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Himalayan glaciers are retreating, and glacial lakes are evolving and proliferating as a result of climate change. Glacier retreat marks in the formation and expansion, and sometimes outburst of moraine-dammed lakes. Lato Lake is one of the high-altitude and unexplored glacial lakes upstream of Gya-Miru village in the Leh-Ladakh region. This study is the first of its kind to assess hydrogeochemistry (HCO3−, SO42−, NO3−, Cl−, F−, Ca2+, Mg2+, Na+, and K+) and studying the dynamics of a moraine-dammed lake in the Ladakh Himalayas. We observed substantial expansion of Lato Lake over the past 50 years between 1969 and 2019, and the areas of the lake have increased while the glacier area is reduced by 16.4% and 4.15%, respectively. The pH values ranging from 7.6 to 8.1 show slightly alkaline. HCO3−, Ca2+, and SO42− were the most dominant ions during the study period 2018–19. The high (Ca2+ + Mg2+) and a low (Na+ + K+) ratio to the total cations show that Lato Lake receives ions from rock weathering, primarily from carbonate rocks. Gibbs and Na-Mixing plot also support the hydrogeochemistry of lake water was primarily controlled by rock weathering. HYSPILT backward trajectory model suggested that atmospheric input mainly originated from the seawater vapor transported by the summer monsoonal and westerly circulation systems. Results show that the lake has a substantial impact on the long-range transport of ocean water relative to local interferences.

Recent studies have endorsed that surface water chemical composition in the Himalayas is impacted by climate change-induced accelerated melting of glaciers. Chemical weathering dynamics in the Ladakh region is poorly understood, due to unavailability of in situ dataset. The aim of the present study is to investigate how the two distinct catchments (Lato and Stok) drive the meltwater chemistry of the Indus River and its tributary, in the Western Himalayas. Water samples were collected from two glaciated catchments (Lato and Stok), Chabe Nama (tributary) and the Indus River in Ladakh. The mildly alkaline pH (range 7.3-8.5) and fluctuating ionic trend of the meltwater samples reflected the distinct geology and weathering patterns of the Upper Indus Basin (UIB). Gibbs plot and mixing diagram revealed rock weathering outweighed evaporation and precipitation. The strong associations between Ca

Background: Guidelines for flexible bronchoscopy in adults recommend both Cricothyroid and Spray-as-you-go method as the acceptable techniques for lignocaine administration. No studies have compared these two methods for topical anesthesia during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Objectives: Co-primary outcomes were the comparison of cough count and operator-rated overall procedure satisfaction on a Visual Analog Scale (VAS) between the groups. The secondary outcomes were cumulative lignocaine dose, time from bronchoscope introduction to crossing the vocal cords, procedure duration, and complications between the groups. Methods: Consecutive participants (age >18 years) undergoing EBUS-TBNA were randomized (1:1) to either cricothyroid or spray-as-you-go methods for lignocaine administration. Results: Three hundred and sixty-five participants were randomized (183: Cricothyroid and 182: Spray-as-you-go). Cough count till reaching carina (median [interquartile range]) was significantly lower (cricothyroid, 1 [0–2] vs. spray-as-you-go, 4 [2–6], P < 0.001) and operator rated overall procedure satisfaction, on VAS (mean ± standard deviation) (cricothyroid, 7.96 ± 1.48 vs. spray-as-you-go, 7.29 ± 1.48, P < 0.001) significantly greater in the cricothyroid group. Cumulative lignocaine dose (163.28 ± 31.50 mg vs. 177.0 ± 30.12 mg, P < 0.0001) and time from bronchoscope introduction to crossing the vocal cords (20.80 ± 11.21 s vs. 38.08 ± 15.26 s, P < 0.001) was significantly lower in the cricothyroid group. Procedure duration was similar in both the groups. Minor complications occurred in three patients in cricothyroid and six patients in the spray-as-you-go group (P = 0.31). Conclusions: Cricothyroid lignocaine administration is associated with less cough and superior operator-rated procedure satisfaction during EBUS-TBNA, at a lower cumulative lignocaine dose administered. Trial Registration: www.clinicaltrials.gov NCT02981264

Understanding of chemical weathering process involved in ionic elution helps in distinguishing the CO2 sequestration rate at the different micro-climatic setup of Himalayan catchments. In the present study, we have selected three glaciated basins from two different climatic zones of Western Himalayas (Lato and Phutse from the cold-arid zone of Ladakh and Chhota Shigri from the monsoon-arid zone of Himachal Pradesh, India) for determining various solute sources, CO2 sequestration rate and its control over melt-water quality. Solute sourcing models used in this work shows major cations like Ca2+ and Mg2+ are from crustal rock-weathering while Na+ and K+ sourced out from the sea-salt origin. However, major anions like SO42- (> 85%) were derived from the crustal origin and HCO3- mostly derived from atmospheric sources (39% to 45 %) in all catchments except HCO3- contribution from carbonation dissolution and silicate weathering is ~29% and ~16% for Ladakh catchments compared to ~9 % and ~29% in Chhota Shigri respectively. The solute model also reveals that the contribution of sulphate oxidative mediated carbonate dissolution (SOCD) in HCO3- flux is relatively higher in Chhota Shigri (~16%) than others (~9%). It is also observed that catchment like Chhota Shigri having a combined network of channelized and distributed drainage patterns with lower specific discharge, more glacierized area, low pH, high pCO2, Low molar ratio [Ca2+ + Mg2+]/[ Na+ + K+], high SMF (~ 0.4), low CO2 carbonate/CO2 silicate ratio (~1.3) show relatively more sulphide oxidative and silicate weathered products than other catchments. Conversely, presence of excess non-glaciated areas in Stok and Phutse having well-channelized subsurface discharge with high CO2 carbonate/CO2 silicate ratio (~10 to ~5) show enhanced carbonation via atmospheric CO2 (CAC) and carbonate dissolution with high annual CO2 sequestration. Thus, varying subglacial drainage system, specific discharge pattern and reactive rock-types with distinct hydro-micro-climatic set up alters the chemical weathering mechanism in these catchments and control meltwater quality.

Objective: Our study aims to establish the potential for tumor heterogeneity evaluated using 18F fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) texture analysis in nonsmall-cell lung carcinoma (NSCLC) patients who underwent platinum-based chemotherapy to provide an independent marker for overall survival (OS) of more than 1-year. Materials and Methods: A total of 42 patients (34 male and 8 female) with biopsy-proven NSCLC and mean age 55.33 ± 10.71 years who underwent a baseline F-18 FDG PET/CT and received platinum-based chemotherapy as first-line treatment were retrospectively included in the study. Ten first order, 21 s order texture parameters and 7 SUV and metabolic tumor volume (MTV) based metabolic parameters were calculated. All these parameters were compared between the two survival groups based on OS ≥1 year and OS

Background: Comparative characteristics of the cricothyroid injection and spray-as-you-go methods for lidocaine administration during diagnostic flexible bronchoscopy are not clear. Objectives: Co-primary outcomes were comparison of cough count from bronchoscope introduction until reaching carina and operator-rated overall procedure satisfaction on a Visual Analogue Scale (VAS) between groups. Secondary outcomes were cumulative lidocaine dose, procedure duration, assistant-rated cough, willingness to return for repeat procedure, and procedural complications between groups. Methods: Consecutive subjects were randomized (1:1) to either the cricothyroid or the spray-as-you-go method for topical anesthesia to the vocal cords and trachea. All received nasal 2% lidocaine gel and pharyngeal 10% lidocaine spray. Results: A total of 500 subjects were randomized, and 495 subjects were analyzed (248 cricothyroid and 247 spray-as-you-go). Cough count until reaching carina (median [range]) was significantly lower (cricothyroid, 1 [0–10], and spray-as-you-go, 4 [0–30], p < 0.0001) and operator-rated overall procedure satisfaction, VAS (mean ± standard deviation) (cricothyroid, 7.86 ± 1.39 and spray-as-you-go, 6.86 ± 1.59, p < 0.0001) significantly greater in the cricothyroid group. Patient willingness to return for repeat procedure was greater (87.1 vs. 70.5%, p < 0.001)) and cumulative lidocaine dose significantly lower (305.08 ± 13.40 vs. 322.18 ± 10.67 mg, p < 0.001) in the cricothyroid group. Minor complications occurred in 6 patients in the cricothyroid group and 9 patients in the spray-as-you-go group. Conclusion: Cricothyroid lidocaine administration is associated with less cough and superior operator-rated procedure satisfaction during bronchoscopy at a lower cumulative lidocaine dose.

BACKGROUND The ideal concentration of lignocaine for topical anesthesia in bronchoscopy remains investigational. In this randomized, double blind study, we compared 1% versus 2% lignocaine for topical anesthesia. METHODS Consecutive patients undergoing bronchoscopy were randomized to receive either 1% or 2% lignocaine solution by spray-as-you-go technique. All received 10% lignocaine spray to the oropharynx along with nasal 2% lignocaine gel. Nebulized lignocaine was not administered. Primary outcomes were operator-rated overall procedural satisfaction, visual analogue scale (VAS)-rated and operator-rated cough, VAS. Secondary objectives were total lignocaine dose administered, patient-rated pain on faces pain scale, cumulative dose of lignocaine and procedural complications. RESULTS A total of 500 patients (250 in each group) were randomized. Baseline characteristics were comparable. Operator-rated overall procedural satisfaction, VAS (72.05±20.16 and 72.20±21.96 in 1% and 2% group respectively; P=0.93) and operator-rated cough, VAS [1% group: 19.1 (12.6-34.6) and 2% group: 20.6 (12.5-36.9); P>0.05] were similar between the 2 groups. Cumulative dose of lignocaine used in 2% lignocaine group was greater (220.89±12.96 mg in 1% and 319.55±19.32 mg in 2% group; P

Background and Objectives: No previous study has compared different concentrations of lignocaine for topical anesthesia during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). In this pilot study, we compared 1% versus 2% lignocaine for topical airway anesthesia during EBUS-TBNA. Methods: In this double-blind, randomized trial, subjects were randomized to receive either 1% or 2% lignocaine for “spray-as-you-go” administration. All received combined moderate intravenous sedation (midazolam and fentanyl). Ten percent pharyngeal lignocaine spray (two sprays) and nebulized lignocaine (2.5 ml of 4% solution) were administered to all subjects. Administration of additional lignocaine was allowed at operator's discretion. The primary endpoints were operator-rated overall procedural satisfaction and cough, each assessed on visual analog scale (VAS), while the secondary outcomes included patient-rated faces pain scale scores, cumulative lignocaine dose, number of subjects receiving lignocaine >8.2 mg/kg, doses of midazolam/fentanyl between groups, and adverse events during procedure. Results: The mean (standard deviation [SD]) VAS scores for operator-rated procedure satisfaction were 64.2 (25.6) and 68.7 (23.7) in 1% and 2% group, respectively (P = 0.35). The median (interquartile range) VAS scores for operator-rated cough were 48.4 (23.9–69.9) in 1% group and 38.7 (18.6–69.5) in 2% group (P = 0.24). The mean [SD] cumulative lignocaine received in the 2% lignocaine group (248.6 [29.1] mg) was significantly greater than in 1% lignocaine group (178.5 [14.6] mg) (P < 0.01). Conclusion: One percent lignocaine is equally efficacious as 2% lignocaine for topical anesthesia during EBUS-TBNA, at a significantly lower cumulative lignocaine dose.

Calcium Homeostasis is a complex physiological process. Its mathematical model results in high order differential equation. In this paper, a model order reduction technique, based on time scale separation is proposed for a 27th order Calcium Homeostasis and Bone Remodeling (CHBR) system. The original state-space model after linearization has been decoupled into three reduced order subsystems: ”Very-Slow”, ”Slow” and ”Fast”, at the same time preserving the structure of the system. The time and frequency response of individual reduced order model has been compared with the response of the original system. Furthermore, the effect of administering a therapeutic daily moderate dose of PTH has been studied with the help of reduced order models.

Background: The role of nebulized lignocaine administration for flexible bronchoscopy is unclear. Methods: In this randomized, double-blind, placebo-controlled trial, subjects undergoing diagnostic flexible bronchoscopy were randomized to receive either nebulized lignocaine (2.5 ml of 4% lignocaine) or nebulized (2.5 ml of 0.9%) saline (placebo). All received 10% lignocaine pharyngeal spray (4 sprays) and 5-ml nasal 2% lignocaine gel. 1% lignocaine solution was used for spray-as-you-go administration in all. Co-primary outcomes were Operator-rated overall procedure satisfaction and Operator-rated cough scores on Visual Analog Scale (VAS). Secondary objectives were cumulative lignocaine dose, proportion of subjects receiving >8.2-mg/kg lignocaine, and complications between the groups. Results: Two hundred and twenty subjects were randomized and 217 (109 – nebulized lignocaine and 108 – placebo) received the intervention. Baseline characteristics were comparable. Operator-rated overall procedure satisfaction scores on VAS (7.30 ± 1.54 nebulized lignocaine and 7.50 ± 1.31 placebo group, P = 0.85) and Operator-rated cough scores on VAS (3 [2–5] nebulized lignocaine and 3 [2–4] placebo group, P = 0.18) were similar. Cumulative lignocaine dose was significantly greater in nebulized lignocaine group (331.46 ± 9.41 mg vs. 232.22 ± 12.77 mg, P < 0.001), and a significantly greater number of subjects in this group received lignocaine dose >8.2 mg/kg. Minor complications occurred in 6 and 9 subjects in nebulized lignocaine and placebo groups, respectively, P = 0.41. Conclusion: Administration of nebulized lignocaine in addition to pharyngeal lignocaine spray, during no-sedation bronchoscopy, increases the cumulative lignocaine dose without improved procedural comfort. Additional nebulized lignocaine during bronchoscopy is not recommended.

Flexible bronchoscopy (FB) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. However, bronchoscopy practices vary widely across India and worldwide. The three major respiratory organizations of the country supported a national-level expert group that formulated a comprehensive guideline document for FB based on a detailed appraisal of available evidence. These guidelines are an attempt to provide the bronchoscopist with the most scientifically sound as well as practical approach of bronchoscopy. It involved framing appropriate questions, review and critical appraisal of the relevant literature and reaching a recommendation by the expert groups. The guidelines cover major areas in basic bronchoscopy including (but not limited to), indications for procedure, patient preparation, various sampling procedures, bronchoscopy in the ICU setting, equipment care, and training issues. The target audience is respiratory physicians working in India and well as other parts of the world. It is hoped that this document would serve as a complete reference guide for all pulmonary physicians performing or desiring to learn the technique of flexible bronchoscopy.

Cardiac malfunctioning is the leading cause of mortality and morbidity today. ECG (Electrocardiogram) and Phonocardiogram, are the two major ways to diagnose the cardiac pathology. ECG can find out defects related to heart electrical activity, Phonocardiogram can find out acoustic information in blood flowing pathway. So, a real time integrated ECG & Phonocardiogram system will give more information about heart. This paper discusses the development of an electronic system that records both electrical activity and heart sounds for better diagnosis of heart pathology. Heart sounds were obtained using a condenser microphone (acted as a transducer) insulated from its surroundings and electrical signals were obtained using surface electrodes. The heart sounds and ECG signals have been amplified and filtered independently of each other. Data acquisition system sends the signals with baud rate of 19200 to the PC. A MATLAB program is written to plot amplitude and powerspectral on a time and frequency varying scale respectively. Further analysis is underway to extract more information from this low cost integrative ECG and Phonocardiogram system. In future this system could be used for telemedicine purpose.

The proposed research focuses on designing a low-cost electromyogram (EMG) data acquisition system (DAQ). The developed system acquires EMG signals from the sub-vocal region and suitable features are extracted using time-frequency transform such as Wavelet Transform. Once the features are extracted, the final classification is carried out using ensemble decision trees called Random Forests (RF). Giving the randomness in the ensemble of decision trees (DT) stacked inside the RF model, this technique can provide at the recall stage, not only the early assessment of classification, but also a probability outcome which quantifies the confidence level of the decision. The performance accuracy is found to be more than 90% when two features were considered compared to 75% with five features. Thus there is a trade-off between the input features versus the classification accuracy. Thus, the proposed data mining based technique will be highly suitable for developing EMG signal acquisition system used for bio-medical instrumentation.