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Over the past few years, the usage of online learning has become the most standard and important part of learning practices among the graduating students. This is the basic tool used by both teachers and students. This website is developed promising the students and teachers involvement enabling distant learning is easy and possible. Our website uses new technologies to make the educating a better experience. There are many platform available online for the students to help them study and train them in their fields. But as of now, there is a few of other platform that help teachers keep the track of student’s performances. This website consists of all of study material available for the computer science students. They can check their understanding of the specific subject as well as specific topic using the quiz provided on our website. When in doubt students can interact with the teachers and clarify their doubts. The website consists of the study material , quizzes to practice their knowledge , student-teacher interaction for the better understanding of the topic, peer-to-peer interaction for the better and healthy competition. This is a platform which not only helps the student to learn and prepare for their university exams but also helps them widen their horizon and helps them in participating in the competitive exams too. A platform where students can interact with their peers, teachers in order to share their views, opinions and doubts. A place where they can compete themselves for college academics and competitive exams using the percentile grading system. Usually it is seen that there is a wide gap of hands-on programming experience or knowledge among the graduating students. It is seen that they only have the placement required knowledge which affects them in long run. So, our motive is to build the web app which can help student boost their coding skill and master their programming knowledge which can help them compete in the competitive programming competitions throughout their life. Here, students can share their views on blogs which later can be evaluated by the teachers and they can share their opinions on them. There are several apis used here which can help students to practice coding . They can even compete among themselves for the better understanding of the concept and the different approach to the problem they might be unaware of and in this way they will have a better understanding of the topics. And after each problem statement students can evaluate their score based on their performance.

Khoa is a rich source of calcium which helps in strengthening of bones and teeth. It is helpful in osteoporosis and abundance of riboflavin in khoa helps to maintain healthy immune system. . The traditional method of khoa making has a number of drawbacks: It has a limited capacity due to batch operation which results in non-uniform product quality and thus not suitable for large volume production, inefficient use of energy and low heat transfer coefficient results in bulky equipment, large spillage losses, it requires more manual labor and sometimes burning of the product occurs which lowers its quality. In the present study a comparison between preparation of khoa by traditional method as well as mechanical method using steam jacketed khoa pan was carried out. Khoa was prepared by traditional method by stirring the raw milk continuously in a pan over a flame until the raw milk was converted into semi solid stage. The drawbacks such as vary in temperature during the experiment because of non-uniform distribution of flame and burn out of milk solids were identified in this method. This leads to burnt flavour and discolouration of khoa. To overcome these drawbacks of traditional method, khoa was made in a steam jacketed khoa pan installed at Dairy and Food Processing Pilot Plant, College of Agricultural Engineeering, Madakasira at a uniform pressure of about 1.5 kg/cm2. In this mechanical method, the khoa was prepared in less time as well as it has good appearance, flavour, texture etc. compared to khoa prepared by traditional method. In traditional method, about 0.242 kg of of khoa was obtained from 0.94 kg of raw milk with addition of 0.0925 kg of sugar while 11.50 kg of khoa was obtained from 40 litres of raw milk with addition of about 4 kg of sugar when khoa was made in steam jacketed khoa pan. In this mechanical method, the khoa was prepared in less time as well as it has good appearance, flavour, texture etc. compared to khoa prepared by traditional method.

Hybrid breeding strategy leading to define heterotic pools expedited execution of hybrid technology for amelioration of yield, quality, wide adaptability and resistance to biotic and abiotic stresses. In case of pigeonpea conventional hybrid breeding programme has yielded good dividends, yet it can be further honed up by understanding the genome wide variations in the hybrid parental lines for defining heterotic pools. Also, combining ability basis of defining heterotic pools offer enormous opportunities for pragmatic exploitation of pigeonpea hybrid technology with high yield advantages realized in farmers’ fields.

Cow’s milk is considered an excellent protein source. However, the digestibility of milk proteins needs to be improved. This study aimed to evaluate the relationship between the functional properties of milk proteins and their structure upon microwave, ultrasound, and thermosonication treatments. The protein content, digestibility, and secondary-structure changes of milk proteins were determined. The results demonstrated that almost 35% of the proteins in the untreated samples had a α-helix structure and approximately 29% a β-sheet and turns structure. Regarding the untreated samples, the three treatments increased the α-helices and correspondingly decreased the β-sheets and turns. Moreover, the highest milk protein digestibility was observed for the ultrasound-treated samples (90.20–94.41%), followed by the microwave-treated samples (72.56–93.4%), whereas thermosonication resulted in a lower digestibility (68.76–78.81%). The milk protein content was reduced as the microwave processing time and the temperature increased. The final milk protein available in the sample was lower when microwave processing was conducted at 75 °C and 90 °C compared to 60 °C, whereas the ultrasound treatment significantly improved the protein content, and no particular trend was observed for the thermosonicated samples. Thus, ultrasound processing shows a potential application in improving the protein quality of cow’s milk.

The present experimental work conducts the CFD analysis and numerical investigation for finding the efficiencies of solar air heater with triangular-shaped duct design. The efficiencies are calculated considering the solar intensity and varying ambient conditions at different time of the day. Present work shows triangular-shaped duct solar air heater having black paint-coated absorber plates on two of its surfaces while the third surface is used as glass plate. Also the CFD analysis of the heat transfer phenomena occurring between absorber plate and air is carried out taking the solar radiation intensity available at 13:00 h time in Jaipur. The parameters calculated in this investigation of heat transfer are glazing temperature, absorber surface mean temperature, efficiency, and heat transfer rate. The maximum rise in efficiency is obtained at a mass flow rate of 0.01911 kg/s. The CFD analysis result shows that the efficiency increases with increase in air mass flow rate and experimental investigation results indicate that lesser the velocity of flowing fluid, the more is the efficiency.

In this paper, novel software has been developed to analyze the solar energy and its use for the generation of electricity. Rajasthan has abundant solar energy for power generation. The software designed is used for the estimation of solar radiation at remote areas, and through that data, the total power that can be obtained can be approximated. It is a very simple application of C++ programming which will be directly used in computing the solar energy production. For computing this calculation, from various districts of Rajasthan state, the data was collected for 20 areas which have large solar radiation. Estimation of solar radiation and computation of the total radiation was evaluated using latitude and longitude. The software program is developed by using input variables like regression constant, declination angle, monthly average global radiation, and latitude angle, and the value of total probable energy through solar radiation can be automatically generated.

Wind energy is a renewable source of energy besides being a clean source of energy. At a time when conservation of resources is the need of the hour, the better utilization of the present reusable sources should be the utmost priority. One of them being the wind turbines. A wind turbine is a device, which converts the energy of wind into mechanical energy, and this mechanical energy with the help of a generator is converted into electrical energy. The conservation of energy is at the top for a sustainable and quality environment and wind energy is one of the few yet best renewable resources. The vast potential of wind energy has never been in doubt however, access to abundance has always been a challenge. This paper covers the possibility of enhancing the existing methods of power transmissions and thereby the better efficient performance of the wind turbine The present electrical methods to cover for the variation in speed of the wind and variable input to the generator is doing a good job but this paper encroaches the mechanical aspect of the system something which has not been looked at while this time. The arrival of Continuously Variable Transmission (CVT) in the automobile industry was a breakthrough in automatic power transmission. We credit our inspiration and approach the CVT only, the ability to provide optimal gear ratio in varying conditions is what we engulfed upon. We are proposing the design of a system based on CVT to provide the solution to the varying input problem to the generator.

In power sector, distributed generators have revamping behavior resulting several impacts over the system which need to be investigated. Protection equipments used in power systems are widely used and distributed all over the entire network and facilitating the utilities to enhance the system against various symmetrical and unsymmetrical faults; their identification and segregation is necessity. This proposed novel method of S-matrix obtained from signal features using Stockwell transform for fault determination along with wind power generation is implemented. This approach depends upon the thresholds and algorithm later detects the faults which are implemented over the IEEE 34-bus systems tested on MATLAB Simulink.

Scientists agree that the increased human impact on the environment since the 19th century has positioned our planet in a period of rapid and intense change, particularly to our natural ecosystems [...]

Objective: The objective of this study is to identify the various electrolyte abnormalities in critically ill children admitted to pediatric intensive care unit (PICU) and their association with morbidity and mortality. Methods: This was a hospital-based prospective observational study conducted on 180 critically ill children in the age group 2 months to 15 years admitted in the PICU of a tertiary care hospital. Venous blood sample was obtained for the estimation of serum sodium, potassium, calcium, magnesium, and phosphate. The incidence of electrolyte abnormalities and their relation to the primary illness was calculated. Morbidity (mean duration of hospital stay) and mortality rates were evaluated and compared to patients with normal electrolyte levels. Results: Electrolyte abnormalities were seen in 108 children (60%); 72 patients (40%) were having normal electrolyte levels. Most common abnormality seen was hyponatremia in 50.5% patients (n=91). Morbidity and mortality were also higher in these patients. Overall mortality with dyselectrolytemia was 30.5% (n=33) as compared to those with normal electrolyte levels (4.1%, n=3) and was statistically significant (p

Introduction: Early diagnosis of pulmonary embolism can reduce morbidity and motility. D-dimer is well known parameter having high negative prediction value. This study focused on role of D-dimer in early prediction of presence and severity of pulmonary embolism. Material and Methods: Thirty patients with clinical suspicion of pulmonary embolism along with high D-dimer value were included in this study. All selected patients underwent computed tomography pulmonary angiography assessment. D-dimer value was correlated with presence and proximity of pulmonary embolism. Results: Out of thirty selected patients 50% had pulmonary embolism on computed tomography pulmonary angiography assessment. D-dimer value correlated well with presence and proximity of pulmonary embolism. Conclusion: D-dimer value more than 4000 ng/ml had high positive prediction value (79%) in suspected clinical cases. Value more than 8000 ng/ml further improve value to nearly 100% in suspected cases.

The world is having COVID 19 pandemic currently. Early diagnosis is a challenge as the COVID 19 illness has variety of presentations. In this regard knowledge about spectrum of clinical presentation may be very helpful. This case report was about presentation of COVID 19 illness as isolated left eye conjunctivitis in a 58 years old male patient. By early diagnosis and appropriate treatment, the patient was recovered completely as well as his positive contacts were also isolated immediately. The study also highlighted the need of awareness among clinicians about isolated left eye conjunctivitis presentation of COVID 19.

Back ground: Glandular cardiac myxoma has varying clinical presentation with uncertain histogenesis and debatable immunohistochemical profile. Glandular epithelial differentiations are rare phenomenon known to be present as an intrinsic component of the tumor. The origin of the glands has been attributed to epithelial differentiation of a totipotent cardiomyogenic precursor cells or the entrapped foregut rests in the tumor. Materials and Methods: Retrospective study includes six cases of glandular cardiac myxoma collected over a perior of 4 years. Sections were examined to define the histogenesis, histological and immunohistochemical profile of the glandular elements. Results: Incidence of glandular cardiac myxoma was 6.6% with a male to female ratio of 1:2.Mean age was 49.9 years. Left atrium was the commonest site. Five were sporadic and one was familial. Chest pain and dyspnea were the commonest clinical symptoms. Histologically all myxoma showed well formed glandular structures with typical myxomatous area. No atypia, mitosis or necrosis was identified in the glandular elements. Markers in six cases of glandular cardiac myxoma were immunopositive for CK7, CK 19, EMA, CEA, focally for E-cadherin while immunonegative for CK20, Chromogranin, Synaptophysin, calretenin, vimentin, B-catenin, TTF-1 and GCDFP-15 favoring enteric differentiation. Conclusion: Glandular cardiac myxoma is a rare entity which shows characteristics similar to those of classical cardiac myxoma with benign glandular elements showing enteric differentiation. Complete surgical excision is the treatment of choice with good prognosis. It is important to recognize this entity to avoid an erroneous diagnosis of metastatic adenocarcinoma.

Background: Prevalence of anemia is higher in girls in low socioeconomic status; In addition it gets precipitated by blood loss during menstruation. Anemia in adolescent girls in future attributes to high maternal mortality rate, high incidence of low birth weight babies, high perinatal mortality and fetal wastage. Methods: This was cross-sectional study. All the adolescent girls studying in standards 9th - 12th class who were given consent to hemoglobin estimation were included in the study. The girls ≥20 years, and those suffering from any chronic disease were not included in the study. A total of 400 girls were interviewed and were investigated for their Hemoglobin concentration. A predesigned and pretested schedule was used to collect the information about the participants. Results: Most of the girls i.e.388 (97%) belonged to the socioeconomic class II, III, IV. The association between SES and anemia was found statistically significant. The association between mother education and anemia was also found statistically significant but association between type of family and anemia was also found statistically Insignificant. Conclusion: Nutrition education along with nutritional supplementation and iron folic acid tablets should be provided to all girls. Key Words: Adolescent Girls, Anaemia, Socio-Demographic Characteristics, Education

Background: Hepatitis B virus (HBV) is a double-stranded circular DNA virus and member of the Hepadnaviridae family of viruses. Methods: This cross sectional study was done on 250 nursing staff. There were total 263 nursing staff in this hospital out of which 250 enrolled voluntarily to participate in this study. The objective, nature and benefits of this study were explained and informed & written consent was taken from all participants. All nursing staff were interviewed structured self-completed quaternaries. Results: Hepatitis B virus (HBV) infection is an occupational health hazard preventable by vaccination. 78% of nursing staff know that Hep B is a vaccine preventable. 42% of participants knew that getting vaccinated offers a protection from infection for 15 years. 16% of nursing staff are aware that a titre value of more than 10 ml U/ml is needed for protection from Hepatitis B infection. 84% of nursing staff are willing to motivate others and encourage them to get vaccinated against Hepatitis B. Conclusion: This study highlighted the need to have nursing staff educated regarding significance of immunization against vaccine preventable disease. Keywords- Hepatitis, Immunization, Liver

Milk allergy is known to cause severe allergic reactions in hypersensitive patients, especially in infants and children. β-Lactoglobulin is one of the major allergens in bovine milk. The influence of thermal and microwave processing on the structural deviations of β-lactoglobulin protein have been studied using molecular modeling techniques. The structural deviations are studied using root mean square deviations, radius of gyration, dipole moment, and solvent accessible surface area. STRIDE analysis showed significant changes in the β-lactoglobulin, especially when oscillating electric fields were applied along with heat. Root mean square fluctuations (RMSF) has been assessed for known epitopes in the β-lactoglobulin molecule. This showed that when the protein is exposed to certain thermal stress, it compacts by burying hydrophobic residues in the core. However, few allergic epitope residues also exhibit increased RMSF leading to higher reactive sites on the surface of the protein molecule. PRACTICAL APPLICATIONS: This study showed that molecular modeling can be used to gain valuable insights regarding the structural changes during processing. In the future, with more computational capacity, it can be used to make comparison between results obtained from simulations and real-time experiments. The current techniques used in food industries such as Nuclear Magnetic Resonance Imaging, Fourier Transformation Infrared Spectroscopy, X-ray diffraction can analyze pre- and post-processing effects. Hence, it become necessary to understand the changes that takes place during the processing techniques. Molecular dynamic simulation could be a useful technique in analyzing the changes occurring during the processing.

A growing population means an ever-increasing demand for food. This global concern has led to antagonism over resources such as water and soil. Climate change can directly influence the quality and availability of these resources, thereby adversely affecting our food systems and crop productivity, especially of major cereals such as rice, wheat and maize. In this review, we have looked at the availability of resources such as water and soil based on several modeling scenarios in different regions of the world. Most of these models predict that there will be a reduction in production rates of various cereal crops. Furthermore, all the major cereal crops are known to have a higher contribution to global warming than alternative crops such as millets which should be considered in mitigating global food insecurity. In this study, we have used the data to predict which regions of the world are most adversely affected by climate change and how the cultivation of millets and other crops could aid in the reduction of stress on environmental resources.

Cardiac myxomas are benign neoplasm of the heart with an incidence of 0.3%. Glandular cardiac myxomas are very rare and accounts for less than 3% of all cardiac myxomas. Here, we report a case of familial glandular cardiac myxoma in a 35 year old male who complained of exertional dyspneoa and weakness of right side of body on clinical presentation. Associated features of Carney's complex were not present. Family history revealed presence of cardiac myxoma in younger brother and sister. Transthoracic echocardiography detected biatrial myxoma. Excision of both lesions was done under cardiopulmonary bypass. Histopathology confirmed myxoma with glandular elements. Postoperative course was uneventful.

In our daily life, power electronic circuits such as inverters, UPS, and SMPS comprise of AC–DC converters and DC–DC converters are widely used. The chapter, however, makes an effort to present a charging circuit comprising of transistors, control circuit, and rectifiers for a discharged battery to make it chargeable which can be used in electric vehicle and mobile applications. In this chapter, we have tried designing a converter using different softwares viz OrCAD, MATLAB, and PROTEUS and tried calculating the different parameters related to each design. Further based on the obtained results, we have done the hardware implementation of the converter. Almost all the designing methods encourage the implementation of different types of SMPS converters because of higher efficiency and greater transformer utilization factor (TUF). Among these converters, half-bridge and full-bridge converters have enormous and important role in the field of power electronics and industry application. The converters can be designed and implemented in different ways depending on the area of application.

A distributed system is referred as an interface among bulky power system and consumers. In such distributed systems the voltage of the power grid is decreased when it moves at far from substations. Other problems are loss of power during transmission, variable voltage profile, increasing cost of system etc. Capacitors are used for performance enhancement of the system. Because all of these factors or problems directly affected by performance or energy efficiency of the system. There are various methods which are used for optimal placement of the capacitors in distributed power system. In this work the hybrid approach which combines two techniques such as GA and State transition have been developed in order to achieve the energy efficient distributed system. The result section proves the performance of proposed work by comparing the various techniques with proposed work.

Benefits of early enteral nutrition in neonates are well established, but the effects of enteral nutrition in neonates with inotropic support for hemodynamic instability are not well studied. A study was planned to compare the clinical outcome in terms of morbidity, mortality, and hospital stay in the neonates with enteral feed versus intravenous (IV) fluid group with inotropes and to evaluate the safety of enteral nutrition in neonates with inotropic support as well as to determine the cutoff levels of the inotropes at which enteral feed is well tolerated. Methods: A randomized control trial was conducted in a tertiary care neonatal intensive care unit, Kanpur, and included 200 neonates on inotropes who were allotted randomly 100 each in enteral feed and IV fluid group. Results: Demographic characteristics were comparable in both the groups, mean gestational age being 36.09 ± 0.4 weeks and 35.96 ± 0.3 weeks, and mean weight on admission being 2321.60 ± 73.9 g and 2214.30 ± 53.1 g for the enteral feed group and IV fluid group, respectively. In enterally fed neonates, 88.3% were discharged and 11.7% were expired, while in the IV fluid group, 69.6% were discharged and 30.4% were expired. There was a significant difference in the mean duration of hospital stay (13.4 ± 5.0 days and 15.5 ± 5.1 days in enteral feed and IV fluid group, respectively). No complications were observed in 88.2% of enterally fed neonates versus 93.5% of neonates in the IV fluid group. There was no significant difference between complications in two groups (P = 0.245). When receiver operating characteristic(ROC) curve analysis was done to find out the cutoff level of inotropes to predict feed tolerance, at cutoff level of dopamine 10 μ/kg/min + dobutamine 7.5 μ/kg/min, the sensitivity and specificity to predict feed tolerance were found to be 61.5% and 77%, respectively.Conclusions: Enteral nutrition in neonates with inotropic support is associated with shorter duration of hospital stay and better survival rate. Neonates can tolerate enteral feed up to dopamine 10 μ/kg/min and dobutamine 7.5 μ/kg/min.

De novo noninfective thrombus formation in the ascending aorta is rare. We report two cases of ascending aortic thrombus, their surgical management, and cardiopulmonary bypass strategy.

Superior cavopulmonary anastomosis and total cavopulmonary anastomosis are the procedures of choice for the management of patients with a functionally univentricular heart. We review the various indications, sites, advantages, and complications of a systemic to pulmonary artery shunt after the creation of superior cavopulmonary anastomosis. Systemic pulmonary artery shunt may be useful as a palliative strategy in patients who have hypoxemia and completion of total cavopulmonary anastomosis is not feasible.

Introduction Patients with untreated Persistent Truncus Arteriosus (PTA) usually do not survive or develop irreversible pulmonary vascular obstructive disease beyond infancy. The present study reports the anatomic and hemodynamic data, and results of surgery in patients undergoing surgical repair of PTA beyond 1 year of age.

By the end of this century, the average global temperature is predicted to rise due to the increasing release of greenhouse gases (GHGs) into the atmosphere. This change in climate can reduce agricultural yields, resulting in food insecurity. However, agricultural activities are one of the major contributors of GHGs and lower yields can trigger increased activity to meet the demand for food, resulting in higher quantities of GHGs released into the atmosphere. In this paper, we discuss the growth requirements and greenhouse gas release potential of staple cereal crops and assess the impact of climate change on their yields. Potential solutions for minimizing the influence of climate change on crop productivity are discussed. These include breeding to obtain cereals that are more tolerant to conditions caused by climate change, increased production of these new cultivars, improved irrigation, and more effective use of fertilizers. Furthermore, different predictive models inferred that climate change would reduce production of major cereal crops, except for millets due to their ability to grow in variable climatic conditions, and in dry areas due to a strong root system. Moreover, millets are not resource-intensive crops and release fewer greenhouse gases compared to other cereals. Therefore, in addition to addressing food security, millets have an enormous potential use for reducing the impact of agriculture on global warming and should be grown on a global scale as an alternative to major cereals and grains.

Background: Empyema thoracis, an accumulation of pus in pleural space, occurs in 5-10% of children with bacterial pneumonia. Often cases are referred to the tertiary care hospital late resulting in significant complications, morbidity and mortality. Our aim was to study the clinical profile, associated complications, morbidity and treatment outcome of empyema in children.Methods: A prospective observational study was conducted on 65 children aged 0-12 yrs diagnosed with empyema thoracis admitted in the hospital. After history taking and clinical examination, relevant investigations like chest X-ray, USG chest and pleural fluid analysis including culture and sensitivity were done. All patients were treated with chest tube drainage, antibiotics and intrapleural fibrinolytic therapy.Results: Maximum patients (61.5%) were seen in age group 1-5 yrs, 18.4% below 1 year, 2 were neonates. Pleural fluid culture was positive in 64.6 % of patients. Staphylococcus aureus (58.4%) was the most frequent organism isolated from pleural fluid. Pyopneumothorax (36.9%), broncho-pleural fistula (27.6%) and pneumothorax (18.4%) were common complications. Broncho-pleural fistula was present at admission in 14 patients, developed later in 4 patients and healed with conservative management in 12 patients. Majority of the patients (n=51, 78.4%) had complete resolution of empyema thoracis with re-expansion of lung on conservative management alone. The success rate of medical management in patients who received intrapleural fibrinolytic (streptokinase) within 14 days of symptom onset was 93.3% while it was 71.4% in patients who received intrapleural fibrinolytic after 14 days. 5 (7.6%) patients died, 5 required surgical intervention(decortication/VATS), 4 patients with broncho-pleural fistula not improving on conservative management were referred to higher centre and were lost to follow-up.Conclusions: Empyema in children causes significant morbidity which can be reduced by prompt and adequate treatment of bacterial pneumonia. Antibiotics, chest tube drainage along with intrapleural fibrinolytic therapy is a safe and effective method to facilitate drainage and resolution of empyema even in cases with delayed presentation in resource poor settings and can reduce the need for surgery.

Protein/gene set comparisons across Fusarium sp. (DOCX 11 kb)

Primer sequences used for qRT-PCR. (DOCX 12 kb)

Phylogenetic tree illustrating the relationship between the Fusarium sp. isolates used in this study Branch support values are shown in red. This tree illustrates that the legume-infecting isolates do not appear to be more closely related to each other than to other ff. spp. (PDF 21 kb)

Sequencing data used for genome assemblies. (DOCX 13 kb)

A 21-year-old patient with familial hypercholesterolemia presented with angina caused by ostial stenosis of the left internal mammary artery and severe calcific aortic stenosis with small aortic root 9 years after coronary revascularization. The ostium of the left internal mammary artery was enlarged using a saphenous vein patch through a left supraclavicular incision, which improved left ventricular function. Successful aortic valve replacement with posterior aortic root enlargement was subsequently performed. The surgical management of this condition is discussed briefly.

The standard surgical treatment of coarctation of the aorta is through a left posterolateral thoracotomy. However, when a concomitant cardiac procedure is required or the conventional approach is not possible or is hazardous, extraanatomic bypass to the supraceliac abdominal aorta may be advantageous. We discuss our technique and report the long-term results.Between January 1986 and January 2015, 25 patients (16 males, 9 females) underwent extraanatomic bypass to the supraceliac abdominal aorta for various lesions of the arch and the descending thoracic aorta. Extraanatomic bypass to the supraceliac abdominal aorta was performed for patients in whom balloon dilatation was not feasible due to associated arch hypoplasia (n = 9), long-segment thoracic aorta narrowing due to nonspecific aortoarteritis (n = 3), or isolated long-segment coarctation of the aorta (n = 3). Patients who needed concomitant cardiac procedures, such as aortic valve replacement (n = 4), ascending aortic aneurysm repair (n = 2), or coronary artery bypass grafting (n = 1), and in whom balloon dilatation had failed, also underwent extraanatomic bypass to the supraceliac abdominal aorta. Extraanatomic bypass was also performed in 3 patients with recurrent coarctation after surgical repair and in whom balloon dilation was not feasible or unsuccessful.There were no early or late deaths. The peak-to-peak gradients between the upper limb and the lower limb decreased from 59.3 ± 16.3 mm Hg to 2.0 ± 2.8 mm Hg (p0.0001). The mean follow-up was 96.6 ± 92.6 months (range, 1 to 240 months; median, 54 months). Doppler interrogation of the lower limb arterial system after a mean follow-up of 86.4 ± 85.2 months showed an unobstructed flow pattern. The ankle-brachial pressure index improved from a preoperative value of 0.60 ± 0.07 to 1.04 ± 0.11 (p0.0001). Systolic blood pressure decreased significantly compared with preoperative values (153.9 ± 18.9 vs 122.8 ± 10.2, p0.0001). Three patients continued to receive antihypertensive medication due to persistent mild hypertension.Extraanatomic bypass to the supraceliac abdominal aorta provides effective palliation for complex aortic obstructions. It is easy and quick to perform, avoids fatal complications, and is well tolerated in all age groups.

Superior cavopulmonary anastomosis and total cavopulmonary anastomosis are the procedures of choice for the management of patients with a functionally univentricular heart. We review the various indications, sites, advantages, and complications of a systemic to pulmonary artery shunt after the creation of superior cavopulmonary anastomosis. Systemic pulmonary artery shunt may be useful as a palliative strategy in patients who have hypoxemia and completion of total cavopulmonary anastomosis is not feasible.

Background: Traumatic brain injury (TBI) is a common cause of death and disability, worldwide. Early recognition of patients with brain cellular damage allows for early rehabilitation and patient outcome improvement. Serum protein S-100B determinations have been widely suggested the most promising biomarker for TBI. It has been proposed that this marker is useful in a Neurointensive Care Unit (NICU) as a monitoring parameter. The main objective of this study is to assess the value of including acute S100B levels in standard clinical data as an early screening tool for brain death after severe TBI. Material and methods: In this prospective study, the clinical conditions of patients with mild to moderate TBI were assessed and patient serum S100B levels measured within 24h of injury were eligible for inclusion in the study using by electro chemiluminescence (ECL). Patients were admitted to The Govt. Trauma Centre, P.B.M. Hospital, Bikaner in NICU and followed up one month later and evaluated for level of consciousness, presence or absence of post-traumatic headache, and daily activity performance (using the Barthel scale). Student’s t-test and the chi-square test were used for the data analysis, which was performed using SPSS software. Result and discussion: The mean serum S100B value was significantly lower for patients with minor TBI than for patients with moderate TBI (20.4 ± 12.6 ng/dl and 124.0 ± 235.0 ng/dl, respectively). Patients with normal CT scans also had statistically significantly lower serum S100B levels than patients with abnormal CT findings. The mean S100B value was statistically significantly higher for patients with suspected diffused axonal injury (596.18 ± 502.1 ng/dl) than for patients with other abnormal CT findings (p=0.000): 20.97 ± 19.9 ng/dl in patients with normal CT results; 39.56 ± 21.7 ng/dl in patients with skull bone fracture; 50.38 ± 22.9 ng/dl in patients with intracranial haemorrhage; and 70.23 ± 31.3 ng/dl in patients with fracture plus intracranial haemorrhage. Conclusion: Serum S100B levels increase in patients with minor to moderate TBIs, especially in those with diffused axonal injury. However, serum S100B values cannot accurately predict one-month neuropsychological outcomes and performance. KEYWORDS: Skull bone fracture, Axonal injury, Haemorrhage, Neuropsychological, SPSS Software, Post-traumatic Headache, Abnormal CT