Unsteady Hybrid (Ag–CuO/Water) Nanofluid Flow and Heat Transfer due to a Stretching Sheet with Variable Temperature

In this paper, the focal aims are (i) to explore the transient boundary-layer flow and heat transfer of an electrically conducting hybrid (Ag–CuO water) nanofluid along a vertical stretching surface (sheet) having non-zero slot velocity at variable temperature, and (ii) to discuss the influences of momentous parameters involved on the heat transfer and skin friction coefficient graphically. The “Tiwari-Das nanofluid model” is used. The central equations (PDEs) are converted into finite difference equations by the powerful Crank Nicolson technique and numerically solved using the Thomas algorithm. The achieved outcomes for a specific case of the challenge are compared with an analytical solution computed using the Laplace transform technique and discovered to be in excellent accord.

Insight into the Dynamics of Water Conveying Silver and Aluminium Oxide Nanoparticles on a Moving Cylinder Subject to Variable Surface Temperature and Lorentz Force

MHD and variable surface temperature are examined numerically in this article to see how they affect the unsteady type natural convection flow of a hybrid nanofluid on a moving vertical cylinder. Nanoparticles of Ag and Al2O3 are considered in the water-based hybrid nanofluid. Using the Crank-Nicolson method, the equations governing flow and heat transport are unravelled. To test the present numerical approach validity, the results are matched to those found in the literature for similar problems and found to be extremely congruent with those findings. Analysis of temperature and velocity portraits, as well as Cf (skin friction coefficient) and Nux (Nusselt number) for each vital parameter, has been illustrated. This study found that by escalating the magnetic parameter, Nux and Cf of Ag–Al2O3/water can be reduced. Also, increasing Gr can be used to augment the Cf and Nux of Ag–Al2O3/water. Further, by increasing δ2, a lower skin friction coefficient and a higher Nusselt number can be achieved. The current findings are useful to the thermal flow processing of magnetic nanomaterials in the metallurgy industries and chemical engineering.

Heart disease detection based on internet of things data using linear quadratic discriminant analysis and a deep graph convolutional neural network

Heart disease is an emerging health issue in the medical field, according to WHO every year around 10 billion people are affected with heart abnormalities. Arteries in the heart generate oxygenated blood to all body parts, however sometimes blood vessels become clogged or restrained due to cardiac issues. Past heart diagnosis applications are outdated and suffer from poor performance. Therefore, an intelligent heart disease diagnosis application design is required. In this research work, internet of things (IoT) sensor data with a deep learning-based heart diagnosis application is designed. The heart disease IoT sensor data is collected from the University of California Irvine machine learning repository free open-source dataset which is useful for training the deep graph convolutional network (DG_ConvoNet) deep learning network. The testing data has been collected from the Cleveland Clinic Foundation; it is a collection of 350 real-time clinical instances from heart patients through IoT sensors. The K-means technique is employed to remove noise in sensor data and clustered the unstructured data. The features are extracted to employ Linear Quadratic Discriminant Analysis. DG_ConvoNet is a deep learning process to classify and predict heart diseases. The diagnostic application achieves an accuracy of 96%, sensitivity of 80%, specificity of 73%, precision of 90%, F-Score of 79%, and area under the ROC curve of 75% implementing the proposed model.

Pharmacometric approach to assist dosage regimen design in neonates undergoing therapeutic hypothermia

BACKGROUND

Therapeutic hypothermia (TH) is the treatment of choice for neonates diagnosed with perinatal asphyxia (PA). Dosing recommendations of various therapeutic agents including antimicrobials were not specifically available for the neonates undergoing TH.

METHODS

A systematic search methodology was used to identify pharmacokinetic (PK) studies of antimicrobials during TH. Antimicrobials with multiple PK studies were identified to create a generalizable PK model. Pharmacometric simulations were performed using the PUMAS software platform to reproduce the results of published studies. A suitable model that could reproduce the results of all other published studies was identified. With the help of a generalizable model, an optimal dosage regimen was designed considering the important covariates of the identified model.

RESULTS

With the systematic search, only gentamicin had multiple PK reports during TH. A generalizable model was identified and the model predictions could match the reported/observed concentrations of publications. Birth weight and serum creatinine were the significant covariates influencing the PK of gentamicin in neonates. A dosage nomogram was designed using pharmacometric simulations to maintain gentamicin concentrations below 10 μg/mL at peak and below 2 μg/mL at trough.

CONCLUSIONS

A generalizable PK model for gentamicin during TH in neonates was identified. Using the model, a dosing nomogram for gentamicin was designed.

IMPACT

Dosing guidelines for antimicrobials during TH in neonates is lacking. This is the first study to identify the generalizable model for gentamicin during TH in neonates. Nomogram, proposed in the study, will aid the clinicians to individualize gentamicin dosing regimen for neonates considering the birth weight and serum creatinine.

COVID-19 presenting as acute transient flaccid limb paralysis

Novel corona virus pandemic in 2020 has created havoc across the world. Since its entry into Indian subcontinent in February 2020, it has become the second most affected country in the world. In this context we wish to share the case of a young man who presented with periodic paralysis was eventually diagnosed to have COVID-19 infection. During this pandemic season, one has to be vigilant and think out of the box to identify COVID-19 infections even among the least suspicious cases.

Hydromagnetic Effects on Hybrid Nanofluid (Cu–Al2O3/Water) Flow with Convective Heat Transfer Due to a Stretching Sheet

In this paper, transient free convective boundary layer flow of a viscous hybrid nanofluid due to a vertical stretching sheet with MHD effects is studied numerically using the Crank Nicolson finite difference numerical technique. To explore the properties of heat transfer and the flow field due to a vertical stretching sheet in the existence of a Lorentz force, two different fluids, specifically Cu–Al2O3/water and Cu/water, are utilized. The results of different physical parameters and the practical quantities of concern that they affect are investigated. According to this article’s results, Cu–Al2O3/water has a superior heat transfer rate than Cu/water in a magnetic field setting. Various other nano mixtures can be attempted to attain the optimal heat transfer rate.

A Community-Based Cross-Sectional Study about the Quality of Life in Postmenopausal Women in Rural Puducherry

BACKGROUND

The aim of this study was to assess the quality of life (QOL) of postmenopausal women, in the rural areas of Puducherry and to find the associated factors.

MATERIALS AND METHODS

A cross-sectional study was done in the rural field practicing area of SLIMS, Puducherry. The sample size was 172 based on the previous study, and simple random sampling technique was used. The women who were receiving hormonal treatment, having chronic illness and those who refused to participate were excluded from the study. The sociodemographic information and menopause-specific QOL questionnaire were used, and data were analyzed using the SPSS 21.

RESULTS

In this study, mean age of the postmenopausal women was 61 ± 7.5 years, 42.4% belonged to socioeconomic status (SES) Class IV. The prevalence of one or more symptoms of vasomotor, psychological, and sexual domains were 23.8%, 87%, and 68%, respectively. We found an association between SES and both vasomotor and psychological symptoms. Furthermore, age and psychological symptoms were associated.

CONCLUSION

The menopause-related symptoms had a negative effect on the QOL of postmenopausal women. The study can help in creating awareness and also in helping in educating women for early identification of the frequent menopausal symptoms.

Profile of Pediatric Chronic Myeloid Leukemia in the Era of Imatinib: A Study from South India

Introduction: Chronic myeloid leukemia (CML), a chronic hematologic malignancy, is rare in pediatric patients. Studies of the tyrosine kinase inhibitor imatinib are required so that uniform guidelines may focus on disease therapy and follow-up for children. We analyzed the clinicohematologic features of the disease, treatment response to imatinib, follow-up measures, and the impact of the disease on the patients and their family. Materials and Methods: All pediatric patients diagnosed with CML and treated and followed-up were studied regarding demographics, clinical features at presentation, and diagnostic profile, including laboratory parameters, peripheral blood smear test, fluorescent in situ hybridization and karyotyping, and reverse-transcriptase polymerase chain reaction for the BCR-ABL fusion gene. Treatment modalities, adverse reactions, remedial measures, assessment at every follow-up visit, patient’s education, parents’ socioeconomic status, and economic and psychological stresses were also evaluated. Results: Six patients were administered upfront therapy with a standard dose of imatinib. Hematological and biochemical parameters were monitored after the drug administration. We assessed the treatment response using molecular detection of the BCR-ABL transcripts. All patients who complied with drug therapy showed a complete molecular response and minimal toxic symptoms. However, parents found it difficult to cope socially and economically. Conclusion: Imatinib mesylate is effective and has a good molecular response, minimal toxicity, and good patient compliance. However, due to its cost, families reacquire financial debt, and the disease creates uncertainty about the child’s future, thereby necessitating psychosocioeconomic support for parents. Changes in the policies of cancer support groups are urgently needed to provide lifelong, lifesaving drugs free of cost.

Preparation and readability assessment of patient information leaflets for diabetic foot ulcers

Context: Patient counseling is the mainstay for prevention and management of diabetic foot ulcer. Hence, patient information leaflet (PIL) can act as an educational material for imparting patient education regarding diabetic foot care for better patient outcome.

Aim: The objective of this study was to develop and to assess the readability of PIL for diabetic foot ulcer.

Materials and Methods: Various online resources such as Patient UK and Micromedex data base were used to prepare PILs on diabetic foot ulcer. Physicians were validated the content of the leaflet. Leaflet was designed and modified according to the physician's suggestions. PILs-readability was checked online by using the website www.readability-score.com and calculated Flesch Reading Ease (FRE) and Flesch-Kincaid grade level (FK-GL). Layout and design features of the PILs were assessed by using Baker Able Leaflets Design (BALD) method.

Results: Readability of the leaflet was assessed by using the FRE and FK-GL scores. After initial assessment leaflets were modified to achieve ideal readability scores. The best FRE score achieved was 69.9 and FK-GL score achieved was 7.1. The BALD score was 27.

Conclusions: PILs prepared had ideal readability score and layout design. The leaflet's estimated FRE and FK-GL scores rate showed that it was fairly easy readable.

Computer Aided Bright Lesion Classification in Fundus Image Based on Feature Extraction

In this paper, a hybrid approach of fundus image classification for diabetic retinopathy (DR) lesions is proposed. Laplacian eigenmaps (LE), a nonlinear dimensionality reduction (NDR) technique is applied to a high-dimensional scale invariant feature transform (SIFT) representation of fundus image for lesion classification. The applied NDR technique gives a low-dimensional intrinsic feature vector for lesion classification in fundus images. The publicly available databases are used for demonstrating the implemented strategy. The performance of applied technique can be evaluated based on sensitivity, specificity and accuracy using Support vector classifier. Compared to other feature vectors, the implemented LE-based feature vector yielded better classification performance. The accuracy obtained is 96.6% for SIFT-LE-SVM.

Preparation, validation and user-testing of pictogram-based patient information leaflets for tuberculosis

INTRODUCTION

Patient education is of paramount importance with regard to the condition of the disease and the treatment given besides lifestyle remodelling in order to get the desired therapeutic outcomes. When verbal information is provided to the patients, they often tend to forget it. Pictorial aids or pictograms, as they are commonly known, are tools that are widely used for imparting knowledge to the patients. The aim of the study is to prepare and validate a Pictogram-based Patient Information Leaflet (P-PILs) on Tuberculosis (TB).

METHODS

P-PILs have been prepared from tertiary, secondary and primary sources. The knowledge-based questions are prepared with respect to the P-PILs. The baseline knowledge of the volunteers and patients has been analyzed before administering the P-PILs by using the validated questionnaire. The post-knowledge of the volunteers and patients has been analyzed after administering the P-PILs (20 minutes) by using the same questionnaire and the user-opinion has also been obtained at the end.

RESULTS

The study results show that the mean scores of the overall user-testing knowledge assessment are found to have improved significantly from the pre-P-PILs administration score of 62.67 to the post-P-PILs administration score of 91. The overall user-opinion about the P-PILs has been found to be good (75%) followed by average (25%).

CONCLUSION

The present study shows that there is significant improvement in the knowledge levels of the patients and volunteers after reading the validated leaflets. The P-PILs are found to be an effective educational tool for TB patients.

An Adult with Haemoptysis: A Rare Case of Congenital Anomaly

A non-smoker adult male presented with haemoptysis of short duration. Chest radiograph (postero-anterior view) suggested an opaque left hemithorax. Further evaluation of lung lesion pointed towards a left lung hypoplasia with absent left pulmonary artery and a right-sided aortic arch (RAA). Both kidneys were enlarged with multiple cysts and thinning of parenchyma. This case describes a unique coexistence RAA and probable autosomal dominant polycystic kidney disease.

Unusual association of Meckel's diverticulum with double appendix - A rare finding

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Duplication of appendix with other congenital anomalies is rare.

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They have clinical and medicolegal significance.

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Surgeons should be aware of these conditions because of the possible clinical implications.

INTRODUCTION

Appendix duplication is an extremely rare congenital anomaly that is seen in 0.004–0.009% of appendectomy specimens. Duplicated appendix may be associated with number of congenital anomalies.

PRESENTATION OF CASE

In this case report, we are presenting a rare case of duplicated vermiform appendix with a co-existing Meckel's diverticulum.

DISCUSSION

Anomalies of appendix are rare and duplication of vermiform appendix is extremely rare. In 1936, Cave classified appendiceal duplication for the first time which was modified by Wallbridge in 1963 into three types. Concomitant malformations or duplications of the large intestine or the genitourinary system may be present, especially in types B1 and C probably due to their similar embryological origin. Here we are presenting a very rare case report of type B1 appendix anomaly associated with Meckel's diverticulum.

CONCLUSION

Surgeons should be aware of these conditions because of the possible clinical implications.

Transient nanofluid flow and heat transfer from a moving vertical cylinder in the presence of thermal radiation: Numerical study

A mathematical model is presented for unsteady free convective flow and heat transfer of a viscous nanofluid from a moving vertical cylinder in the presence of thermal radiation. A range of nanofluids containing nanoparticles of Al2O3, Cu, TiO2 and Ag with nanoparticle volume fraction range less than or equal to 0.04 are considered. The governing partial differential equations with the corresponding initial and boundary conditions are solved numerically by a robust, well-tested, implicit finite difference scheme of Crank–Nicolson type, which is efficient, unconditionally stable and convergent. The obtained results are benchmarked with previously published work for special cases of the problem in order to access the accuracy of the numerical method and found to be in excellent agreement. The influence of significant parameters such as nanoparticle volume fraction, nanofluid type, thermal conduction–radiation parameter and thermal Grashof number on the flow and heat transfer characteristics is discussed. This study is relevant to high-temperature nanofluid materials’ processing, chemical engineering coating operations exploiting nanomaterials and so on.

Diagnostic utility of adenosine deaminase in exudative pleural effusions

Objective:

To determine the diagnostic utility of adenosine deaminase (ADA) in exudative pleural effusions of different etiologies.

Setting and Design:

It was an observational study conducted at a tertiary care teaching institute.

Materials and Methods:

Of a total of 171 pleural fluid samples, 122 were found to be exudates and were included in the study. Pleural fluid ADA was done for all included patients. Pleural fluid ADA ≥40 U/l was taken as diagnostic cut off for TB effusion.

Statistical Analysis:

Sensitivity, specificity positive and negative predictive value of pleural fluid ADA for diagnosing TB was calculated by using clinical calculator – 1, Richard Lowry 2001-2013.

Results:

There were 171 patients with pleural effusion, out of which 122 (71.8%) were found to be exudative and were studied further. There were 49 (40.1%), 36 (29.5%) and 33 (27%) cases of TB, malignancy and para pneumonic effusion respectively, whereas 4 (3.3%) cases remained undiagnosed. Median ADA values for TB, malignancy and para pneumonic effusion were 55.8 U/l (range 9.7-756 U/l), 18 U/l (6.5-81 U/l) and 25 U/l (3.4-172 U/l) respectively. Pleural fluid ADA >40U/l yielded 85.7% sensitivity, 80.8% specificity, 75% positive predictive value and 89.5% negative predictive value.

Conclusion:

Pleural fluid ADA remains useful in diagnosing tuberculosis pleural effusion. The median ADA for TB effusion in present cohort was 51.8 IU/ml. Pleural fluid ADA of 40 U/L yielded 89.5% negative predictive value and 75% positive predictive value. Pleural fluid ADA is cost effective and good screening test for diagnosis of TB.

Paraquat - A deadly poison: Report of a case and review

Paraquat is a bipyridilium herbicide used widely in our country and is a highly toxic compound. A 16-year-old female patient was admitted to the emergency department of our tertiary care hospital in South India with the history of alleged consumption of paraquat poison. Since there is dearth of high quality evidence- based treatment for this poisoning, different treatment modalities have been tried to manage patient's condition. In this case, none of the strategies could work well. Most of the patients reported with paraquat intoxication are from agricultural background; usually such patients cannot afford the treatment expenses. This paper presents a fatal case of acute poisoning with paraquat who succumbed to acute respiratory distress syndrome (ARDS).

Drug-drug interactions in hospitalized cardiac patients

Drug–drug interactions (DDIs) are defined as two or more drugs interacting in such a manner that the effectiveness or toxicity of one or more drugs is altered. DDI in patients receiving multidrug therapy is a major concern. The aim of the present study was to assess the incidence and risk factors of DDIs in patients admitted in cardiology unit of a teaching hospital. A prospective, observational study was carried out for a period of 3 months (April–July 2009). During the study period, a total of 600 prescriptions were analyzed and it was found that 88 patients had at least one DDI. The percentage of DDIs was higher in females compared to males (56.82% vs. 43.18%). DDIs were observed more in the age group of 60 years and above (57.96). Patients with more than 10 prescribed drugs developed DDIs more frequently [58 (65.91%)]. Heparin [55 (62.25%)] and aspirin [42 (47.72%)] were the most common drugs responsible for DDIs. Bleeding was the commonest clinical consequence [76 (86.63%)] found in this study population. On assessment of severity of DDIs, majority of the cases were classified as moderate in severity (61.36%). Aging, female gender and increase in concurrent medications were found to be associated with increased DDIs. Patients having these risk factors can be actively monitored during their stay in the cardiology department to identify DDIs.

Tissue is issue: Not all masses are tumors

Background:

Tuberculosis can disguise itself in any form. Endobronchial tuberculosis usually presents in young adults. Endobronchial tumor-like presentation of tuberculosis (EBTB) is very rare and often mistaken as a malignancy. Diagnosis is usually delayed, as clinical and radiological features are non-specific. Direct implantation of tubercle bacilli into the bronchus, or an contiguous spread, leads to EBTB. Bronchoscopic biopsy and culture are the best modality for diagnosis.

Care Reports:

Clinical and radiological presentations of all cases were similar and one of them had rib erosion on bone scan. All cases were proven to be tuberculosis by histopathology and culturing mycobacterium tuberculosis. All of them are diagnosed as endobronchial tuberculosis, either histopathology or by culture that grew mycobacterium tuberculosis, and were successfully treated with anti-tuberculous treatment alone, without residual scarring.

Conclusions:

Tuberculosis should be considered in the differential diagnosis of endobronchial mass lesions in the appropriate clinical setting since this is an uncommon presentation for which invasive procedures are needed to establish the diagnosis. Initially, it was mistaken as a malignancy and there was delay in diagnosis and initiation of treatment. Prompt treatment is crucial to avert residual bronchostenosis.

SEMG for Human Computer Interface Using Ann to Navigate Wheel Chair

This paper presents an approach to identify hand gestures with muscle activity separated from electromyogram (EMG) using Back Propagation analysis with the goal of using hand gestures for human-computer interaction. While there are a number of previous reported works where EMG has been used to identify movement, the limitation of these works is that the systems are suitable for gross actions and when there is one prime-mover muscle involved. This paper reports overcoming the difficulty by using independent component analysis to separate muscle activity from different muscles and classified using back propagation neural networks. The experimental results show that the system was accurately able to identify the hand gesture using this technique (95%). The advantage of this system is that it is easy to train one to use it and can easily be implemented in real time.

Whole lung lavage: the salvage therapy for pulmonary alveolar proteinosis

A 53-year-old school teacher presented with progressive exertional breathlessness and dry cough of three months duration. His diagnosis was confirmed as pulmonary alveolar proteinosis on open lung biopsy. In about three months, the disease progressed to life threatening respiratory failure. He was subjected to whole lung lavage (WLL) as a salvage therapy. The technical details of WLL performed on this patient are described. At six months follow up, he was clinically and functionally stable and leading a near normal life.

Length of insertion for pulmonary artery catheters to locate different cardiac chambers in patients undergoing cardiac surgery

BACKGROUND

Although, guidelines related to length of insertion of a pulmonary artery catheter to reach a particular cardiac chamber are available, these are not backed by clinical studies. We measured the length of insertion of pulmonary artery catheters to locate the right ventricle, pulmonary artery and pulmonary capillary wedge positions in 300 adult patients undergoing elective cardiac surgery.

METHODS

The pulmonary artery catheters were inserted using a standard technique through the right internal jugular vein. The right ventricle, pulmonary artery and wedge position of the catheter were confirmed by the characteristic waveforms, and the length of insertion to these points was measured.

RESULTS

The right ventricle was reached at 24.6 (3) cm (95% CI 24.2-24.9 cm), pulmonary artery at 36 (4) cm (95% CI 35.6-36.5 cm) and wedge position at 42.8 (5.7) cm (95% CI 42.2-43.5 cm). The length of catheter to reach the right ventricle, pulmonary artery and wedge position was significantly more in patients undergoing valve surgery as compared with those undergoing coronary artery bypass grafting [26 (3.8) and 24 (2.5) cm; 38.5 (4.6) and 35 (3.2) cm; and 47.8 (6.9) and 41.2 (4.1) cm, respectively, P<0.001]. The length of insertion to reach pulmonary artery and pulmonary capillary wedge position was directly related to height of the patient (Pearson's correlation 0.157 and 0.15, respectively).

CONCLUSIONS

We have provided the norms related to length of insertion of pulmonary artery catheter, which should be useful in accurate placement of the catheter and minimize complications related to coiling of the catheter.

Risk factors predicting operative mortality in perforated peptic ulcer disease

Following the introduction of H2-blockers and proton pump inhibitors, there has been a sharp decrease in elective peptic ulcer surgery. However, emergency operations for complications such as perforation are on the rise. This study was undertaken to review the factors which determine mortality following emergency surgery for peptic ulcer perforation. A prospective study of all patients who underwent surgery at our institute for peptic ulcer perforation between September 1999 and August 2001 was carried out. One hundred seventy-four patients underwent surgery for perforated peptic ulcer. Risk of death was related to age more than 60 years, shock at presentation, delay more than 24 hours prior to surgery and size of perforation more than 5 mm. Perforated peptic ulcer disease remains a frequent clinical problem associated with a significant postoperative mortality.