraarticular fractures of the distal humerus is difficult, even in young patients with bone of good quality. Small distal fragment, diminished bone mineral quality and increased trauma-associated joint destruction make stable joint reconstruction more problematic. The anatomically preshaped locking plates allow angular stable fixation for these complex fractures. We evaluated functional results of patients treated with open reduction and internal fixation with distal humerus locking plates for complex distal hu-merus fractures. Methods: Forty-three consecutive patients with ar-ticular fractures of the distal humerus were treated by open reduction and internal fixation with AO distal humerus plate system and locking reconstruction plates. Forty patients were available for the final outcome analysis. According to AO/ASIF classification, there were 2 cases of type A2, 4 cases of type A3, 1 case of type B1, 1 case of type B2, 14 cases of type C1, 7 cases of type C2 and 11 cases of type C3. Open reduction with triceps splitting technique was used in all patients. The clinical and radiographic follow-up was performed and outcome measures included pain assessment, range of motion, and Mayo elbow performance score. Results: Forty patients were available for the final outcome analysis. There were 29 males and 11 females with an average age of 38.4 years (18-73 years). Clinical and ra-diological consolidation of the fracture was observed in all cases at an average of 11.6 weeks (9-14 weeks). The average follow-up was 12 months (10-18 months). Using the Mayo elbow performance score the results obtained were graded as excellent or good results in 33 patients (82.5%). One pa-tient had superficial infection, and 4 had myositis ossificans. There were no cases of primary malposition or secondary displacement, implant failure or ulnar neuropathy. Conclusion: Anatomically preshaped distal humerus locking plate system is useful in providing stable fixation for complex distal articular fracture and facilitating early post-operative rehabilitation. The low rate of implant failure in the present study indicates that the technique is promising and warrants further investigation. Key words: Humerus; Fractures, bone; Bone plates; Fracture fixation, internal

Traumatic abdominal wall hernia is a rare condition that can follow any blunt trauma. Associated intra-abdominal injuries are infrequent. In this study, we are reporting three cases, diagnosed as abdominal wall hernia associated with herniation of bowel loops due to blunt trauma. In one case, injury of the herniated bowel was seen. In western medical literature, only few cases have been reported especially with intra-abdominal injuries.

Background: Polyomavirus nephropathy (PVN) and Cytomegalovirus (CMV) disease are the most common viral pathogens causing allograft dysfunction in renal allograft recipients. They have been observed in transplant recipients with increasing frequency in the recent years with various reports describing wide differences in the incidence of these infections in renal allografts. We present our experience with Polyomavirus (PV) infection and CMV infection in allograft of renal transplant recipients from a transplant centre in North India performing more than 100 transplants per year. Materials and Methods: 390 renal allograft specimens from 327 patients over a 4 year period, presenting with renal dysfunction were re-evaluated for presence of PVN and CMV disease utilizing histo-morphological features and immunohistochemistry. Results: Thirteen patients with PVN and four with CMV disease were identified. All patients were on triple drug immunosuppression receiving cyclosporine, prednisolone and tacrolimus or MMF. The mean period of diagnosis of viral infection after transplant was 12.4 months (seven days to 3.5 yrs) for PVN and 4.8 months (two to seven months) for CMV nephritis. Biopsies showed varying degrees of tubulointerstitial inflammation, viral inclusions and evidence of tubular damage. Associated features of acute rejection were present in 69.2% of patients with PVN. Conclusion: Histological features of PVN involving the kidneys have considerable morphological overlap with acute rejection while CMV disease presents primarily as tubulointerstitial inflammation. We observed a prevalence of 4% for PVN and 1.2% for CMV nephritis in renal allografts.

Context: Pulmonary hypertension (PH) is a serious and sometimes life-threatening event that occurs as a complication of various cardiopulmonary disorders, of which rheumatic heart disease (RHD) is an important example in our country. The pathogenesis of PH is a complex, multistep process in which "pulmonary endothelial dysfunction" (PED) is widely regarded as the central pathogenetic event. PED is, in turn, influenced by several local and systemic factors, of which nitric oxide synthase 3 (NOS3) and endothelin 1 (ET1) are 2 prime candidates, and are the subject of our study. Aims: Our aim was to study the immunoreactivity of NOS3 and ET1 in the pulmonary vasculature of PH patients of various etiologies, with emphasis on RHD cases. Settings and Design: A retrospective, autopsy-based study. Subjects and Methods: A total of 49 autopsy cases (39 patients and 10 controls) were chosen for our study. Of the 39 patients, 20 had PH secondary to RHD, whereas the remaining 19 patients had non-RHD etiologies as the basis of their PH. Lung sections taken from all the 49 cases were subjected to routine H and E, elastic van Gieson, and immunohistochemical staining (with NOS3 and ET1 separately). The intensity of immunostaining in all the cases and controls were then graded as focal/diffuse and weak/strong. Results: Controls showed positivity for both NOS3 (bronchiolar epithelium) and ET1 (endothelium of pulmonary arteries). Characteristic changes of PH on H and E were seen in 14 out of 19 non-RHD cases, which matched with the number of ET1 positivity cases. Similarly, for the RHD cases, 14 out of 20 cases showed changes of PH on H and E, but only 2 cases showed mild, focal positivity for ET1. Surprisingly, NOS3 positivity was largely absent in both the non-RHD and RHD cases. Conclusions: Our study showed NOS3 negativity and ET1 positivity in the lung vasculature of patients with PH, a conclusion more or less in line with the predominant view of the other investigators in this field. But at the same time, our study could not conclude an unequivocal role of NOS3 in PH, whereas it could, in the case of ET1.

We present results for the isovector axial, induced pseudoscalar, electric, and magnetic form factors of the nucleon. The calculations were done using 2 + 1 + 1-flavor HISQ ensembles generated by the MILC collaboration with lattice spacings a ≈ 0.12, 0.09, 0.06 fm and pion masses Mπ ≈ 310, 220, 130 MeV. Excited-states contamination is controlled by using four-state fits to two-point correlators and by comparing two-versus three-states in three-point correlators. The Q2 behavior is analyzed using the model independent z-expansion and the dipole ansatz. Final results for the charge radii and magnetic moment are obtained using a simultaneous fit in Mπ, lattice spacing a and finite volume.

We present the first preliminary results for the semileptonic form factor hA1 (w = 1)/ρAj at zero recoil for the B → D*lv decay using lattice QCD with four flavors of sea quarks. We use the HISQ staggered action for the light valence and sea quarks (the MILC HISQ configurations), and the Oktay-Kronfeld (OK) action for the heavy valence quarks.

We present an update on the status of the calculations of isovector and flavor-diagonal charges of the nucleon. The calculations of the isovector charges are being done using ten 2+1+1-flavor HISQ ensembles generated by the MILC collaboration covering the range of lattice spacings a ≈ 0.12, 0.09, 0.06 fm and pion masses Mπ ≈ 310, 220, 130 MeV. Excited-states contamination is controlled by using four-state fits to two-point correlators and three-states fits to the three-point correlators. The calculations of the disconnected diagrams needed to estimate flavor-diagonal charges are being done on a subset of six ensembles using the stocastic method. Final results are obtained using a simultaneous fit in M2π, the lattice spacing a and the finite volume parameter MπL keeping only the leading order corrections.

For the neutron to have an electric dipole moment (EDM), the theory of nature must have T, or equivalently CP, violation. Neutron EDM is a very good probe of novel CP violation in beyond the standard model physics. To leverage the connection between measured neutron EDM and novel mechanism of CP violation, one requires the calculation of matrix elements for CP violating operators, for which lattice QCD provides a first principle method. In this paper, we review the status of recent lattice QCD calculations of the contributions of the QCD Θ-term, the quark EDM term, and the quark chromo-EDM term to the neutron EDM.

Pulmonary artery thromboendarterectomy (PTE) has been regarded as a promising, potentially curative surgical procedure. However, PTE is associated with specific postoperative complications, such as reperfusion pulmonary edema and right heart failure leading to a considerable mortality of 7-24%. Despite its limitations PTE is a better surgical alternative to lung transplantation which carries high morbidity and mortality. The aim of the study is to analyze the efficacy, safety, morbidity and survival associated in the postoperative period and quality of life after six months of PTE in Indian patients. Forty-one patients with surgically correctable chronic thromboembolic pulmonary hypertension underwent pulmonary endarterectomy. All patients were in New York Heart Association (NYHA) Class II, III or IV. Preoperative mean pulmonary artery pressure was 40.98 ± 9.29 mmHg and mean pulmonary vascular resistance was 418.39 ± 95.88 dynes/sec/cm -5 . All patients were followed up to six months and a telephonic survey was conducted using a standard questionnaire. They were assessed and classified as per NYHA grading. There was a significant reduction in the mean pulmonary artery pressure (from 40.98 ± 9.29 mmHg to 24.13 ± 7.36 mmHg, P < 0.001) and pulmonary vascular resistance (from 418.39 ± 95.88 dynes/sec/cm -5 to 142.45 ± 36.27 dynes/sec/cm -5 , P < 0.001) with a concomitant increase in the cardiac index (from 1.99 ± 0.20 L/min/m 2 to 3.28 ± 0.56 L/min/m 2 , P < 0.001) during the postoperative period. The mortality rate in our study was 12.19% (five patients). Ninety per cent of the patients reported a significant improvement in the quality of life and exercise tolerance after surgery compared to the preoperative state. Pulmonary endarterectomy is an effective and potentially curative surgical treatment for patients with severe chronic thromboembolic pulmonary hypertension. The current techniques of operation make the procedure relatively safe and long-term survival, NYHA functional status and exercise capacity improve significantly.

Background : Diagnosis of sputum/smear-negative pulmonary tuberculosis patients can be both challenging and time consuming with many patients being put on empirical anti-tubercular treatment. Fibreoptic bronchoscopy may provide a confirmative and early diagnosis in such patients. Aims: To assess the role of fibreoptic bronchoscopy in the diagnosis of sputum /smear-negative pulmonary tuberculosis. Materials and Methods: The study was conducted on 75 suspected sputum / smear-negative pulmonary tuberculosis cases attending Pulmonary Medicine Department of Mamata Medical College and Hospital, Khammam, AP. Fibreoptic bronchoscopy was performed; culture of sputum and bronchial washings for Mycobacterium tuberculosis was done by BACTEC method. Results: A final diagnosis of sputum /smear-negative pulmonary tuberculosis was made in 60 patients. Bronchial washings smear for acid-fast bacilli (AFB) was positive in 21 patients while culture of bronchial washings was positive in 39 patients. In 29 patients, smear or culture of bronchial washing alone contributed to the final diagnosis. Total yield of bronchoscopy in diagnosis of sputum smear negative pulmonary tuberculosis was 83.33% (50/60); bronchoscopy was the only diagnostic method in 66% cases (40/60) with bronchial washings being the only diagnostic method in 48.33%. Bronchial washings smear for AFB and histopathological evidence of caseating granuloma made immediate diagnosis possible in 48.33% (29/60) patients. Conclusion: Our study suggests that fibreoptic bronchoscopy can provide excellent material for diagnosis of suspected cases of Pulmonary Tuberculosis in whom smears of expectorated sputum do not reveal mycobacteria.

Background: Mesenteric cysts are rare intra-abdominal masses in the paediatric age group with varied presentation, ranging from an asymptomatic mass to acute abdomen. This study reviews our experience in the diagnosis and treatment of 17 mesenteric cysts in our centre, with especial reference to acute abdominal symptoms. Patients and Methods: Seventeen patients (age less than 10 years) with mesenteric cysts were managed in our hospital. The age ranged from 15 days to 10 years. Patients were admitted with acute or chronic symptoms. They were evaluated with complete history, clinical examination, blood investigations and radiological investigations (x-ray abdomen erect, ultrasound abdomen (USG) and computed tomography (CT) scan in selected cases) to reach a provisional diagnosis. The diagnosis was proven on laparotomy and histologically confirmed. Results: The main presenting symptoms were abdominal pain or lump. The most common mode of presentation was acute small intestinal obstruction. USG was not conclusive in all. Abdominal CT scan with intravenous contrast was diagnostic in nine patients. Five patients had volvulus on exploration. Cysts were located in small intestinal mesentery in 14 cases and three were in the sigmoid mesentery. Seven patients had complete excision, intestinal resection was required in four and marsupialisation with cauterisation of margins was done in six patients. Histologically, all were lymphangiomatous mesenteric cysts. Conclusion: The diagnosis of mesenteric cysts should be kept in mind in any patient presenting with acute abdominal symptoms. Small bowel volvulus with mesenteric cyst constituted a significant number in children with acute abdominal symptoms. Early diagnosis and treatment yields excellent outcome.

Histological classification and grading are prime procedures in the management of patients with astrocytoma, providing vital data for therapeutic decision making and prognostication. However, it has limitations in assessing biological tumor behavior. This can be overcome by using newer immunohistochemical techniques. This study was carried out to compare proliferative indices using proliferating cell nuclear antigen (PCNA), extent of p53 expression and micro vessel morphometric parameters in patients with low grade and anaplastic astrocytoma. Twenty-five patients, each of grade II and grade III astrocytoma were evaluated using monoclonal antibodies to PCNA, p53 protein and factor VIII related antigen. PCNA, p53-labeling indices were calculated along with micro vessel morphometric analysis using Biovis Image plus Software. Patients with grade III astrocytoma had higher PCNA and p53 labeling indices as compared with grade II astrocytoma (29.14 plus/minus 9.87% vs. 16.84 plus/minus 6.57%, p 0.001; 18.18 plus/minus 6.14% vs. 6.14 plus/minus 7.23%, p 0.001, respectively). Micro vessel percentage area of patients with grade III astrocytoma was also (4.26 plus/minus 3.70 vs. 1.05 plus/minus 0.56, p 0.001), higher along with other micro vessel morphometric parameters. Discordance between histology and one or more IHC parameters was seen in 5/25 (20%) of patients with grade III astrocytoma and 9/25 (36%) of patients with grade II disease. PCNA and p53 labeling indices were positively correlated with Pearson′s correlation, p less than 0.001 for both). Increased proliferative fraction, genetic alterations and neovascularization mark biological aggressiveness in astrocytoma. Immunohistochemical evaluation scores over meet the challenge of accurate prognostication of this potentially fatal malignancy.

Tuberculosis (TB) in any form is a devastating disease, which in its most severe form involves the central nervous system (CNS), with a high mortality and morbidity. Early diagnosis of CNS TB is necessary for appropriate treatment to reduce this morbidity and mortality. Routine diagnostic techniques involve culture and immunological tests of the tissue and biofluids, which are time-consuming and may delay definitive management. Noninvasive imaging modalities such as computed tomography (CT) scan and magnetic resonance imaging (MRI) are routinely used in the diagnosis of neurotuberculosis, with MRI offering greater inherent sensitivity and specificity than CT scan. In addition to conventional MRI imaging, magnetization transfer imaging, diffusion imaging, and proton magnetic resonance spectroscopy techniques are also being evaluated for better tissue characterization in CNS TB. The current article reviews the role of various MRI techniques in the diagnosis and management of CNS TB.

Background : This study reports our 28 months experience with minimal access surgery (MAS) in children. Materials and Methods : This was a review of all children who underwent MAS between December 2004 and March 2007 at the Departments of Paediatric Surgery, Seth Gordhandas Sunderdas Medical College (GSMC) and King Edward the VII Memorial (KEM) Hospital, India. Results and observations were tabulated and analysed, comparing with observations by various other authors regarding variety of indications such as, operative time, hospital stay, conversion rate, complications, safety, and feasibilty of MAS in neonates, in the appropriate operative groups. Results : A total of 199 procedures were performed in 193 children aged between 10 days and 12 years (average age: 5.7 years). One case of each, adrenal mass, retroperitoneoscopic nephrectomy, laparoscopic congenital diaphragmatic hernia (CDH) repair, and abdominoperineal pull-through for anorectal malformation, were converted to open surgeries due to technical difficulty. The overall conversion rate was 3%. Morbidity and mortality were very minimal and the procedures were well tolerated in majority of cases. Conclusion : We concluded that MAS procedures appear to be safe for a wide range of indications in neonates and children. Further development and expansion of its indications in neonatal and paediatric surgery requires further multi-institutional studies and larger cohort of patients, to compare with standards of open surgery.

Malnutrition and tuberculosis are both problems of considerable magnitude in most of the underdeveloped regions of the world. These two problems tend to interact with each other. Tuberculosis mortality rates in different economic groups in a community tend to vary inversely with their economic levels. Similarly, nutritional status is significantly lower in patients with active tuberculosis compared with healthy controls. Malnutrition can lead to secondary immunodeficiency that increases the host′s susceptibility to infection. In patients with tuberculosis, it leads to reduction in appetite, nutrient malabsorption, micronutrient malabsorption, and altered metabolism leading to wasting. Both, protein-energy malnutrition and micronutrients deficiencies increase the risk of tuberculosis. It has been found that malnourished tuberculosis patients have delayed recovery and higher mortality rates than well-nourished patients. Nutritional status of patients improves during tuberculosis chemotherapy. High prevalence of human immunodeficiency (HIV) infection in the underdeveloped countries further aggravates the problem of malnutrition and tuberculosis. Effect of malnutrition on childhood tuberculosis and tuberculin skin test are other important considerations. Nutritional supplementation may represent a novel approach for fast recovery in tuberculosis patients. In addition, raising nutritional status of population may prove to be an effective measure to control tuberculosis in underdeveloped areas of world.

Objectives: This study was planned to define the clinical profile of pulmonary tuberculosis (PTB) patients having renal amyloidosis, to identify the factors responsible for development of amyloidosis, to detect the time period between onset of amyloidosis and PTB, and analyze clinical features of amyloidosis in PTB patients for early diagnosis and timely assessment. Materials and Methods: Patients of PTB having pedal edema, proteinuria, and grossly diseased kidneys on ultrasound abdomen were subjected to renal biopsy and appropriate biochemical investigations. Clinical profile of biopsy proven amyloidosis cases was analyzed. Results: There were 43 patients (32 males, 11 females, age range 20-65 years) having PTB with pedal edema, proteinuria, and renal medical disease on abdominal ultrasound where amyloidosis was confirmed by renal biopsy. The total duration of illness ranged from two months to seven years (mean 2.25 years) and was less than five years in 93% patients. All patients had significant proteinuria. Nephrotic syndrome was seen in 23, hypertension in 19, hypoalbuminemia in 33, hypercholesterolemia in 29, and deranged renal functions in 32 patients. Ninety percent patients had moderate to far advanced pulmonary lesions on chest radiography with smear positivity in 21 patients. Conclusions: Renal amyloidosis is an important complication of PTB and should be suspected clinically in patients presenting with a triad of pedal edema, proteinuria, and medical renal disease on ultrasound. Contrary to general belief, renal amyloidosis may occur in PTB patients having disease for relatively shorter duration, and even if adequately treated.

Context: Headache patients commonly report sleep disruption and sleep disorders. Available literature suggests that the sleep pattern of headache sufferers is different from the control group. Patients in these studies were recruited from headache clinics; they did not include tension type headache. Aims: The aim of this study is to find out whether primary headaches affect sleep patterns. Settings and Design: Community based cross sectional study Materials and Methods: This study was conducted in three high schools. Children in the 12-19 age group were allowed to participate. They were given a questionnaire in the presence of at least one of the authors, who assisted them in filling it. They were asked to provide responses based on most severe recurrent headache that they had experienced rather than the more frequent ones. The questionnaire included questions regarding demographic data and the characteristics of headache according to International Classification of Headache Disorders-2 criteria. Part B of the questionnaire contained questions regarding sleep habits. The children were asked to provide data regarding sleep habits on a normal school day. Diagnosis was based upon the information contained in the questionnaire. A telephonic interview was also done, where the information provided was found inadequate. Statistical Analysis Used: Analysis was done with the help of SPSS v. 11.0., descriptive analysis, Chi square, and one way ANOVA with post hoc analysis. Kruskall-Wallis tests were run. Results: A total of 1862 subjects were included in the study. Migraineurs and tension type headache sufferers comprised 35.7% and 13.4% of the group respectively. Migraineurs had the highest prevalence of nocturnal awakenings ( P < 0.001), abnormal movements ( P =0.001) and breathing problems during sleep ( P < 0.001). Approximately half the migraineurs felt sleepy during the day ( P < 0.001) and spent around 1.17 hours in sleep during the day ( P = 0.007). Similarly, values for frequency of nocturnal awakenings per week ( P < 0.001), wake time after sleep onset and offset ( P < 0.001 and 0.002 respectively) were the maximum in migraineurs. Only 32.8% migraineurs reported refreshing sleep ( P < 0.001). Post hoc analysis revealed that migraineurs were different from the other two groups on most of the parameters. Conclusions: Sleep disruption is more common in migraineurs than those in the tension type headache sufferers and the control group.

Purpose: To examine the hypothesis that initial smear examination results have a significant bearing on the management and outcome of suspected microbial keratitis. Materials and Methods: One hundred and seventy consecutive patients with suspected microbial keratitis were included in a prospective nonrandomized comparative study and their detailed clinical and microbiological data (smears and cultures of corneal scrapings) were captured on a predesigned corneal ulcer database. Patients were divided into two groups: Group 1 included 68 patients with corneal scrapings negative in smears while Group 2 included 102 patients with corneal scrapings positive in smears. The two groups were compared for their clinico-microbiological profile, management and clinical outcome. The outcome was noted at three months. Fisher′s exact test was applied for statistical analysis. Results: Cultures were sterile in 57.3% of patients in Group 1 compared to 17.6% in Group 2. Scrapings that grew S. pneumoniae , gram-negative organisms, fungi and Acanthamoeba were more often positive in smears (18.6%, 11.8%, 19.6% and 2.9% respectively). While data on duration of prior treatment was not available, prior medication made no significant difference to smear results. More (79.3%) patients of Group 1 had small infiltrate size (< 25 mm[[2]]) compared to Group 2 (49%). Significantly more patients in Group 2 than in Group 1 were treated with antifungals (5.4% vs. 41%) and fortified antibiotic combination (12.7% vs. 27%). Broad-spectrum antibiotic (ciprofloxacin) was started more often in Group 1 than Group 2 (60% vs. 15% respectively). The corneal infiltrate resolved in 33.3% of cases in Group 2, which was significantly more than in Group 1 (33.3% and 7.3% respectively). Conclusions: Initial smear examination helps in instituting specific therapy thereby improving the outcome in cases of microbial keratitis. Positive smears indicate greater severity of disease and prior medication may not be a significant cause of smear negativity.