Objective: To study the incidence of sinonasal mucormycosis in active and post COVID-19 patients in a district-level hospital in India. Study Design: A prospective, interventional cohort study conducted from April 2021 to January 2022. Setting: A district-level/secondary level hospital in North India. Methods: Inclusion Criteria: All COVID-19 positive patients with diabetes mellitus as co-morbidity and with at least one of the following:received steroid therapy and/or on high flow oxygen therapy and/or had prolonged hospital stay (>7 days). Exclusion Criteria: Patients already immunocompromised/having malignancy/organ transplant recipients. Clinical workup: History, examination, imaging (CECT/MRI nose and paranasal sinuses if indicated), diagnostic nasal endoscopy + Nasal scrapings for KOH mount to detect fungal elements. Results: Fourteen out of 250 patients tested positive for Mucormycosis (incidence 5.6%). Out of these 13 were symptomatic and only one patient was asymptomatic and detected on screening. No significant difference was found in mucormycosis vs. non-mucormycosis group with respect to HbA1c status, vaccination status or steroid + oxygen treatment (p>0.05 in all scenarios). Patients were treated with intravenous Liposomal Amphotericin B and surgical debridement when indicated. Two succumbed to disease (survival 85.7%). A clinical screening protocol was thus developed which can be used as an effective tool even at far-flung and remote healthcare facilities for diagnosis and timely referral of patients. Conclusion: Mucormycosis is a potentially lethal disease which needs rapid diagnosis and timely action to decrease morbidity and mortality.

The health monitoring for disease diagnosis and prognosis in a desired smart medical structure is realized by interpreting the health data. The advances in sensor technologies and biomedical data acquisition tools have led to the new era of big data, where different sensors collect massive medical data every day. This special issue explores the latest development in emerging technologies of biomedical engineering, including big medical data, artificial intelligence, cloud/fog computing, federated learning, ubiquitous computing and communication, internet of things, wireless technologies, and, security and privacy. The biological wearable sensors can enhance the decision-making and early disease diagnosis processes by intelligently investigating and collecting large amounts of biomedical data (i.e., big health data). Hence, there is a need for scalable advanced learning, and intelligent algorithms that lead to reliable and interoperable solutions to make effective decisions in emergency medicine technologies. The optimization algorithms can be used in order to acquire the sensor data from multiple sources for fast and accurate health monitoring.

Introduction: While steerable sheaths are widely used to improve catheter stability and contact force during radiofrequency (RF) catheter ablation in patients with atrial fibrillation (AF), steerable sheaths are less commonly used during transseptal puncture. This study evaluated whether left atrial catheterization efficiency can be improved using the VersaCross combined steerable sheath and transseptal system compared to previous standard workflow. Methods: This study retrospectively analyzed AF ablation performed using the Versacross Workflow consisting of VersaCross steerable sheath and RF wire for transseptal puncture and catheter ablation (VCW) to the standard workflow using a fixed curve sheath with RF needle followed by exchange for an Agilis steerable sheath for catheter ablation (STW). Results: Thirty patients underwent RF ablation for paroxysmal or persistent AF, 15 using the VCW and 15 using the STW. Transseptal puncture time was 10.8 mins faster with the VCW compared to the standard workflow (20.9 ± 5.9 min vs. 31.7 ± 15.1 min; p=0.024). Time to left atrial catheterization was 40% faster with the VCW compared to the STW (21.3 ± 5.8 min vs. 35.2 ± 14.4 min; p=0.003). Overall procedure time was 14.2 min faster in the VCW compared to the STW (86.3 ± 16.1 min vs. 100.5 ± 19.3 min; p=0.044). Conclusions: Use of the VersaCross steerable system significantly reduced time to transseptal puncture, time to left atrial catheterization, and overall RF ablation time.

As sessile organisms, plants are constantly challenged by a dynamic growing environment. This includes fluctuations in temperature, water availability, light levels, and atmospheric conditions. In concert with changes in abiotic conditions, plants experience changes in biotic stress pressures, including plant pathogens, viruses, and herbivores. Human-induced increases in atmospheric carbon dioxide (CO 2) levels have led to alterations in plant growth environments that challenge their productivity and nutritional quality. Additionally, it is predicted that climate change will alter the prevalence and virulence of plant pathogens, further challenging plant productivity. A knowledge gap exists in the complex interplay between plant responses to biotic and abiotic stress conditions. Closing this gap is crucial for developing climate resilient crops in the future. Here, we review the physiological responses of plants to elevated CO 2, temperature, tropospheric ozone (O 3), and drought conditions, as well as the interaction of these abiotic stress factors with plant pathogen pressure. Additionally, we describe the crosstalk and trade-offs involved in plant responses to both abiotic and biotic stress, and outline targets for future work to develop a more sustainable future food supply in light of future climate change.

Consider amiodarone pneumonitis as an important differential diagnosis of ARDS , especially In clinically ill patients with renal failure who recently received Intravenous amiodarone .

Long QT syndrome (LQTS) is a serious condition that can cause sudden cardiac death. Subsequently, a heterozygous mutation of KCNH2 was identified. This has led to the hypothesis that the use of maternal tacrolimus may cause LQTS or have an effect that may facilitate the early occurrence of congenital LQTS.

Fat embolism is a potentially life-threatening condition that can develop after trauma or lower limb orthopaedic surgery. Characterized as a triad of respiratory, neurological and cutaneous symptoms. High index of suspicion is important. Rapid recognition and supportive treatment are key in improving the outcome. The prognosis is usually good.

Underestimating the impact of complexity is an important reason for the poor performance of large-scale construction project management. The purpose of this paper is to improve the understanding of the perceived complexity of contractors, identify the complexity factors of construction projects in China, and provide basic research results for the treatment of complexity. From the perspective of contractors in the construction implementation stage, the literature on construction projects complexity is sorted out, and 17 initial indicators of influencing factors are determined through document analysis and expert interviews. Taking 130 questionnaires as samples, 17 influencing factors passed reliability and validity tests. Through exploratory factor analysis (EFA), a four-dimensional framework for influencing factors of perceived complexity of construction project contractors is proposed, including Social Complexity, Environment Complexity, Technical Complexity and Stakeholder Complexity. Among those factors, the project funding, geological conditions, survey and design quality, stakeholder relationships are the key factors affecting the perceived complexity of construction project contractors in China. The research results are mainly applied in the field of construction project complexity management, which can provide basis and reference for the complexity management of railway, highway, subway and other large engineering construction projects.

A patient with schizoaffective disorder and receiving long-term treatment with lithium developed prolonged delirium. She had recently been diagnosed with stage IIIC1 endometrial cancer and presented a deteriorating general condition. Toxic levels of lithium were measured in serum. After hemodialysis, lithium levels gradually decreased and the symptoms disappeared completely.

In this paper, we consider switched systems that allow discontinuous jumps in the state when switching occurs. In particular we analyze the case where these jumps are dictated by a state reset rule. We show that it is possible to study the state trajectories of a switched system with state reset by means of some switched systems without state resets, i.e., with continuous state trajectories. We establish some sufficient conditions for stability of switched systems with state reset using the associated systems without reset. The obtained results are used in numerical examples to show the effectiveness of the proposed approach.

A document by Diptiben Ghelani, written on Authorea.

Obesity is reaching epidemic proportions worldwide with profound impact on health resulting in reduced quality of life, early death. Deposition of excess fatty acids (FAs) into fat cells in the form of triglycerides (TGs) is the biochemical basis of obesity, thus any imbalance in food intake and energy utilization may result in obesity. This homeostasis is complex and is regulated by a host of metabolic and endocrine factors which are poorly understood. Obesity contributes to pathologies, such as the metabolic syndrome (MetS), cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM), hypertension, endothelial dysfunction [ED] and testosterone deficiency (hypogonadism). An increases in the prevalence of overweight (body mass index (BMI) 25-29.9 kg m−2) and obesity (BMI ≥ 30 kg m−2) in adult men by more than 25% in the last 8 years according to WHO estimates. Overweight and moderate obesity is predominantly associated with reductions in total testosterone; whereas, free testosterone levels remain within the reference range, especially in younger men. Reductions in total testosterone levels are largely a consequence of reductions in sex hormone binding globulin (SHBG) due to obesity-associated hyperinsulinemia. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are used for weight loss and insulin dose reduction in obese insulin-using type 2 diabetic patients. A plausible mechanism by which GLP-1 RA may induce weight loss is by suppressing appetite signalling in the brain and increasing satiety, leading to a reduced food intake [9, 10]. GLP-1 receptors are present in the central nervous system suggesting direct actions of GLP-1 in the brain [11]. GLP-1 infusions can enhance satiety and reduce energy intake in type 2 diabetes patients [12]. Furthermore, GLP-1 RA attenuates binge eating in obese patients [13], suggesting a role of GLP-1 RA in certain eating types. A recent systematic review and meta-analysis including 2.8 million people and 270 000 deaths reported increased overall mortality only in those with extreme obesity (BMI > 35 kg m−2, hazard ratio (HR) 1.29, 95% confidence interval (CI) 1.18-1.41), but not in grade 1 obesity (BMI

This document presents a in reference to the developments in AI and ML to make the grading and feedback process easier. Building machines which comprehend and react to text or voice data-and answer with text or speech from their own a manner closer to that of humans is the goal of natural language processing. Grading is a tiresome and time-consuming procedure, and it's frequently difficult to get regular feedbacks. So, to goal is to implement AI and machine learning algorithms to facilitate in grading and/or provide comments on submitted curriculum in the field of education and training using NLP. Modern computing necessitates sorting algorithms and their implementations to be more efficient in sorting huge data sets, both in terms of time and memory used. In order to choose an algorithm depending on the properties of the data set, this paper reviews a variety of adaptive sorting algorithms. By analyzing the trial data, machine learning enables us to build an adaptable algorithm

The main goal of this paper is to develop a control for maintaining the state of charge of the energy storage system which is used to regulate the power/frequency of microgrids and will also act as a spinning reserve to micro-grid fluctuations. SYSTEM DESIGN: One microgrid consists of a DEG, solar PV and wind power, and load. The other microgrid has DEG, wind power, and load. The tie-line connected MMG system has a common ESS. OPERATION CONSIDERATIONS: • In this system, batteries voltage, current, and temperature are controlled centrally. • Tie-line is used to exchange energy between control areas to provide inter-area support in case of a faulted condition. • Algorithm logic here is When the change in frequency (Δf) becomes negative, the ESS supplies power to the system. (This SOC should be more than the predefined value only then ESS will supply power else it won't supply power and once frequency change becomes positive, the system will charge ESS). RESULTS OF RESEARCH: • From 0 to 58s both the microgrids operate independently. • Each DEG supplies the deficit power in the respective MG. • From 58 to 245s surplus renewable energy is available at MG1 and extra energy is transferred from MG1 to MG2 depending on the load demand or stored at ESS. • To operate economically, DEG2 is stopped, and ESS is used as the spinning reserve.

Aim: Quantify identifiable sources of variability, including key pharmacogenetic variants in oxypurinol pharmacokinetics and their pharmacodynamic effect on serum urate. Methods: Hmong participants (n=34) received 100 mg allopurinol twice daily for 7 days followed by 150 mg allopurinol twice daily for 7 days. Serum urates (SU) were obtained pre- and post-allopurinol. Serum oxypurinol concentrations were obtained at times 0, 2, 4, and 6 hours after the last dose. A sequential population pharmacokinetic pharmacodynamics (PKPD) analysis with non-linear mixed-effects modeling evaluated the impact of anthropometrics, concomitant medications, and genetic variants on oxypurinol PKPD parameters. Allopurinol maintenance dose to achieve target SU was simulated based on the final PKPD model. Results: A one-compartment model with first order absorption and elimination best described the oxypurinol concentration-time data. Inhibitory of SU by oxypurinol was described with a direct inhibitory Emax model using steady-state oxypurinol concentrations. Fat-free body mass, estimated creatinine clearance and SLC22A12 rs505802 genotype were found to predict differences in oxypurinol clearance. Oxypurinol concentration required to inhibit 50% of xanthine dehydrogenase activity was affected by PDZK1 rs12129861 genotype. Most individuals with both PDZK1 rs12129861 AA and SLC22A12 rs505802 CC genotypes achieve target SU with allopurinol below the maximum dose, regardless of renal function and body mass. In contrast, individuals with both PDZK1 rs12129861 GG and SLC22A12 rs505802 TT genotypes would require more than the maximum dose, thus alternative medications. Conclusion: The proposed allopurinol dosing guide uses individuals’ fat-free mass, renal function, and SLC22A12 rs505802 and PDZK1 rs12129861 genotypes to achieve target SU.

Background The Organ Care System (OCS) is a revolutionary ex vivo organ perfusion technology that can potentially expand the organ retrieval range. The OCS Lung device uses packed red blood cells (pRBC) with a proprietary solution. We report the ability to reduce blood waste during this procedure by using a thermal packaging solution in conjunction with the OCS platform. Methods We retrospectively reviewed all OCS Lung recoveries performed by our recovery team, using packed red blood cells (pRBC) from May 2019 to January 2021. Initially, units were stored using passive refrigeration with the Performance cooler at a temperature range of 1 to 6 °C for 4 hours. Subsequently, thermal control technology with the ProMed cooler was utilized to maintain the same temperature range for 72 hours. Results Twenty-three recoveries were initiated with 63 pRBC. The Performance cooler was used for eight while the ProMed cooler for thirteen. 37.5% of pRBC transported with the Performance cooler was used within the validated time range, while 25.0% were used beyond the validated time range based on clinical judgment. In addition, 37.5% of pRBC transported with the Performance cooler were returned to the institution after canceled recoveries with an estimated loss of $1,800; the ProMed cooler had no wastage. Conclusions This study showed that using an advanced thermal packaging solution facilitates proper storage of pRBC and represents an advancement for extended donor lung preservation. The elimination of blood wastage in this initial study portends ongoing benefits for the limited blood supply and reduced cost.

Coronavirus (COVID-19) infection exposes patients with heart failure to a higher risk of morbidity and mortality. In LVAD patients, one of the key problems that can lead to life-threatening low-flow or pump malfunction due to thrombus development in the inflow cannula, device body, or outflow graft, implicating hemodynamic instability, hemolysis, renal or hepatic failure, or cerebral or peripheral thromboembolism. [Endothelial protein C receptor and thrombomodulin levels are elevated along with procoagulants such as factor VIII, P-selectin, and von Willebrand factor and downregulated along with thrombomodulin as a result of the cytokine storm released by endothelial and immune cells. In general ,](#ref-0013) LVAD thrombosis has been found to occur in 2–13% of adult patients who use current continuous-flow devices. However, LVAD thrombosis due to COVID-19 is underreported and a few cases presented. We present a case of accelerated LVAD outflow thrombosis in the setting of COVID-19 infection with multiorgan failure.

Increasing rice yield has always been one of the primary objectives of rice breeding. However, panicle degeneration, a complex phenomenon regulated by many genetic and environmental factors, often occurs in rice-growing regions and severely curbs rice yield. In this study, we obtained a new apical panicle degeneration mutant named ym48, which induces a marked degeneration rate and diminishes the final grain yield. Cellular and physiological analyses revealed that the apical panicle in ym48 undergoes programmed cell death, accompanied by excessive accumulations of peroxides. Following, the panicle degeneration gene OsCAX1a was identified, which was involved in Ca2+ transportation in the ym48 mutant. In OsCAX1a, a relative conserved T to A substitution was noted at the 64th amino acid, which disrupted Ca2+ transport. Hydroponics assays and Ca2+ quantification confirmed that Ca2+ transportation and distribution to apical tissues were restricted and over-accumulated in mutant sheath. RNA-Seq data indicated that the abnormal CBLs (calcineurin b-like proteins) pathway mediated by Ca2+ might occurred in mutant, resulting in the burst of ROS. In general, Ca2+ deficiency in the apical panicle of ym48 mediated by OsCAX1a stimulated the peroxide accumulation and led to the programmed cell death, finally resulted to panicle degeneration. Our results explained the key role of OsCAX1a in Ca2+ transportation and distribution and laid a foundation to further explore the genetic and molecular mechanisms of panicle development and differentiation in rice.

Cardiac involvement of hydatid cyst disease is a rare presentation but may lead to life-threatening complications such as cyst rupture and should be treated surgically A 10-year-old male patient with cranial and complicated cardiac hydatid cyst disease lesions that caused lower extremity peripheral arterial occlusion and aneurysmatic dilatation in the left ventricular apex is presented. Although the patient was in the pediatric age group, the Dor procedure was successfully applied to preserve the ventricular geometry. The Dor procedure for a ventricular aneurysm caused by a cardiac hydatid cyst was rarely applied in the pediatric age group. Inconclusion, this case differs from other cardiac hydatid cysts previously reported in the literature due to the advanced stage of the disease, atypical clinical presentation, and rare complications despite the young age of the case. The surgical method used in treating the patient makes the subject more interesting.

Objective To test whether A-PACs in cranberry juice have an anti-Candida effect in the vagina of women. Design An open, randomized, parallel design study. Setting West China Second Hospital of Sichuan University in China. Population 300 women with Vulvovaginal candidiasis (VVC). Methods At baseline, all patients were randomly divided into three groups. Patients in Group1 were treated with standard antifungal therapy; Patients in Group2 received oral Azmasol® (cranberry juice) 16ml daily for 6 days based on the treatment regimen of Group1; Patients in Group3 were given oral Azmasol® 16ml daily for 6 days and vaginal Miconazole suppository 400mg at bedtime for 3 days. Patients who were clinically cured at 7th day follow-up in Group2 received maintenance therapy by oral Azmazol® 8ml every day. Main Outcome Measures The clinical cure rate and disease-free survival were the primary outcomes, and the secondary outcomes included microbiological eradication rates and symptom scores. Results At the 7th day follow-up, both the clinical cure rate in group 2 and group 3 were not-inferior to group 1. Cox regression analysis showed maintenance therapy was not significantly associated with short-term recurrence (HR 0.44 [0.11–1.67]; P=0.23) but significantly associated with long-term recurrence (HR 0.57 [0.33–0.99]; P<0·05). Conclusions A-PACs in cranberry juice can be used as an oral alternative to azole antibiotics for the treatment and prevention of VVC.

Objectives: The aim of the study is to identify the success rate of a repeat cycle of induction of labour (IOL) with prostaglandins, and any association between smoking and patient response to prostaglandin. Design: Retrospective cohort study. Setting: Basildon and Thurrock University Hospital, UK. Sample: IOL data from patients at Basildon University Hospital, between 01/01/2021 and 30/03/2021 were included. Methods: Data were retrieved from hospital records and categorised by prostaglandin cycle(s), administration of oxytocin, artificial rupture of membranes (ARM), spontaneous rupture of membranes (SROM), smoking status, patient BMI, age, ethnicity, gestation age, Bishop score, and delivery method (assisted, unassisted, or Caesarean (C-)section). The data were analysed using chi-square, binomial and multinomial logistic regression. Main Outcome Measures: Success rate was interpreted from relative frequencies of delivery method (unassisted, assisted or C-section). Results: Unassisted vaginal delivery (n =121; 48.0%) was the most common outcome with prostaglandin IOL followed by C-section (n = 105 41.7%). Only 10.3% had an assisted vaginal delivery. Of those who had a repeated IOL cycle, 85.7% had a C-section. There was no difference in prostaglandin administration by smoking status or any association between smoking status and mode of delivery in IOL. Conclusion: Repeat cycle of IOL does not enhance the vaginal delivery with only 14.3% unassisted vaginal births. There was no evidence that smoking impacted on response to prostaglandins or method of delivery. Funding: There was no funding for this study. Keywords: artificial rupture of membranes; C-section; repeat induction of labour; spontaneous rupture of membranes; Unassisted vaginal delivery.

In 2022, Monkey pox disease was declared as a Global Health Emergency. With the emergence of an epidemic such as this, it becomes imperative that accurate information is imparted to all the individuals. However, as seen in the case of Covid-19 pandemic, it is evident that people consume most of the information through social media platforms such as Instagram, Facebook, Twitter and others. With this, there is a possibility of an increase in dissemination of misinformation which was very well noted in case of Covid-19 Pandemic. Aims: To analyse the information that is available on Instagram regarding Monkey Pox disease and to determine its accuracy. Methodology: A cross-sectional, observational type of study where total of 522 posts were analysed over a period of two days was done. Top 90 posts from the top six monkey pox related hashtags were analysed on the basis of a proforma made of pre-selected questions via the platform google docs and accordingly the results were calculated. Results showed that, most of the posts are descriptive in nature, and only a few(11.65%) were posted by doctors. Most of them were posted by news or other agencies. Some of the posts were from unverified sources as well(27.65%). Discussion: As witnessed in Covid 19, there is prevalent misinformation when a global health emergency is concerned, attributed to vast access to social media platforms. In order to combat this dissemination of false information, such platforms should be regulated and should operate under guidelines of WHO.

We consider the system of linear equations arisen from the finite element discretization of the distributed optimal control problem with time-periodic parabolic equations. A block alternating splitting iteration (BASI) method is presented for solving the obtained system. We prove that the BASI method is unconditionally convergent. We derive the BASI preconditioner and present an estimation formula for the parameter of the BASI preconditioner. Numerical results are presented to verify the efficiency of both the BASI method and the BASI preconditioner. Comparison with some existing methods are also given.

In materials research involving additive manufacturing (AM)-based techniques for fabrication of a wide variety of materials, the latest trend at present is to focus largely on 3D printing (3DP) of nanoceramics, which at present is highly challenging, from both fundamental and industrial viewpoints inspite of the tremendous versatility offered by these techniques in terms of addressing design complexities [1]-[6]. The two main reasons for the same are: (i) low density and (ii) poor mechanical properties of nanoceramic parts fabricated using 3DP techniques [7]-[9]. The fundamental reason behind the two aforementioned features of 3DP-fabricated nanoceramic parts is the huge extent of microstructural inhomogeneity arising primarily due to variation in cooling rates during 'point by point', 'line by line' or 'layer by layer' deposition methodology followed in 3DP techniques [10]-[16], leading to a number of defects in the microstructure [17], [18]. Moreover, the industrial application of nanoceramic parts manufactured using 3DP techniques, is rather limited, primarily owing to the high manufacturing cost associated with these nanoceramic parts. Although, in the last ten years, there has been a considerable volume of work on 3DP-based techniques for manufacturing ceramic parts with enhanced densities and improved mechanical properties, however, there is limited understanding on the correlation of microstructure of 3DP-fabriated nanoceramic components with the mechanical properties. On the other hand, in the recent decade, the 'correlative' methodology of characterising microstructures from micro to nanoscale, involving a number of different structural and chemical characterisation techniques, for the study of a number of defects ranging from the equilibrium point (or 0-D) to non-equilibrium volume (or 3-D) defects, has been hugely employed in a number of metallic materials [19]-[21]. This has completely revolutionised the understanding of structure-property correlation and microstructural defects in these materials and paved a whole new dimension towards a systematic correlation of structure (ranging from bulk to nano-scale) to a wide range range of properties in these materials. However, in the context of 3DP-fabricated nanoceramic parts, at present, there is hardly report on understanding structure-property correlation using the aforementioned methodology. The present review is aimed to review some of the most commonly used 3DP techniques for the fabrication of nanoceramics and provide an overview of the future perspectives, associated with the necessity towards developing a systematic structure-property correlation through 'correlative' characterisation methodology in these materials.