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A new method is proposed for the characterization of the atmospheric turbulence strength parameter ( C n 2 ) based on the principal component analysis (PCA) of the texture of the speckle intensity pattern obtained on long-range propagation of a focused charge +1 vortex beam. Employing the split-step propagation method, datasets containing instantaneous intensity images of the focused vortex beam are generated for three distinct C n 2 values, specifically 1 × 10 − 14 m − 2 / 3 , 5 × 10 − 14 m − 2 / 3 , and 1 × 10 − 13 m − 2 / 3 , representing medium to high turbulence levels for a 2 km propagation distance. The gray level co-occurrence matrix (GLCM) methodology is employed to extract key texture attributes, like contrast, correlation, homogeneity, and energy from the intensity images. These extracted texture parameters serve as inputs for training a PCA model, enabling the identification of associated C n 2 values. The PCA analysis exhibits distinct clustering of the first three principal components for each of the three C n 2 values, forming individual clusters on the PCA plot. Standard deviational ellipses are drawn to clearly demarcate these clusters on the PCA plot. The texture-based PCA classification of atmospheric turbulence was also performed for a focused Gaussian beam. The comparison of PCA plots between vortex and Gaussian beams showed that a pronounced clear separation of C n 2 values is obtained for the vortex beam. This indicates that the non-zero orbital angular momentum of the vortex beam also plays an important role in achieving the distinct separation of C n 2 values on the PCA plot. The proposed method can provide efficient real-time turbulence estimation solely on the basis of texture of the instantaneous intensity speckle with prior training and therefore may simplify the estimation of turbulence strength parameter. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of uniform literature on the outcome of children with neuroblastic tumours from developing countries. This study aims to present the outcome in children having neuroblastic tumours. Materials and Methods: We retrospectively reviewed patients with neuroblastic tumours from January 2014 to March 2020. Data analysed were pertaining to the age, sex, presentation, site, stage, diagnostic evaluation performed, management and follow-up results, etc., The final outcomes were assessed as complete response; partial response (PR); no response (NR) and progressive disease. International Neuroblastoma Risk Group staging was used and patients were categorised on the basis of age, site and stage of tumour. Overall survival (OS) was calculated from the date of diagnosis to the date of last follow-up and event for OS was death. Results: Forty-seven patients were included with median age of 60 months (ranges of 2–180; mean = 61.87 ± 47.56). About 72.3% (n = 34) patients were males. Out of total, 6.4% (n = 3), 53.2% (n = 25) and 38.3% (n = 18) were in stage L1, L2 and M, respectively, whereas 2.1% (n = 1) patients were in stage MS. Surgery was performed in 25 (53.19%) patients, but gross total excision was achieved in 48.90% (n = 23) patients. Onlu 10.60% (n = 5) patients were referred, whereas 14.89% (n = 7) patients reported recurrences. Mean and median follow-up time of the patients was 24.64 ± 16.04 and 18 months (range: 3–60 months). Out of total, 53.2% (n = 25) and 29.8% (n = 14) patients had complete and PRs, respectively, whereas 17% (n = 8) patients had NR. Out of the total 47 patients, 8 (17%) achieved events (deaths), whereas the rest, 39 (83%) patients, were censored. Mean event-free OS time was 50.04 months. Conclusion: There was a significant difference in patient deaths in recurrence and non-recurred patients (4/7, 57.1% vs. 4/40/, 10%, P = 0.011). Survival time was significantly higher in patients with stages L1-L2 as compared to Stage 4. Stage and age were found predictors of survival. [ABSTRACT FROM AUTHOR]

This paper presents an automated method for detection of the diagnostically prominent frames containing optic nerve sheath (ONS) from ocular ultrasonography video using deep learning; such frames are referred to as "Good View" frames in this paper. Vivid acquisition and measurement of diagnostic features during ultrasound imaging is a challenging task; it needs a highly skilled and experienced medical expert. Automated detection of the Good View frame and the subsequent automatic measurement of optic nerve sheath diameter (ONSD), predicting elevated intracranial pressure (ICP) status, will eliminate the need for frequent intervention of a medical expert for continuous monitoring and ICP status in traumatic patients. In the presented work, the proposed model automatically detects the appropriate frames containing ONS, from an ultrasound video, by using faster region-based CNN (Faster R-CNN) object detection model. The region proposal detection network finds the ONS by using bounding boxes. In addition, three CNN-based architectures are used for its feature extraction. Finally, SoftMax classifier classifies the ONS containing Good View frame. The Inceptionv2, ResNet50, and ResNet101 architectures are then compared by utilizing the optimized learning rate and epoch parameters for the CNN model so as to provide better detection of the Good View frame. The performance of the developed module has been analyzed by proposing a grading criterion of the Good View frame. Based on the detection score and mean opinion score, an USG frame is considered a Good View for a 95–99% detection score, and this Good View frame is used for measuring the ONSD value. It is found that Faster R-CNN ResNet101 (model 3) is an optimal model in terms of sensitivity and specificity for Good View frame detection at a learning rate of 0.0003. The sensitivity and specificity of this model are obtained as 90.41 and 91.45, respectively. Furthermore, the ONSD value is measured from Good View-detected frames using an automated algorithm involving image processing and computational methods. Considering the Good View frame (detection score 95–99), the algorithm-generated ONSD values are compared with the radiologist's measured value of ONSD to validate the findings; a small percent root mean square difference (PRD) of 0.501 is found between these values, which is strong indicative of the accuracy of algorithm generated ONSD measurement using automatically detected Good View ocular USG frames. [ABSTRACT FROM AUTHOR]

This paper presents a prototype implementation of arrhythmia classification using Probabilistic neural network (PNN). Arrhythmia is an irregular heartbeat, resulting in severe heart problems if not diagnosed early. Therefore, accurate and robust arrhythmia classification is a vital task for cardiac patients. The classification of ECG has been performed using PNN into eight ECG classes using a unique combination of six ECG features: heart rate, spectral entropy, and 4th order of autoregressive coefficients. In addition, FPGA implementation has been proposed to prototype the complete system of arrhythmia classification. Artix-7 board has been used for the FPGA implementation for easy and fast execution of the proposed arrhythmia classification. As a result, the average accuracy for ECG classification is found to be 98.27%, and the time consumed in the classification is found to be 17 seconds. [ABSTRACT FROM AUTHOR]

We show that the far-field speckle patterns observed on the transmission of polarization structured light beams through a random diffuser screen have distinct spatial textures, which significantly differ from the texture of the fully developed scalar speckle. In particular, we report on speckle observed using the V-point and C-point polarization singular beams for illumination in this work. The V-point and C-point polarization singularities are generated by a combination of different orbital angular momentum (OAM) states in orthogonal polarizations. When passed through a random diffuser screen, the on-axis far-field diffraction intensity is an incoherent summation of speckle intensities due to the individual OAM states. Unlike the typical grainy structure in the scalar speckle, the speckle patterns observed with V-point and C-point illuminating beams are seen to have a noodle-like and sponge-like textures respectively. The speckle from V-point and C-point illuminations is difficult to distinguish using the usual intensity statistics which does not account for the distinct spatial structure of the speckle patterns. The Gray Level Co-occurrence Matrix (GLCM) methodology was therefore used to extract a number of spatial textural features from the speckle patterns observed using scalar and polarization structured illuminations. The principal component analysis (PCA) technique when applied to the texture parameters shows that it is possible to identify the nature of the illuminating beam by simply observing the texture properties of the resultant speckle pattern. When coherent light beams pass through a random medium resulting in a fully developed speckle pattern, the information regarding the profile of the input beam is generally considered to be lost. Our new observations on distinct textural features in speckle from structured light therefore suggest the possibility of information transmission through random media by means of switching the polarization structure of the incident beam. [ABSTRACT FROM AUTHOR]

Holt–Oram syndrome or heart–hand syndrome consists of phenotypic and genotypic abnormalities. It is characterized by abnormalities of upper limbs and congenital cardiac defects. It is an autosomal dominant disorder due to a mutation in TBX5 gene located on chromosome 12, but sporadic cases have also been reported. We describe a 26-year-old female with a history of shortness of breath for 5 years. She had bilateral hand deformities, and on evaluation, found to have ostium secundum atrial septal defect which is common cardiac defect in Holt–Oram syndrome. [ABSTRACT FROM AUTHOR]

Aim and Objectives: Despite the significant advancements in the management of anorectal malformations (ARMs), there are various surgical and functional complications reported. Complications are closely related with the surgical techniques adopted and the types of malformations. In this article, we present our experiences with ARM patients who required reoperation after unsuccessful previous surgeries or who had developed complications related to the previous surgical techniques. Materials and Methods: We retrospectively reviewed clinical and electronic records of all the patients with ARM who were operated for ARMs in our institute from June 2010 to May 2016. All ARM patients who needed reoperation were included in the study. These patients were previously operated outside our institute and referred to us with ongoing problems of constipation, stool impaction with overflow incontinence, perineal soiling, and difficult urination. Results: There were 31 patients (M:F = 2.1:1) of ARM, reoperated for 38 indications during the above-mentioned period. Five patients had more than one problem. Presentation included neoanal stenosis (11), complete obliteration of neoanus (2), malpositioned neoanus (2), persistent/recurrent rectourethral fistula (3), iatrogenic rectovaginal fistula (4), rectal prolapse (5), large widened neoanus with soiling (2), and urethral stricture (2), which required revision interventions. Six patients had megarectum. All patients showed improvement in their symptoms after revision surgery, but 10 (41.7%) patients required further regular bowel management program (BMP) to avoid the soiling and constipation. Fourteen (58.3%) patients stayed clean without regular BMP. Conclusion: All these complications had clear explanations and are well described in the literature. Revision surgery in such patients had fair outcome, but some sort of BMP was required. Both posterior sagittal anorectoplasty and anterior sagittal anorectoplasty are excellent techniques for revision surgery with few simple modifications. [ABSTRACT FROM AUTHOR]

The Present study is an endeavor to laminar flow heat transfer of Cu-water nanofluid inside a square cavity. The cavity is heated by different length heaters with isothermal boundary condition placed symmetrically on two adjacent sides. The moving lid has low temperature and rest of the boundaries are insulated. A thermally conducting solid cylinder is placed at the center of the cavity. The effect of different parameters, nanoparticles volume fraction (0 -0.08), Richardson Number (0.01-10) on the fluid flow and temperature fields have been studied. The average Nusselt number increases with the increase in nanoparticle concentration and size of the heater. The effect of concentration of nanoparticles reduces with decrease in Richardson Number. [ABSTRACT FROM AUTHOR]

Objective Surgery is still indicated as the treatment of choice in subset of patients with unilateral multicystic dysplastic kidney (UMCDK) because of its potential complications and malignant change. The purpose of this study is to present our observation that early nephrectomy may cure hypertension early in children with UMCDK and review the literature. Materials and Methods We report here four children (two males and two females) with antenatally diagnosed UMCDK with hypertension, treated in the past 4 years. All have antenatal diagnosis of UMCDK and referred to us after their birth. Diagnosis of hypertension (blood pressure > 95th percentile) was made after 3 months of follow-up in all patients. Nephrectomy was performed in all children in variable time duration. Hypertension, urinary tract infection, and desire of parents were the main indication of surgery. Results All children showed decrease in the size of their dysplastic kidney with time, but hypertension was persistent and needed antihypertensive drugs; even increase in the doses in successive follow-up. After nephrectomy, three children who were operated early got cured having normal blood pressure within variable time duration, while a child, operated late, still had high blood pressure and needed antihypertensive drugs. Conclusion Early nephrectomy in recently diagnosed hypertension in UMCDK is advisable and can cure hypertension early. Levels of Evidence The level of evidence is IV (case series with no comparison group). [ABSTRACT FROM AUTHOR]

Introduction: This article proposes a novel, cost-effective, flexible, and easy-to-deploy wireless teleophthalmology network architecture and performance evaluation for its potential use in remote areas. This study has used practical telecommunication standards, which is widely deployed throughout India. Methods: In the proposed scenario, patient's eye images are obtained using a specified imaging modality, and then sent to a server at the primary eye care centre (PECC) using ZigBee a short-range wireless network. It is linked to the main server at the base eye hospital (BEH) through a GSM/UMTS (3G)/WiMAX (Worldwide Interoperability for Microwave Access) network. After diagnostic evaluation of the eye image using various automated diagnostic software, data are sent to a physician in an urban center for further validation, which is connected through GSM/UMTS (3G)/WiMAX network. Performance evaluation of these wireless networks is carried out for their use in teleophthalmology application based on network parameters, namely throughput, average end-to-end delay, and average jitter. It is found that end-to-end delay is the most critical network parameter affecting overall quality of service (QoS) of the proposed teleophthalmology network. Results and Conclusions: The results demonstrate that WiMAX is the most suitable network among the considered networks for connecting PECC nodes with BEH main server, and further connecting main server with a doctor on the move. It is also deduced that for a given set of QoS parameters, WiMAX supports a load capacity of 22,000 packets at center nodes and the main server and it performs well even when the mobility speed of doctor exceeds 200 KPH. [ABSTRACT FROM AUTHOR]

The present study was carried out on 36 growing piglets to evaluate the possibility of soybean meal as protein source in place of fish meal (FM) and ground nut cake (GNC) in feed mixture. The diets were prepared by replacing the 100% FM by DOC Soya (T2) and 100% replacing both FM and GNC by DOC soya (T3) of basal diet (T1). Significantly higher daily weight gain in growing piglet during the experimental period of 91 days was recorded in T3 (0.46±0.04 kg) and T2 (0.43±0.04 kg) than T1 (0.35±0.04 kg). CP and NFE digestibility were higher in group T3 followed by T2 and T1, the value being 67.00 and 75.60%, 74.76 and 80.81% and 78.89 and 84.83%, respectively. The balances of N, Ca and P were in positive direction and were higher in T3 than T2 and lowest in T1. Hematological indices were also higher in T3 followed by T2 and T1. [ABSTRACT FROM AUTHOR]

Infantile Choledochal Cysts (IFCC) usually present with jaundice, acholic stool and abdominal lump or abdominal distension. If the surgical intervention is delayed, they rapidly progress to liver fibrosis which is considered to be irreversible if progressed to cirrhosis. We present the data of four cases (aged one month to seven months) of IFCC presented with cholangitis managed in one surgical unit in last two years. In one case, cholangitis was treated with prolonged antibiotic course before definitive repair whereas in rest, external drainage of cyst was done in addition to intravenous antibiotic to treat cholangitis. All the infants had features of cholangitis at time of presentation. Total leucocyte count ranged from 18x1000/UL to 30.6x1000/UL. Total bilirubin level at presentation ranged from 8.2 mg/dl to 18 mg/dl and Prothrombin time (INR) ranged from 1.33 to 1.9. Hepatic fibrosis was observed in all cases but cirrhosis was observed in only one case. There was no mortality but one patient had postoperative complication with prolonged hospital stay. External drainage helps in early recovery from cholangitis and better optimization of liver function. It also delays further progression to liver fibrosis by relieving the biliary outflow obstruction while waiting for definitive repair. [ABSTRACT FROM AUTHOR]

Background: To analyse our experience with acute presentations of abdominal tuberculosis (TB) in children for early diagnosis and management.Materials and Methods: From December 2010 to April 2016, available electronic and operation theatre (OT) records of 17 patients with confirmed diagnosis of abdominal TB were analysed retrospectively. Parameters reviewed were age, sex, presentations, diagnostic investigations, surgery/intervention performed, final outcome and follow-up.Results: Out of 17 patients, 6 (35.3%) were already operated elsewhere. The duration of symptoms ranged from 4 to 58 weeks. Abdominal pain was present in all cases whereas 11 (64.7%) had abdominal distension, 16 (94.1%) fever, 14 (82.3%) ascites, 9 (52.9%) vomiting, 14 (82.3%) weight loss, 6 (35.3%) anorexia and 4 (23.5%) night sweat. All patients needed surgical intervention for definitive diagnosis. Thirteen (76.5%) out of 17 patients managed by staged surgery and primary anastomosis/repair/adhesiolysis were done in 4 (23.5%) patients. The main post-operative problems were wound infections (8; 47.1%), subacute bowel obstruction (6; 35.3%) and chest infections (12; 70.6%). Follow-up period ranged from 3 months to 5.5 years.Conclusion: Abdominal TB should always be considered in differential diagnosis in children presenting with abdominal pain/distension, fever and ascites or with abdominopelvic mass. Recurrent bowel obstruction or anastomotic disruptions also give clues of its diagnosis. A careful history of illness, high index of suspicion, ascitic fluid adenosine deaminase or polymerase chain reaction for Mycobacterium needed for early diagnosis. Prompt minimal surgical interventions, preferred diversion over primary anastomosis, algorithmic vigilant post-operative care and early antitubercular treatment required for success in acute crisis. [ABSTRACT FROM AUTHOR]

Introduction: More than 20,000 pacemakers are implanted each year in India and the numbers are growing annually. Despite this growing numbers, there is no national registry in India who collects or tracks data of implanted devices. Aim: The present study aimed to provide a small fraction of demographic profile of patients who underwent Permanent Pacemaker (PPM) implantation at our premises, one of the largest tertiary care centres in South-east Asia. Materials and Methods: This was a single centre, retrospective study. Patients who underwent pacemaker implantation between December 1999 and February 2014 were included in this study. The data were extracted from a prospectively maintained database, 1551 patients were included in this study. The data analysis was based on patient's age, gender, indication of PPM implantation, surgical parameters and modes of pacing and pacing parameters. Data were analysed with SPSS. Results: Of the PPM implantation procedures, 56.8% were performed on males and the mean age of population was 60.1 years. The prime indication for pacemaker implantation was degenerative complete heart block (68.3%) followed by sick sinus syndrome (9.0%). Of the total population, 68.3% patients acquired single chamber PPM and 55.9% patients received VVI pacemakers followed by DDDR pacemakers (20.8%). Conclusion: More number of pacemakers was implanted to male patients than female and there was no major age difference between genders. Degenerative complete heart block was the prime indication for PPM implantation. Single chamber devices were used significantly more than the dual chamber devices. [ABSTRACT FROM AUTHOR]

The present paper describes a novel and fairly inexpensive catalytic kinetic method for the determination of Pd 2 + in the concentration range 17.71–177.14 ppb (ng mL − 1 ). The method is based on the catalytic effect of Pd 2 + on the substitution of cyanide by 4-cyanopyridine (4-CNpy) in hexacyanoferrate(II) in acidic media. The reaction was followed by measuring an increase in the initial rate of the indicator reaction with respect to the product, [Fe(CN) 5 (4-CNpy)] 3 − , formation at 477 nm. The effects of various parameters, such as pH and ionic strength of the reaction medium, concentration of the reactants and temperature, on the rate of the indicator reaction were studied to optimize the reaction conditions to achieve the highest sensitivity and to get lowest limit of detection of [Pd 2 + ]. The fixed time procedure, as a measure of the initial rate, was followed to obtain a linear regression equation relating the absorbance and [Pd 2 + ] in the range 17.71–177.14 ppb i.e. 1 × 10 − 7 to 1 × 10 − 6 mol L − 1 . The effects of the presence of various cations commonly associated with Pd 2 + and some anions have also been investigated and discussed. The detection limit of the method was calculated to be 9 ppb. The maximum average error of the proposed method was quite low. The method was successfully applied for the determination of Pd 2 + in synthetic and environmental water samples. The proposed method is selective, accurate and inexpensive compared to many other methods available in literature for Pd 2 + determination. [ABSTRACT FROM AUTHOR]

An easy-to-synthesize Schiff base as a selective and colorimetric fluoride sensor via modulation of intramolecular charge transfer (ICT) has been demonstrated. A typical dual-ion binding property along with its distinct reversibility has been explored for YES, NOR and INH logic functions and a potential "Write-Read-Erase-Read" mimic. [ABSTRACT FROM AUTHOR]

The article presents a series of cystic hygroma (CH) or cystic lymphangioma of rare sites like breast, parotid gland and anterior chest wall managed with intralesional bleumycin (ILB). Topics discussed include the distribution of the lesion in the series, clinical characteristics of CH, and observation on most of the atypical lesions. The need to consider CH as differential diagnosis of cystic lesion in the sites other than head and neck is emphasized.

Background: In acute decompensated heart failure (ADHF), diuretic use, the mainstay therapy for congestion, is associated with electrolyte abnormalities and worsening renal function. Vasopressin mediates fluid retention in heart failure. In contrast to diuretics, the vasopressin antagonist tolvaptan may increase net volume loss in heart failure without adversely affecting electrolytes and renal function. Hyponatremia (serum sodium concentration, <135 mEq/L) is a predictor of death among patients with heart failure. Objective: We prospectively observed the short term efficacy and safety of low dose (15 mg) tolvaptan in admitted patients with hyponatremia and ADHF in Indian population. Methodology: A total of 40 patients with ADHF along with hyponatremia (<125 mEq/L) on standard therapy were treated with 15 mg of tolvaptan at a single oral dose for 7 days. Results: Serum sodium concentrations increased significantly after treatment with tolvaptan from baseline (P < 0.02). There was a significant improvement in symptoms and New York Heart Association (NYHA) class after starting tolvaptan (P ≤ 0.05). Total diuretic dose and mean body weight was reduced non-significantly at 7th day from the baseline. Side-effects associated with tolvaptan included increased thirst, dry mouth and increased urination. Few patients had worsening renal function. However, several patients developed hypernatremia. Conclusion: In this small observational study, tolvaptan initiation in patients with ADHF with hyponatremia in addition to standard therapy may hold promise in improvement in NYHA class and serum sodium. At the same time, we observed that serious adverse events such as renal function deterioration and hypernatremia developed after tolvaptan treatment, which needs to be addressed in future by randomized study with larger sample size. [ABSTRACT FROM AUTHOR]

Ventricular noncompaction has been recognized as a distinct form of rare cardiomyopathy characterized by numerous, prominent ventricular trabeculations and deep intertrabecular recesses and is caused by a disorder of endomyocardial morphogenesis. Concomitance of either valvular pathologies or complete atrioventricular block with biventricular noncompaction has rarely been reported. Herein, we present a case of 67 years old male presented with syncopal attack and congestive heart failure due to biventricular noncompaction with significant left ventricular dysfunction associated with complete atrioventricular block. He was formerly diagnosed as dilated cardiomyopathy for last 2 years. Review of literatures of all reported cases has been discussed. [ABSTRACT FROM AUTHOR]

Introduction: Gastrointestinal tuberculosis often involves the ileocecal region. Duodenal and gastric tuberculosis found in only 1% of patients suffering from pulmonary tuberculosis with associated HIV infection in non-endemic areas. Duodenal obstruction due to tuberculosis is very rare and needs high index of suspicions for diagnosis. Mostly this entity is suspected on intraoperative findings. In this manuscript we emphasized on ways and means for establishing histopathological diagnosis before starting anti-tubercular treatment in such cases. Method and Material: All patients of suspected gastroduodenal tuberculosis presented with feature of gastric-outlet obstruction managed during Jan 2009 to June 2011 were included in the study. After proper evaluation (routine hematological and biochemical examination, microbiological examination, serological and endoscopic evaluation) exploratory laparotomy was done and if there is no mesenteric lymphadenopathy or it is not safe to take biopsy form the diseased duodenum, multiple FNAC were taken from the diseased portion for histopathological and microbiological diagnosis. Result: A total of five patients were treated during this period. The most common presentation was vomiting followed by failure to thrive and weight loss; two patients had abdominal pain. Biopsy of mesenteric lymph node was possible in two cases. FNAC from diseases portion was taken in all cases. FNAC showed granulomas in four cases. Cases where even FNAC fi nding was non-conclusive on HPE/ Microbiology was not subjected to antitubercular drug. Conclusion: Multiple intra-operative FNAC may be taken from the diseased portion of the duodenum to establish the histopathological diagnosis if diagnosis is not established by any other mean. [ABSTRACT FROM AUTHOR]

Background: Spontaneous biliary peritonitis is a rare cause of acute abdomen. In spontaneous biliary peritonitis there is perforation in the wall of the extra-hepatic or intra-hepatic duct occurs without any traumatic or iatrogenic injury and have been described more often in neonates. The symptoms may be acute or insidious delaying the diagnosis. Present manuscript deals with diagnosis and management of these cases. Materials and Methods: This is a prospective study and all patients of suspected biliary peritonitis presented during Dec 2010 to Feb 2012 were included in the study. After preliminary investigations in all patients abdominal paracentesis was done and in cases where intra-abdominal fluid bilirubin level was several fold higher than serum bilirubin level were subjected to exploratory laparotomy. Further investigation like T-tube cholangiogram and magnetic resonance cholangiopancreatography (MRCP) was done to rule out choledochal cyst before leveling these cases as SPBD. Results: A total of 6 patients were included in present series commonest presenting symptom was progressive abdominal distension without signs of overt peritonitis followed by progressive jaundice, fever and abdominal pain. On exploration site of perforation was observed in 50% of cases and in 50% of cases bile duct was not dilated. Second surgery was not required in 34% of cases. There was no mortality or significant morbidity in our series. Conclusion: Spontaneous perforation of bile duct is rare disease and high index of suspicion is required for diagnosis. Simple bed side test can help in diagnosis but T tube cholangiogram or MRCP are must to rule out choledochal cyst. [ABSTRACT FROM AUTHOR]

The kinetics and mechanism of formation of [Fe(CN)5INH]3- by a ligand substitution reaction between aquapentacyanoferrate(II) ion and isoniazid, (pyridine-4-carboxylic acid hydrazide) (INH) have been investigated spectrophotometrically in acidic media at 435 nm ( lmax of product), under pseudo-first order conditions, using excess of INH over [Fe(CN)5H2O]3-. The reaction was studied as a function of [Fe(CN)5 H2O3-], [INH], pH, ionic strength and temperature, by varying only one of these variables while other variables were held constant. The reaction exhibited first-order kinetics in [INH] while it was independent of [Fe(CN)5H2O3-] in the chosen concentration range. The effect of temperature on the reaction rate yielded the activation parameters. The most plausible mechanism consistent with the experimental results has been proposed. [ABSTRACT FROM AUTHOR]

The kinetics and mechanism of formation of [Fe(CN)5INH]3- by a ligand substitution reaction between aquapentacyanoferrate(II) ion and isoniazid, (pyridine- 4-carboxylic acid hydrazide) (INH) have been investigated spectrophotometrically in acidic media at 435 nm (λmax of product), under pseudo-first order conditions, using excess of INH over [Fe(CN)5H2O]3-. The reaction was studied as a function of [Fe(CN)5H2O3-], [INH], pH, ionic strength and temperature, by varying only one of these variables while other variables were held constant. The reaction exhibited first-order kinetics in [INH] while it was independent of [Fe(CN)5H2O3-] in the chosen concentration range. The effect of temperature on the reaction rate yielded the activation parameters. The most plausible mechanism consistent with the experimental results has been proposed. [ABSTRACT FROM AUTHOR]

The kinetics of the palladium(II)-catalysed ligand exchange of the hexacyanoferrate(II) complex ion with 4-Cyanopyridine (4-CNpy) in aqueous acidic medium have been investigated at 25.0 + 0.1 °C, pH 3.2 + 0.02 and ionic strength, I = 0.1 M (KNO3). The reaction was followed spectrophotometrically by measuring the increase in absorbance of the intense cherry red complex [Fe(CN)54-CNpy]3-, corresponding to metal-to-ligand charge transfer (MLCT) transitions, at λmax 477 nm. The effects of pH, ionic strength, the concentrations of [Fe(CN)64-], Pd2+ and 4-CNpy on the reaction rate have been studied and analysed. The kinetic data suggest that substitution follows an interchange dissociative (Id) mechanism and occurs via formation of a solvent-bound intermediate. The effects of the dielectric constant of the medium on the reaction rate have been used to visualize the formation of a polar activated complex and an interchange dissociative mechanism for the reaction. A most probable mechanism has been proposed in order to interpret the kinetic data. Kinetic evidence is reported for the displacement of CN by 4-CNpy in [Fe(CN)64-]. Activation parameters for the proposed reaction have been evaluated using an Eyring plot, and provided further support to the proposed mechanistic scheme. [ABSTRACT FROM AUTHOR]

The kinetics and mechanism of formation of [Fe(CN)5D-PA]3− by ligand substitution reaction between aquapentacyanoferrate(II) ion, and D-pencillamine (D-PA) has been investigated spectrophothmetrically in presence of anionic surfactant micelle, sodium dodecylsulphate (SDS) at 421 nm (λmax of product) under pseudo-first order conditions using excess of D-PA over [Fe(CN)5H2O]3−. The reaction was studied as a function of [Fe(CN)5H2O3−], [D-PA], [SDS], pH, ionic strength, and temperature, by varying only one of these variables at a time while the other variables held constant. The reaction exhibited first order kinetics in [D-PA] while it was independent of [Fe(CN)5H2O3−] in the chosen concentration range. The sodium dodecylsulphate (SDS) micelle, being of negatively charged, does not reveal any regular effect except at or near its critical micelle concentration (cmc). The effect of temperature on the reaction rate was also studied to calculate the activation parameters, computed by Arrhenius and Eyring plots. The most plausible mechanism consistent with the experimental results has also been proposed. [ABSTRACT FROM PUBLISHER]

Abstract: A kinetic spectrophotometric method for the determination of thiocyanate, based on its inhibitory effect on silver(I) catalyzed substitution of cyanide ion, by phenylhydrazine in hexacyanoferrate(II) is described. Thiocyanate ions form strong complexes with silver(I) catalyst which is used as the basis for its determination at trace level. The progress of reaction was monitored, spectrophotometrically, at 488nm (λ max of [Fe(CN)5PhNHNH2]3−, complex) under the optimum reaction conditions at: 2.5×10−3 M [Fe(CN)6]4−, 1.0×10−3 M [PhNHNH2], 8.0×10−7 M [Ag+], pH 2.8±0.02, ionic strength (μ) 0.02M (KNO3) and temperature 30±0.1°C. A linear relationship obtained between absorbance (measured at 488nm at different times) and inhibitor concentration, under specified conditions, has been used for the determination of [thiocyanate] in the range of 0.8–8.0×10−8 M with a detection limit of 2×10−9 M. The standard deviation and percentage error have been calculated and reported with each datum. A most plausible mechanistic scheme has been proposed for the reaction. The values of equilibrium constants for complex formation between catalyst–inhibitor (K CI), catalyst–substrate (K s) and Michaelis–Menten constant (K m) have been computed from the kinetic data. The influence of possible interference by major cations and anions on the determination of thiocyanate and their limits has been investigated. [Copyright &y& Elsevier]

PURPOSE: To present a single-center experience with 25 cases of bronchopulmonary malformations and the review the literature. MATERIALS AND METHODS: We conducted a retrospective analysis of the medical records of patients with congenital bronchopulmonary malformations who were operated between July 1997 and July 2007 in our institute; we examined the modes of presentations, management, and outcome. Outcome of all patients was assessed over a short follow-up period (average 1.8 months). RESULTS: Out of 25 patients, 18 (72%) were male and 7 (28%) were female. Age of patients ranged from 1 day to 11 years. The histopathological diagnosis was congenital cystic adenomatoid malformations [CCAM; n = 14 (56%)], congenital lobar emphysema [CLE; n = 5 (20%)], pulmonary sequestrations [PS; n = 3 (12%)], and bronchogenic cysts [BC; n = 3 (12%)]. Antenatal diagnosis was available in only 2 (8%) patients. The common presenting symptoms were respiratory distress and chest infections. Lobectomy was the procedure of choice . Mortality was 16% (n = 4; M: F = 3: 1). Two patients died because of overwhelming sepsis, one from compromised cardiac function, and one from aspiration which might possibly have been prevented. CONCLUSION: Patients with progressive respiratory distress due to these anomalies may require urgent surgical intervention regardless of age. The surgical outcome is favorable, with manageable complications. Plain x-ray chest and CT of thorax are usually sufficient for diagnosis and planning of treatment. Pathological diagnosis may differ from the imaging diagnosis. Mortality is found to be more in neonates. Apart from initial stabilization, resection of lesion and careful postoperative care is necessary to reduce mortality and morbidity. [ABSTRACT FROM AUTHOR]

Primary cardiac tumors are relatively rare, and myxoma, the most common variety, is found predominantly in the left atrium. Clinical presentation varies from asymptomatic incidental masses to serious life-threatening cardiovascular complications. Some cases are difficult to diagnose, as symptoms can be nonspecific. We present a case of a young female with 4 months of history of dyspnea, weight loss, and night sweats, eventually diagnosed as a case of large left atrial myxoma arising from the anterior mitral valve through transthoracic echocardiography. [ABSTRACT FROM AUTHOR]

Background: Empirical use of pharmacogenetic test(PGT) is advocated for many drugs, and resource-rich setting hospitals are using the same commonly. The clinical translation of pharmacogenetic tests in terms of cost and clinical utility is yet to be examined in hospitals of low middle income countries (LMICs). Aim: The present study assessed the clinical utility of PGT by comparing the pharmacogenetically(PGT) guided- versus standard of care(SOC)- warfarin therapy, including the health economics of the two warfarin therapies. Methods: An open-label, randomized, controlled clinical trial recruited warfarin-receiving patients in pharmacogenetically(PGT) guided- versus standard of care(SOC)- study arms. Pharmacogenetic analysis of CYP2C9*2(rs1799853), CYP2C9*3(rs1057910) and VKORC1(rs9923231) was performed for patients recruited to the PGT-guided arm. PT(Prothrombin Time)-INR(international normalized ratio) testing and dose titrations were allowed as per routine clinical practice. The primary endpoint was the percent time spent in the therapeutic INR range(TTR) during the 90-day observation period. Secondary endpoints were time to reach therapeutic INR(TRT), the proportion of adverse events, and economic comparison between two modes of therapy in a Markov model built for the commonest warfarin indication- atrial fibrillation. Results: The study enrolled 168 patients, 84 in each arm. Per-protocol analysis showed a significantly high median time spent in therapeutic INR in the genotype-guided arm(42.85%; CI 21.4-66.75) as compared to the SOC arm(8.8%; CI 0-27.2)(p < 0.00001). The TRT was less in the PG-guided warfarin dosing group than the standard-of-care dosing warfarin group (17.85 vs. 33.92 days) (p = 0.002). Bleeding and thromboembolic events were similar in the two study groups. Lifetime expenditure was ₹1,26,830 in the PGT arm compared to ₹1,17,907 in the SOC arm. The QALY gain did not differ in the two groups(3.9 vs. 3.65). Compared to SOC, the incremental cost-utility ratio was ₹35,962 per QALY gain with PGT test opting. In deterministic and probabilistic sensitivity analysis, the base case results were found to be insensitive to the variation in model parameters. In the cost-effectiveness-acceptability curve analysis, a 90% probability of cost-effectiveness was reached at a willingness-to-pay(WTP) of ₹ 71,630 well below one time GDP threshold of WTP used. Conclusion: Clinical efficacy and the cost-effectiveness of the warfarin pharmacogenetic test suggest its routine use as a point of care investigation for patient care in LMICs. [ABSTRACT FROM AUTHOR]

We are reporting the first case of rare association between multiple congenital cardiac malformations with severe rheumatic mitral stenosis which is an acquired structural cardiac disease. A 16 years old female patient presented with progressive dyspnoea & cyanosis for the last one month with past history of recurrent pneumonia since infancy. Physical examination revealed presence of cyanosis, grade I clubbing, radio-radial & radio-femoral delay, loud & single second heart sound, apical long mid diastolic murmur and left parasternal ejection systolic murmur. Transthoracic echocardiography revealed severe rheumatic mitral stenosis, multiple ventricular septal defects (VSD) with bidirectional shunt, hypoplastic aortic arch, Coarctation of aorta and severe pulmonary hypertension. Transesophageal echocardiography revealed the same findings along with the presence of moderate mitral regurgitation and 9 mm perimembranous VSD extending into muscular septum. Cardiac catheterization study confirmed the echocardiographic findings and demonstrated large patent ductus arteriosus (PDA). We have planned for high-risk percutaneous transmitral commissurotomy (PTMC) for this patient to decrease the back pressure on pulmonary vasculature. So that right to left shunt will be decreased and cyanosis will also improve. But parents refused to give consent for PTMC. She was on treatment with regular penicillin prophylaxis, diuretics, sildenafil and infective endocarditic prophylaxis. We should be aware of this kind of complex association between congenital and acquired structure heart disease. Eisenmenger syndrome could also be a presentation of juvenile severe rheumatic mitral stenosis when it is associated with congenital shunt lesion like VSD/PDA in our case. [ABSTRACT FROM AUTHOR]

In patients with rheumatic mitral valve stenosis having atrial fibrillation, the "Ball valve thrombus" is an uncommonly encountered complication. A case of 42-year-old male with rheumatic severe mitral stenosis, mild aortic stenosis with moderate regurgitation presented with recurrent episodes of non-exertional syncope for seven days as chief symptom. He was in atrial fibrillation with controlled ventricular rate and echocardiography, showed a large ball valve thrombus in the left atrium. Thus, echocardiography facilitated for rapid diagnosis and earliest surgical intervention as a life saving measure. [ABSTRACT FROM AUTHOR]

Two male children with ano/recto-urethral fistula without anorectal malformation were managed in our institute. These patients had variable clinical manifestations and associated anomalies including congenital urethral hypoplasia, renal agenesis and patent urachus. Both were treated successfully according to their status of disease-complexes. This is to discuss these rare cases and its management with review of the literature. [ABSTRACT FROM AUTHOR]

Renal artery thrombosis is a rare medical emergency and needs to be diagnosed early and treated urgently to prevent irreversible renal injury. We report a case of 35-year-old male, who presented with the total thrombotic occlusion of right renal artery and was managed with percutaneous transluminal angioplasty with a drug eluting stent. [ABSTRACT FROM AUTHOR]

Cystic lymphangioma of small bowel mesentery is rare with clinical features ranging from an asymptomatic abdominal lump to acute intestinal obstruction. We discuss two cases of lymphangioma of small bowel mesentery who presented to us as acute intestinal obstruction. In the first case exploratory laparotomy revealed a large multicystic lesion arising from small bowel mesentery just distal to the duodenojejunal junction having multiple small cysts filled with milky white fluid. The involved region of the bowel was excised. The second case had a large multicystic lesion involving the mesentery of proximal jejunum, dudenojejunal junction, encasing the entire superior mesenteric vessels. For this patient, debulking was done. [ABSTRACT FROM AUTHOR]

Introduction: The most familiar kidney disease in children is nephrotic syndrome (NS), associated with dyslipidemia and causes various cardiovascular complications. Persistent hyperlipidemia can further raise difficulties of NS and relapse cases. Earlier diagnosis and appropriate intervention increase the possibility of saving other vital organs. Methods: An observational study was conducted with 85 children aged 2-15 years with a history of NS. The study group was divided into first NS and second-episode relapse cases. They were further subgrouped into Frequent Relapse NS (FRNS) and Infrequent Relapse NS (IFRNS). Fasting lipid profiles were performed among active sufferers with a follow-up after 4 weeks. Results: The male-to-female ratio was 1.93:1. In the first episode of NS, all lipid parameters were high in the acute phase and returned to normal during remission. In relapse cases, lipid parameters were significantly higher even in remission. Serum triglyceride and very low-density lipoprotein were significantly more elevated in the FRNS group than in the IFRNS. Low-density lipoprotein was increased considerably in FRNS. Mean high-density lipoprotein was also significantly lower in the FRNS group than in the IFRNS. Conclusion: Persistent hyperlipidemia is most typical among FRNS. Hyperlipidemia management is urgent to prevent among pediatric NS. [ABSTRACT FROM AUTHOR]

Congenital anomalies, congenital malformations, or birth defects can be defined as any structural or functional anomalies that develop prenatally and could be identified before, at birth, or later in life. Approximately 6% of babies are born with a congenital anomaly, which results in 2.4 million newborn deaths worldwide. This systematic review and meta-analysis ascertained the quantitative studies published in PubMed, ClinicalKey, Embase, CINAHL, Cochrane Library, and Google Scholar. Two authors independently screened and extracted the data from the primary studies that analyzed the efficacy of early enteral nutrition (EEN) on the postoperative outcome. This systematic review and meta-analysis adopted Cochrane Collaboration guidelines and reported using the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. The methodological quality of trials was assessed by Cochrane Collaboration's risk of bias tool. Six trials, representing 488 children, with age ranging from 10 days to 6.5 years, fulfilled the inclusion criteria. EEN has significantly shortened hospital stay, induced early fecal movement, and reduced postoperative wound infections in children with congenital gastrointestinal abnormalities undergoing gastrointestinal anastomosis compared with children who received late enteral nutrition. The review also found that the experimental group who received EEN had no significant impact on the anastomosis leakage, vomiting, and abdominal distension. EEN has some positive effects on postsurgery outcomes among children with congenital gastrointestinal anomalies undergoing gastrointestinal anastomosis. [ABSTRACT FROM AUTHOR]

Introduction: Malrotation is a congenital anatomical anomaly that affects the normal positioning of the intestines. Traditional management of malrotation, as described by Ladd, consists of detorsion of the volvulus if present, division of Ladd's bands, widening of the mesenteric root, proper positioning of the small and large bowels, and a prophylactic appendectomy. This study was done to determine whether appendectomy should be an integral part of the Ladds procedure or if it can be avoided. Materials and Methods: This retrospective observational study was conducted in one pediatric surgical unit in the tertiary care center of North India. All the cases of malrotation of the gut managed from January 2008 to December 2018 were reviewed. The details of the patients were recovered from the electronic data recording system of the hospital and manual operation theater records. The cases that have a follow-up of <5 years were not included in the study. The details were charted in an Excel Sheet for the analysis. No statistical test was performed because there was no event in patients in whom prophylactic appendectomy was not done. Results: The data analysis revealed that a total of 66 malrotation patients were managed during this period, those who fulfilled the inclusion criteria. Among 66 cases included in the study, in 41 cases, prophylactic appendectomy was done, whereas in the rest 25, prophylactic appendectomy was not done. During the follow-up, none of the patients in whom the appendix was preserved presented with signs or symptoms related to appendicitis or any other complications. Conclusion: Ladds procedure without appendectomy can be performed in view of the potential use of the appendix in the future, and with the fact that in the current era of advanced medicine, appendicitis can be diagnosed early due to the advancement of imaging and better record keeping. [ABSTRACT FROM AUTHOR]

Introduction: Cystic Lymphangioma (CL) commonly involves head and neck region and axilla. Involvement of other sites like salivary glands is very rare. This study was done to assess the role of bleomycin sclerotherapy in salivary gland CL with relevant review of literature. Aim: To assess the outcome of intralesional bleomycin as sclerotherapy in CL of major salivary glands. Materials and Methods: This was an observational study, done in Department of Paediatric surgery and Plastic surgery from July 2013 to July 2017. All diagnosed cases of pure CL involving major salivary glands were included, where as those with venous or arterial component were excluded from the study. Patients having previous surgery or other treatment modalities were also excluded. Primary mode of treatment of CL at present center was sclerotherapy using aqueous bleomycin. As per our protocol sclerotheray was done under sedation for paediatric patients using dopler ultrasound. Relevant demographic and clinical data of all 7 patients was collected in structured proforma and results were analysed. Results: Out of seven cases, four patient's lesion responded well in a single session, two patients reported unfavourable response even after second session hence, were managed surgically and one patient responded partially after first session and managed surgically later on. Conclusion: Cystic lymphangioma should be included in the differential diagnosis of cystic lesion of parotid and submandibular gland though its involvement is rare. Bleomycin sclerotherapy can be used as a safe and low cost treatment modality for the management of this rare entity. [ABSTRACT FROM AUTHOR]

Introduction: Usually, the residual umbilical stump separates by 7-15 days postpartum and the umbilical ring closes with epithelisation. In few infants, the umbilicus ring does not get epithealialised completely it forms an umbilical polyp and disappears in 2-3 weeks. Umbilical polyp requires medical attention if it persists beyond 3 weeks. Application of common salt for management of umbilical granuloma is one of the known modality of treatment owing to its hygroscopic action, though literature is sparse on the topic. Aim: To observe the effect of common salt on umbilical granuloma. Materials and Methods: Common salt application for management of umbilical granuloma is a standard modality at the study Institute. This was a retrospective observational study from January 2015 to December 2018. All data on infants of diagnosed umbilical granuloma, managed with application of salt, were evaluated. A total of 76 cases were managed during this period. Detailed demographic and clinical data was retrieved and collected in structured proforma from the electronic and manual record system. Descriptive statistical analysis was done. Results: In all cases, the granuloma healed within a span of two weeks. Number of salt application ranged from 8 to 24 applications. Total time for which salt remained in contact of umbilicus ranged from 8 to 24 hours. The number of sessions of salt application from presentation of patient to cure ranged from 8 to 24; median for sessions of salt application for complete cure was 12. Median for 25 quartile and 75 quartile was 12. Parents did not report any behavioural changes, sleep disturbances, or irritability in the infants after the application. No other complication or recurrence was noted in follow-up of 1 year. Conclusion: Common salt can be an effective modality to treat umbilical granuloma. [ABSTRACT FROM AUTHOR]

Background and Aim: Portal hypertension determines the outcome of children with biliary atresia (BA) and is common even after a successful Kasai portoenterostomy (KPE). However, there are no clear‐cut guidelines on the age of starting surveillance and the modality (endoscopy vs non‐invasive tests [NITs]). In this cohort study, we analyzed our database to find out the utility of NITs in detecting high‐risk esophageal varices in BA. Methods: From June 2010 to May 2022, consecutive children of BA who underwent upper gastrointestinal (UGI) endoscopy were included. Esophageal varices were classified as high‐risk (grade II with red‐color signs or grade III or IV irrespective of red‐color signs. NITs such as splenomegaly (clinical and USG), platelet count, aspartate transaminase to platelet ratio index (APRI), and platelet‐to‐spleen diameter ratio were compared between cases with high‐risk and low‐risk varices. Results: A total of 110 children, 75 boys (66 successful KPE and 44 failed/KPE not performed) were enrolled. The median age at KPE was 85 days (IQR 63–98). Thirteen (11.8%) children presented with UGI bleeding. The first endoscopy revealed gastroesophageal varices in 75.4% of cases, and 32% of them had high‐risk varices. Multivariate analysis revealed failed KPE, history of UGI bleeding, bigger spleen size (> 3.5 cm), lower platelet count (< 150 000), and higher APRI (> 2) are independent predictors of the presence of high‐risk esophageal varices. Conclusion: Endoscopy is the best in predicting the presence of high‐risk varices that might bleed; hence, early surveillance endoscopy should be started in children with splenomegaly, thrombocytopenia, and high APRI score to prevent variceal bleeding. [ABSTRACT FROM AUTHOR]

Cantrell's pentalogy with ectopia cordis is an extremely rare and lethal congenital anomaly, with a reported incidence of 1:100000 births in developed countries. We report a neonate who presented with ectopia cordis along with cleft lower sternum, upper abdominal wall defect, ectopic umbilicus, diaphragmatic defect, and interventricular septal defect. The neonate had respiratory distress with peripheral cyanosis and died because of acidosis and electrolyte imbalance before surgical intervention could be undertaken. We discuss the case and present a brief review of literature and of embryogenesis. [ABSTRACT FROM AUTHOR]

A 12-hour-old male infant presented with prolapsed abdominal content through a defect on left side of chest wall with respiratory distress. A thorough clinical examination suggested absence of ectopia cordis, abdominal wall defect, and any bony anomaly. The child expired after 6 hours of admission because of respiratory distress and electrolyte imbalance. Is congenital defect of chest wall associated with diaphragmatic hernia without ectopia cordis and omphalocele, an unusual variant of Cantrell's pentalogy? [ABSTRACT FROM AUTHOR]

Background: Intralesional bleomycin scelro-therapy has become a favored line of treatment for macrocystic lymphatic malformations. However the need for multiple sessions is a drawback associated with this treatment modality. Our aim is to document whether multiple session of intra-lesional sclero-therapy is necessary for complete resolution of cystic lymphatic malformation. Method: Intralesional bleomycin under Ultrasound guidance was used for macrocystic lymphangioma at concentration of 3mg/ml but not exceeding the total dose (1mg/kg) body weight for single session or cumulative dose of 5mg/kg. In all cases intralesional sclerosant (ILS) was installed under proper aseptic precaution in operation theatre in general anesthesia or sedation depending on the site or size of lesion and age of the patient. Age of patients at the time of enrolment in study ranged from 3 months to 18 years. Clinical examination was the main stay of diagnosis which was supplemented by USG and/or computed tomography. Compression of the lesion site was done for few hours wherever it was possible after the ILS session. Result: A total of 21 patients included in our study. The age ranged from 3 months to 18 years. Male to female ratio was 8:13. The most common site of involvement was neck and axilla followed by anterior chest wall and nape of the neck. Complete resolution after single session was observed in 90.5% cases where as surgery was required in 9.5% case. Major complication was observed in one patient, who had intralesional bleeding which was managed conservatively. Transient pain and fever was observed in 23.8% of cases. Only two patient required surgical intervention where one had persistent subcutaneous fibrotic nodule and other one did not respond to ILS. Conclusion: Intralesional bleomycin is an effective treatment for macrocystic lesion, and complete resolution may be achieved by single session of ILS if proper principle are followed. [ABSTRACT FROM AUTHOR]

This paper presents a prototype filter design using the orthant optimization technique to assist a filter bank multicarrier (FBMC) modulation scheme of a NextG smart e-healthcare network framework. Low latency and very high reliability are one of the main requirements of a real-time e-healthcare system. In recent times, FBMC modulation has gotten more attention due to its spectral efficiency. The characteristics of a filter bank are determined by t's, prototype filter. A prototype filter cannot be designed to achieve an arbitrary time localization (for low latency) and frequency localization (spectral efficiency), as time and frequency spreading are conflicting goals. Hence, an optimum design needed to be achieved. In this paper, a constraint for perfect or nearly perfect reconstruction is formulated for prototype filter design and an orthant-based enriched sparse ℓ1-optimization method is applied to achieve the optimum performance in terms of higher availability of subcarrier spacing for the given requirement of signal-to-interference ratio. Larger subcarrier spacing ensures lower latency and better performance in real-time applications. The proposed FBMC system, based on an optimum design of the prototype filter, also supports a higher data rate as compared to traditional FBMC and OFDM systems, which is another requirement of real-time communication. In this paper, the solution for the different technical issues of physical layer design is provided. The presented modulation scheme through the proposed prototype filter-based FBMC can suppress the side lobe energy of the constituted filters up to large extent without compromising the recovery of the signal at the receiver end. The proposed system provides very high spectral efficiency; it can sacrifice large guard band frequencies to increase the subcarrier spacing to provide low-latency communication to support the real-time e-healthcare network. [ABSTRACT FROM AUTHOR]

• Modelling of non-cooperative and cooperative WBAN using CM3A channel model operating at UWB, WMTS, US-ISM, and W-ISM bands. • Evaluation of various link quality metrics and critically comparing them for cooperative and non-cooperative WBAN. • Optimization of transmission energy using Particle Swarm Optimization (PSO) for energy-efficient WBAN. This work presents performance evaluation and energy optimization of a cooperative Wireless body area network (WBAN). Link metrics like Bit Error Rate (BER), Signal-to-Noise ratio (SNR), spectral efficiency (SE), and outage probability have been investigated to evaluate the performance of non-cooperative and cooperative WBAN at different frequency bands supporting body-centric communication (Ultra-wideband (UWB), Worldwide Industrial, Scientific and Medical (W-ISM) band, US-ISM (U-ISM) band and Wireless Mobile Telemetry Services (WMTS)). Evaluation reveals that cooperative communication shows better performance by exhibiting improved SNR and SE and lower BER and outage probability compared to non-cooperative communication. A critical comparison of Amplify and forward (A&F) cooperation has been performed with decode and forward (D&F) cooperation. Results reveal that the D&F scheme performs better with increased SNR and SE and lower levels of BER and outage probability in comparison to the A&F scheme by 43.74%, 1.64%, 0.15%, and 99%, respectively. W-MTS with the highest SNR and SE and lowest BER and outage probability outperforms the other frequency bands under both non-cooperative and cooperative scenarios. Further, the threshold distance has been evaluated using the Eigenvalues to optimize the transmission energy for the D&F scenario to enhance the performance of on-body WBAN resulting in an average decrease of 3.8% in the transmitted energy, with UWB showing a maximum reduction of 5.25% thus making the network more energy efficient. [ABSTRACT FROM AUTHOR]

The optical coherence tomography (OCT) is useful in viewing cross-sectional retinal images and detecting various forms of retinal disorders from those images. Image processing methods and computational algorithms underlying this paper try to detect the shadowing region beneath exudates automatically. This paper presents a novel method for detecting hard exudates from retinal OCT images, often associated with macular edema near or within the outer plexiform layer. In this paper, an algorithm can automatically detect the presence of hard exudates in retinal OCT images, and these exudates appear as highly reflective spots. Still, they do not appear as noticeable bright spots because of their minute sizes in predevelopment phases. In the proposed work, we are using a method to detect the presence of hard exudates by analyzing their shadowing effect instead of focusing on brightness spots. The raster scanning operation is performed by traversing the retina horizontally, and noting up any change in normalized summation of brightness intensity (summing up the intensity from top to bottom retinal layers and normalized concerning retinal width) leads to the detection of minute as well as the presence for the detection of large exudates detection by differentiating this brightness intensity graph. The shadow region helps identify the hard exudates; in our proposed method, the output for three input images has been shown. There is an excellent agreement between the results generated by the proposed algorithm and the diagnostic opinion made by the ophthalmologist. The proposed method automatically detects the hard exudates using shadow regions, and it does not need any parameter settings or manual intervention. It can yield significant results by giving the position of shadow regions, which indicates the presence of exudates. [ABSTRACT FROM AUTHOR]

This paper presents a power efficient, low delay and rate adaptive dual chamber pacemaker (PLRDPM) using heart rate and accelerometer sensor. In recent years, number of modifications have been done in the pacemaker design. However, design of an implantable device on an open source is still challenging. Through this paper, we are proposing a "proof of concept" for the design of PLRDPM on FPGA for improving the vital parameters: delay and power consumption. The proposed PLRDPM comprises of accelerometer and heart rate sensors to measure physical activity's effect on heart rate of the bradycardia patients. A rate adaptive pacing algorithm has been designed using two sensor's data, to reduce the delay and power consumption. However, delay in the responses of various components in the circuitry produces an accumulative delay effect in any practical circuit. The delay and the power consumption for the proposed PLRDPM are found to be 2.82 ns and 9 mW, respectively. [ABSTRACT FROM AUTHOR]

Introduction: Recanalized thrombus (RCT) of coronary arteries is frequently unrecognized in interventional cardiology practice. Intravascular imaging conclusively establishes its diagnosis, which otherwise is often misdiagnosed as fresh thrombus, spontaneous coronary artery dissection, or severe calcification based on angiography, alone. We hereby report our experience of 10 RCT patients, who had the intravascular imaging-guided diagnosis, followed by the successful percutaneous coronary intervention (PCI).Methods: It was a retrospective analysis of 10 patients, who had angiographic haziness of the target lesion during PCI, which were found to be RCT on intravascular imaging. Either optical coherence tomography (OCT) or intravascular ultrasound (IVUS) was performed to characterize RCT in 9 and 1 patient, respectively.Results: The mean age was 53 ± 13.1 years, comprising 9 men and 1 woman. Six patients had acute coronary syndrome, while four had chronic stable angina. Coronary angiography revealed ≥ 70% angiographic stenosis, with intracoronary haziness/filling defects which were linear, spiral or braided in appearance. OCT findings in 9 patients include signal-rich, high backscattered septa dividing the lumen into multiple small cavities communicating with each other, giving a "Swiss cheese" or "honeycomb" appearance. Intravascular ultrasound (IVUS) findings in one patient showed multiple cavities filled with blood speckling consistent with recanalized thrombus. All patients underwent successful PCI with image-guided optimization.Conclusion: With the increasing use of intravascular imaging during PCI, RCT is frequently identified. OCT remains the investigation of choice to differentiate it from other similar entities on angiography. [ABSTRACT FROM AUTHOR]

Abstract: A kinetic analytical method using uncatalyzed ligand substitution reaction and spectrophotometeric monitoring for the quantification of D-pencillamine (D-PA) i.e. 2-amino-3-mercapto-3-methylbutanoic acid or β,β-dimethylcysteine or 3-mercaptovaline or 3-mercapto-D-valine in pure as well as dosage forms has been validated and applied. The method is based on the uncatalyzed ligand substitution reaction between [Fe(CN)5(H2O)]3− and D-PA which produces the complex [Fe(CN)5(D-PA)]3−. The substituted complex [Fe(CN)5(D-PA)]3− shows an absorption maximum at 421nm. The proposed method shows good linear dynamic range of 14.92–149.21μgmL−1. By measuring the fixed time absorbance as a measure of initial rate of the complex formation during the course of the reaction at this wavelength, D-PA can be determined in the range 14.92–149.21μgmL−1. The recoveries of D-PA from various samples spiked at the usage level have been quantitative. The limit of quantification (3σ) was determined as 5.16, 3.68 and 3.13μgmL−1 of D-PA corresponding to the fixed time of 2, 3 and 5min respectively. The common excipients used as additives in pharmaceuticals did not interfere in the proposed method. The method was successfully employed for the analysis of D-PA content in commercial pharmaceutical preparations (tablets) and revealed quantities almost equal to those measured using the standard method, and demonstrated good accuracy and precision. The proposed method is rapid, simple, accurate and precise without the need for authentic analyte standards. It could therefore be used as an alternative to the quantification of D-PA in various samples. [Copyright &y& Elsevier]