Search results for: Sameer Dixit

Authors: Ahmed Sameer El Khatib

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The aim of the present paper is to examine the revenue efficiency of the Indonesian Islamic banking sector. The study also seeks to investigate the potential internal (bank specific) and external (macroeconomic) determinants that influence the revenue efficiency of Indonesian domestic Islamic banks. We employ the whole gamut of domestic and foreign Islamic banks operating in the Indonesian Islamic banking sector during the period of 2009 to 2018. The level of revenue efficiency is computed by using the Data Envelopment Analysis (DEA) method. Furthermore, we employ a panel regression analysis framework based on the Ordinary Least Square (OLS) method to examine the potential determinants of revenue efficiency. The results indicate that the level of revenue efficiency of Indonesian domestic Islamic banks is lower compared to their foreign Islamic bank counterparts. We find that bank market power, liquidity, and management quality significantly influence the improvement in revenue efficiency of the Indonesian domestic Islamic banks during the period under study. By calculating these efficiency concepts, we can observe the efficiency levels of the domestic and foreign Islamic banks. In addition, by comparing both cost and profit efficiency, we can identify the influence of the revenue efficiency on the banks’ profitability.

Keywords: Islamic Finance, Islamic Banks, Revenue Efficiency, Data Envelopment Analysis

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Authors: Tapan Upadhyay, Aqib Siddiqui, Sameer Khan

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Railway crossing system in India is a manually operated level crossing system, either manned or unmanned. The main aim is to protect pedestrians and vehicles from colliding with trains, which pass at regular intervals, as India has the largest and busiest railway network. But because of human error and negligence, every year thousands of lives are lost due to accidents at railway crossings. To avoid this, we suggest a solution, by using Programmable Logical Controller (PLC) based automatic system, which will automatically control the barrier as well as roadblocks to stop people from crossing while security warning is given. Often people avoid security warning, and pass two-wheelers from beneath the barrier, while the train is at a distance away. This paper aims at reducing the fatality and accident rate by controlling barrier and roadblocks using sensors which sense the incoming train and vehicles and sends a signal to PLC. The PLC in return sends a signal to barrier and roadblocks. Once the train passes, the barrier and roadblocks retrieve back, and the passage is clear for vehicles and pedestrians to cross. PLC’s are used because they are very flexible, cost effective, space efficient, reduces complexity and minimises errors. Supervisory Control And Data Acquisition (SCADA) is used to monitor the functioning.

Keywords: level crossing, PLC, sensors, SCADA

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Authors: Rasikha Ramanand, Priyanka Dixit

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Background: Continuum of maternal care which includes antenatal care, delivery care and postnatal care aids in averting maternal deaths. The objective of this paper is to identify the association between previous experiences of child death on Continuum of Care (CoC) of recent child. Further, the study aimed at understanding where the drop-out rate was high in the continuum. Methods: The study was based on the Nation-wide District Level Household and Facility Survey (DLHS-4) conducted during 2012-13, which provides information on antenatal care, delivery care, percentage of women who received JSY benefits, percentage of women who had any pregnancy, delivery, the place of delivery etc. The sample included women who were selected from the non-EAG states who delivered at least two children. The data were analyzed using SPSS 20.Binary Logistic regression was applied to the data in which the Continuum of Care (CoC) was the dependent variable while the independent variables were entered as the covariates. Results: A major finding of the study was the antenatal to delivery care period where the drop-out rates were high. Also, it was found that a large proportion of women did not receive any of the services along the continuum. Conclusions: This study has clearly established the relationship between previous history of child loss and continuum of maternal care.

Keywords: antenatal care, continuum of care, child loss, delivery care, India, maternal health care, postnatal care

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Authors: Vikas Sharma, V. K. Dixit

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Anacyclus pyrethrum (A. pyrethrum) has been used as Vajikaran Rasayana (aphrodisiac) in traditional Indian ayurvedic medicine to treat male sexual dysfunction, including infertility. Aphrodisiac activity may be due to an increase in the production or effect of androgens, so this study sought to evaluate the androgenic and spermatogenic potential of the alkylamide-rich ethanol solution extract. Male Wistar strain rats weighing between 150 and 180 g were completely randomized divided into five groups. The ethanol solution extract of A. pyrethrum was administered to groups of rats in 50, 100, and 150 mg/kg doses for a period of 28 days, and the action was compared with control and testosterone-treated rats. Thirteen N-alkylamides were detected in the extract by using HPLC/UV/electrospray ionization mass spectrometry method. Extract administration at all the doses produced significant increase in body weight, sperm count, motility, and viability along with serum testosterone, luteinizing hormone, and follicle-stimulating hormone concentrations. Histoarchitecture of testis revealed increased spermatogenic activities. Seminal fructose content was also significantly increased after 28 days of treatment. Our results suggest that the ethanol solution extract of the roots of A. pyrethrum has androgenic potential and may improve male fertility by enhancing spermatogenesis.

Keywords: N-alkylamides, testosterone, Anacyclus pyrethrum, androgen

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Authors: Tripta Dixit, Smita Sahu, William Selvamurthy, Sadhana Srivastava

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India is battling with the issues of accessibility, affordability and availability of quality health to the masses. Indian medical heritage which dated back to 3000 BC unveils the rich knowledge pool which has undergone a perceptible change over years, such as eradication of many communicable diseases, increasing individual awareness of quality health and import driven medical device market etc. Despite a slew of initiatives the holistic slogan of ‘health for all’ remains elusive and a concern for the nation. The 21st-century projects a myriad of challenges like cultural diversity, large population, demographic dividend and geographical segmentation leading to varied needs of people as per their regional conditions of climate, disease prevalence, nutrition and sanitation. But these challenges are also opportunities for the development of indigenous, low cost and accessible technologies to tackle them. This requires reinforcing the potential of indigenous technologies in coordination with prevailing health issues in various regions of country. This paper emphasis on the strategy for exploring the indigenous technologies with entrusted up-scaling to meet the diverse needs of the people. This review proposes to adopt technology transfer as a strategy to establish a vibrant ecosystem for identifying and up-scaling the indigenous medical technologies with diligent hand-holding for public health.

Keywords: health, indigenous, medical technology, technology transfer

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Authors: Ankur Dixit, Hiroaki Wagatsuma

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The crack detection on a concrete bridge is an important and constant task in civil engineering. Chronically, humans are checking the bridge for inspection of cracks to maintain the quality and reliability of bridge. But this process is very long and costly. To overcome such limitations, we have used a drone with a digital camera, which took some images of bridge deck and these images are processed by morphological component analysis (MCA). MCA technique is a very strong application of sparse coding and it explores the possibility of separation of images. In this paper, MCA has been used to decompose the image into coarse and fine components with the effectiveness of two dictionaries namely anisotropic diffusion and wavelet transform. An anisotropic diffusion is an adaptive smoothing process used to adjust diffusion coefficient by finding gray level and gradient as features. These cracks in image are enhanced by subtracting the diffused coarse image into the original image and the results are treated by Sobel edge detector and binary filtering to exhibit the cracks in a fine way. Our results demonstrated that proposed MCA framework using anisotropic diffusion followed by Sobel operator and binary filtering may contribute to an automation of crack detection even in open field sever conditions such as bridge decks.

Keywords: anisotropic diffusion, coarse component, fine component, MCA, Sobel edge detector and wavelet transform

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Authors: Kshitij Bhardwaj, R.K. Trivedi, Shipra Dixit

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We used biological detoxification method that converts toxic residue waste of Jatropha curcas oil seeds (non edible oil seed) into industrial bio-products and animal feed material. Present study describes the complete degradation of phorbol esters by Aspergillus Niger strain during solid state fermentation (SSF) of deoiled Jatropha curcas seed cake. Phorbol esters were completely degraded in 15 days under the optimized SSF conditions viz deoiled cake 5.0 gm moistened with 5.0 ml distilled water; inoculum 2 ml of overnight grown Aspergillus niger; incubated at 30◦ C, pH 7.0. This method simultaneously induces the production of Protease enzyme by Aspergillus Niger which has high potential to be used in feedstuffs .The maximum Protease activities obtained were 709.16 mg/ml in Jatropha curcas oil seed cake. The protein isolate had small amounts of phorbol esters, phytic acid, and saponin without any lectin. Its minimum and maximum solubility were at pH 4.0&12.0. Water and oil binding capacities were 3.22 g water/g protein and 1.86 ml oil/g protein respectively.Emulsion activity showed high values in a range of basic pH. We concluded that Jatropha Curcas seed cake has a potential to be used as a novel source of functional protein for food or feed applications.

Keywords: solid state fermentation, Jatropha curcas, oil seed cake, phorbol ester

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Authors: Abhishek Dixit, Sandip S. Sathe, Chandan Mahanta

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The Siang river originates in Angsi glacier in southern Tibet (there known as the Yarlung Tsangpo). After traveling through Indus-Tsangpo suture zone and deep gorges near Namcha Barwa peak, it takes a south-ward turn and enters India, where it is known as Siang river and becomes a major tributary of the Brahmaputra in Assam plains. In this study, we have analyzed the bed sediment of the Siang river at two locations (one at extreme upstream near the India-China border and one downstream before Siang Brahmaputra confluence). We have also sampled bed sediment at the remote location of Yammeng river, an eastern tributary of Siang. The magnetic hysteresis properties show the combination of paramagnetic and weak ferromagnetic behavior with a multidomain state. Moreover, curie temperature analysis shows titanomagnetite solid solution series, which is causing the weak ferromagnetic signature. Given that the magnetic mineral was in a multidomain state, the presence of Ti, Fe carrying heave mineral, may be inferred. The Chemical index of alteration shows less weathered sediment. However, the Yammeng river sample being close to source shows fresh grains subjected to physical weathering and least chemically alteration. Enriched Ca and K and depleted Na and Mg with respect to upper continental crust concentration also points toward the less intense chemical weathering along with the dominance of calcite weathering.

Keywords: bed sediment, magnetic properties, Siang, weathering

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Authors: Nirupama Dixit, Anyaa Mittal, Neeru Sood

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Alzheimer’s disease (AD) is a progressive form of dementia, contributing to up to 70% of cases, mostly observed in elderly but is not restricted to old age. The pathophysiology of the disease is characterized by specific pathological changes in brain. The changes (i.e. accumulation of metal ions in brain, formation of extracellular β-amyloid (Aβ) peptide aggregates and tangle of hyper phosphorylated Tau protein inside neurons) damage the neuronal connections irreversibly. The current issues in improvement of life quality of Alzheimer's patient lies in the fact that the diagnosis is made at a late stage of the disease and the medications do not treat the basic causes of Alzheimer's. The targeted delivery of drug through the blood brain barrier (BBB) poses several limitations via traditional approaches for treatment. To overcome these drug delivery limitation, nanoparticles provide a promising solution. This review focuses on current strategies for efficient targeted drug delivery using nanoparticles and improving the quality of therapy provided to the patient. Nanoparticles can be used to encapsulate drug (which is generally hydrophobic) to ensure its passage to brain; they can be conjugated to metal ion chelators to reduce the metal load in neural tissue thus lowering the harmful effects of oxidative damage; can be conjugated with drug and monoclonal antibodies against BBB endogenous receptors. Finally this review covers how the nanoparticles can play a role in diagnosing the disease.

Keywords: Alzheimer's disease, β-amyloid plaques, blood brain barrier, metal chelators, nanoparticles

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Authors: Sujata Sethi, Pawan Kumar, Sameer Aggarwal

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Depression and anxiety are of significant concern in youth with type 1 diabetes mellitus (T1DM) and these are correlated with glycemic control in multiple ways. The extent of depression and anxiety in children with T1DM remains poorly studied in India. The index study aimed to find the prevalence of depression and anxiety and their correlation with HbA1c (glycated hemoglobin) levels in children with T1DM. Material and methods: This study was a cross-sectional study carried out on a purposive sample of 45 children with T1DM. Depressive symptoms were assessed using Children’s Depression Rating Scale-Revised (CDRS-R) and anxiety symptoms were assessed using Spence Children’s Anxiety Scale (SCAS). Glycated hemoglobin (HbA1c) levels of all the participants were recorded. Results: 43 out of 45 children were analyzed as HbA1c status for two was not known. 48.8% were females. Mean age was 12.95+2.04. The average duration of diabetes was 3.63+1.82. Mean CDRS-R score was 41.6+12.25 and mean SCAS score was 33.07+12.29. Mean recording of HbA1c level was 7.90+1.51. 27 (62.8%) out of 43 participants had abnormal scores on CDRS-R and 24 (55.8%) out of 43 had abnormal scores on SCAS. The correlation coefficient between HbA1c levels and the CDRS-R score came out to be 0.57 and between HbA1c and SCAS, it was 0.53. Both correlations were significant with the p-value of < 0.02. Conclusion: Children with T1DM have high co-morbidity of depression and anxiety which is significantly correlated with the HbA1c levels. Thus, it becomes important to screen the patients for depression and anxiety for better outcomes.

Keywords: anxiety, depression, HbA1c, T1DM

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Authors: Areej Almalkawi, Sameer Hamadna, Parviz Soroushian, Nalin Darsana

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The work on indigenous binders in this paper focused on the following indigenous raw materials: red clay, red lava and pumice (as primary aluminosilicate precursors), wood ash and gypsum (as supplementary minerals), and sodium sulfate and lime (as alkali activators). The experimental methods used for evaluation of these indigenous raw materials included laser granulometry, x-ray fluorescence (XRF) spectroscopy, and chemical reactivity. Formulations were devised for transforming these raw materials into alkali aluminosilicate-based hydraulic cements. These formulations were processed into hydraulic cements via simple heating and milling actions to render thermal activation, mechanochemical and size reduction effects. The resulting hydraulic cements were subjected to laser granulometry, heat of hydration and reactivity tests. These cements were also used to prepare mortar mixtures, which were evaluated via performance of compressive strength tests. The measured values of strength were correlated with the reactivity, size distribution and microstructural features of raw materials. Some of the indigenous hydraulic cements produced in this reporting period yielded viable levels of compressive strength. The correlation trends established in this work are being evaluated for development of simple and thorough methods of qualifying indigenous raw materials for use in production of indigenous hydraulic cements.

Keywords: one-part geopolymer cement, aluminosilicate precursors, thermal activation, mechanochemical

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Authors: Mohammed G. Alotaibi, Sameer Albahkaly, Salwa M. Bahkali, Abdullah M. Alghamdi, Raseel S. Alswidan, Maha Bin Shafi, Sarah Almaiman

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Introduction: Rhinitis is common in Saudi Arabia. Therefore, our study was designed to evaluate the prevalence, triggering factors, severity and progression of rhinitis during pregnancy. Methods: Prospective cross-sectional study was conducted in eight governmental and private medical centers in Riyadh, Saudi Arabia, during June and July 2014. Validated Arabic language self-administered questionnaire was used. Sample size of 260 Saudi pregnant women was calculated by Raosoft sample size calculator. Random sampling was achieved by choosing one and skipping every five patients in the clinic list. Data were coded and entered manually into spreadsheets then transferred to SPSS statistical package version 16.0 for Windows. Consent, Privacy and confidentiality of information were assured. Results: Pregnancy rhinitis was reported 31.2% (CI 25.6 - 37.2%). Symptoms arising in first trimester appeared in 79.2% of PR cases and mostly worsen. The most prevalent symptoms were nasal pruritis (67.5%), followed by sneezing (57.1%), congestion (50.6%), and post nasal drip (46.7%). The major triggering factor was dust (71.4%), followed by Tobacco/Shisha smoke (57.6%) and perfume(47%). Preexisting allergic diseases were markedly associated with developing pregnancy rhinitis. Conclusion: Rhinitis during pregnancy manifested in one third of Saudi pregnant ladies. Nasal pruritus was the most common symptom and dust was the widespread triggering factor.

Keywords: allergy, pregnancy, Rhinitis, sneezing

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Authors: B. A. Parate, K. D. Deodhar, V. K. Dixit, V. V. Rao

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This article outlines the ballistics of main seat ejection cartridges for aircraft application. The ballistics of main seat ejection cartridges plays a vital role during the ejection of the pilot in an emergency. The ballistic parameters such as maximum pressure, time is taken to reach the maximum pressure, and time required to reach half the maximum pressure contributes to the spinal injury of the pilot. Therefore, the evaluations of these parameters are very critical during various stages of development. Elaborate testing was carried out for main seat ejection cartridges on seat ejection tower (SET) at different operating temperatures considering physiological limits. As these trials are cumbersome in nature, a vented vessel (VV) testing facility was devised to lay down the performance parameters at hot and cold temperature conditions. Single base (SB) propellant having hepta-tubular configuration is selected as the main filling. Gun powder plays the role of a booster based on ballistic requirements. The evaluation methodology of various performance parameters of main seat ejection cartridges is explained in this paper. Physiological parameters such as maximum seat ejection velocity, acceleration, and rate of rising of acceleration are also experimentally determined on seat ejection tower. All the parameters are observed well within physiological limits. This paper addresses the internal ballistic of main seat ejection cartridges, propellant selection, its calculation, and evaluation of various performance parameters for an aircraft application.

Keywords: ballistics of seat ejection, ejection seat, gas generator, gun propulsion, main seat ejection cartridges, maximum pressure, performance parameters, propellant, progressive burning and vented vessel

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Authors: Tripta Dixit, Smita Sahu, William Selvamurthy, Sadhana Srivastava

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The translation of healthcare technologies is an expensive, complex affair, current healthcare challenges in Asian countries and their efforts to meet Millennium Development Goals (MDGs), necessitates continuous technology advancement to save countless lives, improve the quality of life and for socio-economic development. India’s consistently improving global innovation index (57) demonstrates its innovation potential, but access to health care is asymmetric and lacks priority in India. Therefore, there is utmost need of a robust translation system for point-of-care (POC) solutions, inexpensive, low-maintenance, reliable, and easy-to-use diagnostic technologies. Few cases of POC technologies viz. Elisa based diagnostic kits for regional viral disease, a device for detection of cancerous lesions were studied to understand the process and challenges involved in their translation. Accordingly, the entire translation ecosystem was summarized proposing a nexus of various actors such as technology developer, technology transferor technology receiver, funding entities, government/regulatory bodies and their effect on translation of different medical technologies. This study highlights the role and concerns pertaining to these actors for POC such as unsystematic and unvalidated research roadmap, low profit preposition, unfocused approach of up-scaling, low market acceptability and multiple window regulatory framework, etc. This provides an opportunity to devise solutions to overcome problem areas in translation path.

Keywords: healthcare technologies, point-of-care solutions, public health, translation

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Authors: Savita Dixit

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Rutin is the bioactive flavonoid isolated from the straw part of Triticum aestivum and possess various pharmacological applications. The aim of this study is to evaluate the chemopreventive potential of rutin in an experimental skin carcinogenesis mice model system. Skin tumor was induced by topical application of 7, 12-dimethyl benz(a) anthracene (DMBA) and promoted by croton oil in Swiss albino mice. To assess the chemopreventive potential of rutin, it was orally administered at a concentration of (200 mg/kg and 400 mg/kg body weight) continued three times weekly for 16th weeks. The development of skin carcinogenesis was assessed by histopathological analysis. Reductions in tumor size and cumulative number of papillomas were seen due to rutin treatment. Average latent period was significantly increased as compared to carcinogen-treated control. Rutin produced a significant decrease in the activity of serum enzyme serum glutamate oxalate transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), alkaline phosphatase (ALP) and bilirubin when compared with the control. They significantly increased the levels of enzyme involved in oxidative stress glutathione (GSH), superoxide dismutase (SOD) and catalase. The elevated level of lipid peroxidase in the control group was significantly inhibited by rutin administration. The results of the present study suggest the chemopreventive effect of rutin in DMBA and croton oil-induced skin carcinogenesis in swiss albino mice and one of the probable reasons would be its antioxidant potential.

Keywords: chemoprevention, papilloma, rutin, skin carcinogenesis

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Authors: Priyanka Dixit

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Reproductive health problem is an important public health issue in most of the developing countries like India. It is a common problem in India for women in the reproductive age group to suffer from reproductive illnesses and not seek care. Existing literatures tell us very little about the several dimensions of reproductive morbidity. In addition the general perception says, metros have better medical infrastructure, so its residents should lead a healthier life. However some of the studies reveal a very different picture. Therefore, the present study is conducted with the specific objectives to find out the prevalence of reproductive health problem and treatment seeking behavior of currently married women in four metro cities in India namely; Mumbai, Delhi, Chennai and Kolkata. In addition, this paper also examines the effect of socio-economic and demographic factors on self-reported reproductive health problems. Bi-variate and multivariate regression have been applied to achieve the proposed objectives. Study is based on National Family Health Survey 2015-16 data. The analysis shows that the prevalence of any reproductive health problem among women is the highest in Mumbai followed by Delhi, Chennai, and Kolkata. A bulk of women in all four metro cities has reported abdominal pain, itching and burning sensation as the major problems while urinating. However, in spite of the high prevalence of reproductive health problems, a huge proportion of such women in all these cities do not seek any advice or treatment for these problems. This study also investigates determinants that affect the prevalence of reproductive health problem to policy makers plan for proper interventions for improving women’s reproductive health.

Keywords: reproductive health, India, national family health survey-4, city

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Authors: Rajendra N. Ghosh, Paramjeet Singh, Niranjan Khandelwal, Sameer Vyas, Pratibha Singhi, Naveen Sankhyan

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Background: Tuberculoma and neurocysticercosis (NCC) are two most common intracranial infections in developing country. They often simulate on neuroimaging and in absence of typical imaging features cause significant diagnostic dilemmas. Differentiation is extremely important to avoid empirical exposure to antitubercular medications or nonspecific treatment causing disease progression. Purpose: Better characterization and differentiation of CNS tuberculoma and NCC by using morphological and multiple advanced functional MRI. Material and Methods: Total fifty untreated patients (20 tuberculoma and 30 NCC) were evaluated by using conventional and advanced sequences like CISS, SWI, DWI, DTI, Magnetization transfer (MT), T2Relaxometry (T2R), Perfusion and Spectroscopy. rCBV,ADC,FA,T2R,MTR values and metabolite ratios were calculated from lesion and normal parenchyma. Diagnosis was confirmed by typical biochemical, histopathological and imaging features. Results: CISS was most useful sequence for scolex detection (90% on CISS vs 73% on routine sequences). SWI showed higher scolex detection ability. Mean values of ADC, FA,T2R from core and rCBV from wall of lesion were significantly different in tuberculoma and NCC (P < 0.05). Mean values of rCBV, ADC, T2R and FA for tuberculoma and NCC were (3.36 vs1.3), (1.09x10⁻³vs 1.4x10⁻³), (0.13 x10⁻³ vs 0.09 x10⁻³) and (88.65 ms vs 272.3 ms) respectively. Tuberculomas showed high lipid peak, more choline and lower creatinine with Ch/Cr ratio > 1. T2R value was most significant parameter for differentiation. Cut off values for each significant parameters have proposed. Conclusion: Quantitative MRI in combination with conventional sequences can better characterize and differentiate similar appearing tuberculoma and NCC and may be incorporated in routine protocol which may avoid brain biopsy and empirical therapy.

Keywords: advanced functional MRI, differentiation, neurcysticercosis, tuberculoma

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Authors: Sameer Jung Karki, Gokhan Saygili

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The allowable bearing capacity of foundation systems is determined by applying a factor of safety to the ultimate bearing capacity. Conventional ultimate bearing capacity calculations routines are based on deterministic input parameters where the nonuniformity and inhomogeneity of soil and site properties are not accounted for. Hence, the laws of mathematics like probability calculus and statistical analysis cannot be directly applied to foundation engineering. It’s assumed that the Factor of Safety, typically as high as 3.0, incorporates the uncertainty of the input parameters. This factor of safety is estimated based on subjective judgement rather than objective facts. It is an ambiguous term. Hence, a probabilistic analysis of the bearing capacity of an isolated footing on a clayey soil is carried out by using the Monte Carlo Simulation method. This simulated model was compared with the traditional discrete model. It was found out that the bearing capacity of soil was found higher for the simulated model compared with the discrete model. This was verified by doing the sensitivity analysis. As the number of simulations was increased, there was a significant % increase of the bearing capacity compared with discrete bearing capacity. The bearing capacity values obtained by simulation was found to follow a normal distribution. While using the traditional value of Factor of safety 3, the allowable bearing capacity had lower probability (0.03717) of occurring in the field compared to a higher probability (0.15866), while using the simulation derived factor of safety of 1.5. This means the traditional factor of safety is giving us bearing capacity that is less likely occurring/available in the field. This shows the subjective nature of factor of safety, and hence probability method is suggested to address the variability of the input parameters in bearing capacity equations.

Keywords: bearing capacity, factor of safety, isolated footing, montecarlo simulation

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Authors: Diab Z., Hamad A., Dixit A., Al-Rikabi M., Keshaverzi F.

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Introduction: According to the NICE guidelines, 2020Prasugrel is the recommended first line treatment in adults with acute coronary syndromes (ACS) in patients with ST-segment-elevation myocardial infarction (STEMI), defined as ST elevation or new left bundle branch block on ECG , that cardiologists intend to treat with primary percutaneous coronary intervention (PCI). The current literature suggests that this is largely due to safety and efficacy, and cost effectiveness. We wanted to do an audit to examine the adherence of the MRI hospital with guidelines in using prasugrel as first-line therapy in patients with STEMI and undergoing PPCI. AIM: To examine the adherence of the MRI hospital with guidelines in using prasugrel as first-line therapy in patients with STEMI and undergoing PPCI Methods: We looked at the patients presented to MRI during1^st of January 2022 to 28th February 2022. We included all the people who were above 18 and were brought to the hospital through the PPCI pathway and diagnosed as ACS and underwent PPCI. We excluded Patients who were brought to the hospital through the PPCI pathway and underwent coronary angiography and their diagnosis was found other than STEMI or if the outcome was death before discharge or they were above age >75 (as per guideline increase bleeding risk of prasugrel in a person aged 75 or older). Results: The total number of patients was 100. There were a total of seventy patients who had STEMI and fit the criteria for inclusion. Out of these, only 72.9% (51) were given Prasugrel as a first line. Seventeen (17) 24.3% STEMI patients were candidates for prasugrel as first-line therapy but were instead offered (clopidogrel/ticagrelor). Two 2 (2.9%) STEMI patients were not given prasugrel as first-line therapy because of C/I (CVA) or the use of anticoagulant Nine 9 (9%) of them died before discharge. Eleven 11 (11%) were above the age of 75. Ten 10 (10%) of patients had a diagnosis other than STEMI. Conclusions and recommendations: Our audit has shown the need to increase awareness amongst staff re: the first line use of Prasugrel as per NICE guidelines. We aim to arrange awareness sessions for staff and increase visibility of the guidelines for the staff to encourage them to adhere to the guideline. Further research is needed to find the optimum treatment in patients above 75.

Keywords: pasurgrel, PCI, NICE, STEMI

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Authors: Sameer Gupta, Prant Gupta

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Context: Fractures in the distal humerus are complex and challenging injuries for orthopaedic surgeons that can be effectively treated with open reduction and internal fixation. Aims: The study analyses clinical outcomes in patients with intra-articular distal humerus fractures (AO type 13 C3 excluded) treated using a different method of fixation ( LCPMS). Subject and Methods: A study was performed, and the author's personal experiences were reported. Thirty patients were treated using an intercondylar screw with lateral column plating and percutaneous medial column screw fixation. Detailed analysis was done for functional outcomes (average arc of motion, union rate, and complications). Statistical Analysis Used: SPSS software version 22.0 was used for statistical analysis. Results: In our study, at the end of 6 months, Overall good to excellent results were achieved in 28 patients out of 30 after analysis on the basis of MEP score. The majority of patients regained full arc of motion, achieved fracture union without any major complications, and were able to perform almost all activities of daily living (which required good elbow joint movements and functions). Conclusion: We concluded that this novel method provides adequate stability and anatomical reconstruction with an early union rate observed at the end of 6 months. Excellent functional outcome was observed in almost all the patients because of less operating time and initiation of early physiotherapy, as most of the patients experienced mild nature of pain post-surgery.

Keywords: intra arricular distal humerus fracture, percutaneous medial screw, lateral column plate, arc of motion

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Authors: J. Vinay , Kusumbati Besra, Niharika Pattnaik, Shivaram Prasad Singh, Manjusha Dixit

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Gallbladder cancer (GBC) is rare but highly malignant cancer; its prevalence is more in certain geographical regions and ethnic groups, which include the Northern and Eastern states of India. Previous studies in India have reported genetic predisposition as one of the risk factors in GBC pathogenesis. Although the matrix metalloproteinase-14 (MMP14) is a well-known modulator of the tumor microenvironment and tumorigenesis and TCGA data also suggests its upregulation yet, its role in the genetic predisposition for GBC is completely unknown. We elucidated the role of MMP14 promoter variants as genetic risk factors and their implications in expression modulation. We screened MMP14 promoter variants association with GBC using Sanger’s sequencing in approximately 300 GBC and 300 control subjects and 26 GBC tissue samples of Indian ethnicity. The immunohistochemistry was used to check the MMP14 protein expression in GBC tissue samples. The role of promoter variants on expression levels was elucidated using a luciferase reporter assay. The variants rs1004030 (p-value = 0.0001) and rs1003349 (p-value = 0.0008) were significantly associated with gallbladder cancer. The luciferase assay in two different cell lines, HEK-293 (p = 0.0006) and TGBC1TKB (p = 0.0036) showed a significant increase in relative luciferase activity in the presence of risk alleles for both the single nucleotide polymorphisms (SNPs). Similarly, genotype-phenotype correlation in patients samples confirmed that the presence of risk alleles at rs1004030 and rs1003349 increased MMP14 expression. Overall, this study unravels the genetic association of MMP14 promoter variants with gallbladder cancer, which may contribute to pathogenesis by increasing its expression.

Keywords: gallbladder cancer, matrix metalloproteinase-14, single nucleotide polymorphism, case control study, genetic association study

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Authors: Mohamed Elkoushy, Sameer Munshi, Waseem Tayeb

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Background: Flexible ureteroscopy (fURS) has dramatically improved the minimally invasive management of complex nephrolithiasis. fUR is increasingly being used as the first-line treatment for patients with renal stones. Stone-free status (SFS) is the primary goal in the management of patients with urolithiasis. However, substantial variations exist in the reported SFS following fURS. Objectives: This study determines the predictors of SFS after a single session of fURS with holmium laser lithotripsy (HLL) for renal calculi. Methods: A retrospective review of prospectively collected data was performed for all consecutive patients undergoing fURS and HLL for renal calculi at a tertiary care center. Patients with previous ipsilateral URS for the same stones were excluded. All patients underwent JJ ureteral stent insertion at the end of the procedure. SFS was defined as the presence of no residuals or ≤4-mm non-obstructing stone and was assessed by CT/KUB imaging after 3-4 weeks post-operatively. Multivariate logistic regression was used to detect possible predictors of SFS. Results: A total of 212 patients were included with a mean age of 52.3±8.3 years and a stone burden <20 mm (49.1%), 20-30 mm (41.0%) and >30 mm (9.9%). Overall SFS after a single session of fURS was 71.7%, 92% and 52% for stones less and larger than 20 mm, respectively. Patients with stones> 20 mm need retreatment with a mean number of 1.8 (1.3-2.7) fURS. SFS was significantly associated with male gender, stone bulk <20 mm (95.7% vs. 56.2%), non-lower pole stones, hydronephrotic kidney, low stone intensity, ureteral access sheath, and preoperative stenting. SFS was associated with a lower readmission rate (5.9% vs. 38.9%) and urinary tract infections (3.8% vs. 25.9%). In multivariate regression analysis, SFS maintains its significant association with low stone burden of <20 mm (OR: 5.21), stone intensity <600 HFU (OR: 2.87), and non-lower caliceal stones (OR: 3.84). Conclusion: Best results after a single-session fURS for renal stone were obtained for the stone burden of less than 20 mm and low stone attenuation. Lower calyceal stones may influence stone clearance and need a different approach than fURS, especially for higher stone burden.

Keywords: ureteroscopy, kidney stone, lithotripsy, stone-free, predictors

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Authors: Anuoluwapo S. Taiwo, David S. Ayre, Morteza Khorami, Sameer S. Rahatekar

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This investigation aims to characterize the effect of Corn Cob (CC), an agricultural waste, for potential use as a filler material, reducing cement in natural fibre-reinforced cement composite boards used for building applications in low-cost housing estates in developing countries. The corn cob is readily and abundantly available in many West African States. However, this agricultural waste product has not been put to any effective use. Hence, the objective of the current research is to convert this massive agro-waste resource into a potential material for use as filler materials reducing cement contents in fibre-cement board production. Kraft pulp fibre-reinforced cement composite boards were developed with the incorporation of the corn cob powder at varying percentages of 1 – 4% as filler materials to reduce the cement content, using a laboratory-simulated vacuum de-watering process. The mechanical properties of the developed cement boards were characterized through a three-point bending test, while the fractured morphology of the cement boards was examined through a Scanning Electron Microscope (SEM). Results revealed that the flexural strength of the composite board improved significantly with an optimum enhancement of 39% when compared to the reference sample without corn cob replacement, however, the flexural behaviour (ductility) of the composite board was slightly affected by the addition of the corn cob powder at higher percentage. SEM observation of the fractured surfaces revealed good bonding at the fibre-matrix interface as well as a ductile-to-brittle fracture mechanism. Overall, the composite board incorporated with 2% corn cob powder as filler materials had the optimum properties which satisfied the minimum requirements of relevant standards for fibre cement flat sheets.

Keywords: agricultural waste, building applications, fibre-cement board, kraft pulp fibre, sustainability

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Authors: Rohin Rameswarapu, Sameer Valsangkar

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Background: Globally, musculoskeletal disorders are the largest single cause of work-related illnesses accounting for over 33% of all newly reported occupational illnesses. Risk factors for MSD need to be delineated to suggest means for amelioration. Material and methods: In this current cross-sectional study, the prevalence of MSDs among workers in an electrical company assembly line, the socio-demographic and job characteristics associated with MSD were obtained through a semi-structured questionnaire. A quantitative assessment of the physical risk factors through the Rapid Upper Limb Assessment (RULA) tool, and measurement of psychosocial risk factors through a Likert scale was obtained. Statistical analysis was conducted using Epi-info software and descriptive and inferential statistics including chi-square and unpaired t test were obtained. Results: A total of 263 workers consented and participated in the study. Among these workers, 200 (76%) suffered from MSD. Most of the workers were aged between 18–27 years and majority of the workers were women with 198 (75.2%) of the 263 workers being women. A chi square test was significant for association between male gender and MSD with a P value of 0.007. Among the MSD positive group, 4 (2%) had a grand score of 5, 10 (5%) had a grand score of 6 and 186 (93%) had a grand score of 7 on RULA. There were significant differences between the non-MSD and MSD group on five out of the seven psychosocial domains, namely job demand, job monotony, co-worker support, decision control and family and environment domains. Discussion: The current cross-sectional study demonstrates a high prevalence of MSD among assembly line works with inherent physical and psychosocial risk factors and recommends that not only physical risk factors, addressing psychosocial risk factors through proper ergonomic means is also essential to the well-being of the employee.

Keywords: musculoskeletal disorders, India, occupational health, Rapid Upper Limb Assessment (RULA)

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Authors: Kathryn Strachan, Sameer Otoom, Amal AL-Gallaf, Ahmed Al Ansari

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Introduction: Introducing a reliable method to select graduates for an award in higher education can be challenging but is not impossible. Multisource feedback (MSF) is a popular assessment tool that relies on evaluations of different groups of people, including physicians and non-physicians. It is useful for assessing several domains, including professionalism, communication and collaboration and may be useful for selecting the best interns to receive a University award. Methods: 16 graduates responded to an invitation to participate in the student award, which was conducted by the Royal College of Surgeons of Ireland-Bahrain Medical University of Bahrain (RCSI Bahrain) using the MSF process. Five individuals from the following categories rated each participant: physicians, nurses, and fellow students. RCSI Bahrain graduates were assessed in the following domains; professionalism, communication, and collaboration. Mean and standard deviation were calculated and the award was given to the graduate who scored the highest among his/her colleagues. Cronbach’s coefficient was used to determine the questionnaire’s internal consistency and reliability. Factor analysis was conducted to examine for the construct validity. Results: 16 graduates participated in the RCSI-Bahrain interns’ award based on the MSF process, giving us a 16.5% response rate. The instrument was found to be suitable for factor analysis and showed 3 factor solutions representing 79.3% of the total variance. Reliability analysis using Cronbach’s α reliability of internal consistency indicated that the full scale of the instrument had high internal consistency (Cronbach’s α 0.98). Conclusion: This study found the MSF process to be reliable and valid for selecting the best graduates for the interns’ awards. However, the low response rates may suggest that the process is not feasible for allowing the majority of the students to participate in the selection process. Further research studies may be required to support the feasibility of the MSF process in selecting graduates for the university award.

Keywords: MSF, RCSI, validity, Bahrain

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Authors: Sameer A. Pathan, Biswadev Mitra, Zain A. Bhutta, Isma Qureshi, Elle Spencer, Asmaa A. Hameed, Sana Nadeem, Ramsha Tahir, Shahzad Anjum, Peter A. Cameron

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Background: This study aimed to compare epidemiology, clinical presentations, management and outcomes of renal colic presentations in two major academic centers and discuss potential implications of these results for the applicability of current evidence in the management of renal colic. Methods: We undertook a retrospective cohort study of patients with renal colic who presented to the Hamad General Hospital Emergency Department (HGH-ED), Qatar, and The Alfred ED, Melbourne, Australia, during a period of one year from August 1, 2012, to July 3, 2013. Cases were identified using ICD-9-CM codes, and an electronic template was used to record the data on predefined clinical variables. Results: A total of 12,223 from the HGH-ED and 384 from The Alfred ED were identified as renal colic presentations during the study period. The rate of renal colic presentations at the HGH-ED was 27.9 per 1000 ED visits compared to 6.7 per 1000 ED visits at The Alfred ED. Patients presenting to the HGH-ED were significantly younger [34.9 years (29.0- 43.4) than The Alfred ED [48 years (37-60); P < 0.001]. The median stone size was larger in the HGH-ED group [6 (4-8) mm] versus The Alfred ED group [4 (3-6) mm, P < 0.001]. The intervention rate in the stone-positive population was significantly higher in the HGH-ED group as opposed to The Alfred ED group (38.7% versus 11.9%, p<0.001). At the time of discharge, The Alfred ED group received less analgesic prescriptions (55.8% versus 83.5%, P < 0.001) and more tamsulosin prescriptions (25.3% versus 11.7%, P < 0.001). Conclusions: Renal colic presentations to the HGH-ED, Qatar, were younger, with larger stone size, compared to The Alfred ED, whereas, medical expulsion therapy use was higher at the Alfred ED. Differences in epidemiology should be considered while tailoring strategies for effective management of patients with renal colic in the given setting.

Keywords: kidney stones, urolithiasis, nephrolithiasis, renal colic, epidemiology

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Authors: Sameer Masood, Lucas Chartier

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Head injuries are a commonly encountered presentation in emergency departments (ED) and the Choosing Wisely Canada (CWC) campaign was released in June 2015 in an attempt to decrease imaging utilization for patients with minor head injuries. The impact of the CWC campaign on imaging utilization for head injuries has not been explored in the ED setting. In our study, we describe the characteristics of patients with head injuries presenting to a tertiary care academic ED and the impact of the CWC campaign on CT head utilization. This retrospective cohort study used linked databases from the province of Ontario, Canada to assess emergency department visits with a primary diagnosis of head injury made between June 1, 2014 and Aug 31, 2016 at the University Health Network in Toronto, Canada. We examined the number of visits during the study period, the proportion of patients that had a CT head performed before and after the release of the CWC campaign, as well as mode of arrival, and disposition. There were 4,322 qualifying visits at our site during the study period. The median presenting age was 44.12 years (IQR 27.83,67.45), the median GCS was 15 (IQR 15,15) and the majority of patients presenting had intermediate acuity (CTAS 3). Overall, 43.17% of patients arrived via ambulance, 49.24 % of patients received a CT head and 10.46% of patients were admitted. Compared to patients presenting before the CWC campaign release, there was no significant difference in the rate of CT heads after the CWC (50.41% vs 47.68%, P = 0.07). There were also no significant differences between the two groups in mode of arrival (ambulance vs ambulatory) (42.94% vs 43.48%, P = 0.72) or admission rates (9.85% vs 11.26%, P = 0.15). However, more patients belonged to the high acuity groups (CTAS 1 or 2) in the post CWC campaign release group (12.98% vs 8.11% P <0.001). Visits for head injuries make up a significant proportion of total ED visits and approximately half of these patients receive CT imaging in the ED. The CWC campaign did not seem to impact imaging utilization for head injuries in the 14 months following its launch. Further efforts, including local quality improvement initiatives, are likely needed to increase adherence to its recommendation and reduce imaging utilization for head injuries.

Keywords: choosing wisely, emergency department, head injury, quality improvement

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Authors: Alok Kumar Yadav, Saurabh Saraswat, Preeti Sirohi, Manjoo Rani, Sameer Srivastava, Manish Pratap Singh, Nand K. Singh

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The development of antibiotic resistance in bacteria is increasing at an alarming rate, and this is considered as one of the most serious threats in the history of medicine, and an alternative solution should be derived so as to tackle this problem. In many countries, people use the medicinal plants for the treatment of various diseases as these are cheaper, easily available and least toxic. Syzygium cumini is used for the treatment of various kinds of diseases but their mechanism of action is not reported. The antimicrobial activity of Syzygium cumini was tested by the well diffusion assay and zone of inhibition was reported to be 20.06 mm as compared to control with MIC of 0.3 mg/ml. Genomic DNA fragmentation of Bacillus subtilis revealed apoptosis and FE-SEM indicate cell wall cracking on several intervals of time. Propidium iodide staining results showed that few bacterial cells were stained in the control and population of stained cells increase after exposing them for various period of time. Flow cytometric kinetic data analysis on the membrane permeabilization in bacterial cell showed the significant contribution of antimicrobial potential of the seed extract on antimicrobial-induced permeabilization. Two components of Syzygium cumini methanolic seed extract was found to be quite active against four enzymes like PDB ID- 1W5D, 4OX3, 3MFD and 5E2F which have a very crucial role in membrane synthesis in Bacillus subtilis by in silico analysis. Through in silico analysis, lupeol showed highest binding energy for macromolecule 1W5D and 4OX3 whereas stigmasterol showed the highest binding energy for macromolecule 3MFD and 5E2F respectively. It showed that methanolic seed extract of Syzygium cumini can be used for the inhibition of foodborne infections caused by Bacillus subtilis and also as an alternative of prevalent antibiotics.

Keywords: antibiotics, Bacillus subtilis, inhibition, Syzygium cumini

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Authors: Sarah Saad Alamer, Shujon Mohammed Alazzam, Amjad Khater Alanazi, Mohamed Ahmed Sankari, Jana Sameer Sendy, Saleh Al-Khaldi, Khaled Allam, Amani Badawi

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Background: Self-medication is defined as the selection of medicines by individuals to treat self-diagnosed. There are a lot of concerns about the safety of long-term use of nonprescription ophthalmic drugs, which may lead to a variety of serious ocular complications. Topical steroids can produce severe eye-threatening complications, including the elevation of intraocular pressure (IOP) with possible development of glaucoma and infrequent optic nerve damage. In recent times, many OTC ophthalmic preparations have been possible without a prescription. Objective: In our study, we aimed to determine the prevalence of self-medication ocular topical steroid practice and associated factors among adult ophthalmic patients attending King Saud medical city. Methods: This study was conducted as a cross-sectional study, targeting participants aged 18 years old or above who had used topical steroids eye drops to determine the prevalence of self-medication ocular topical steroid practice and associated factors among adult patients attending ophthalmology clinic in King Saud Medical City (KSMC) in the central region. Results: A total of 308 responses, 92(29.8%) were using ocular topical, 58(18.8%) with prescription, 5(1.6%) without prescription, 29(9.4%) with and without prescription while 216(70.1%) did not use it. The frequency of using ocular topical steroids without a prescription among participants was 11(12%) once and 33 (35%) many times. 26(28.3%) were having complication, mostly 11(12.4%) eye infection, 8(9%) Glaucoma, 6 (6.7%) Cataracts. Reasons for self-medication ocular topical steroid practice among participants were 14 (15.2%) repeated symptoms, 11(15.2%) had heard an advice from a friend, 11 (15.2%) thought they had enough knowledge. Conclusion: Our study reveals that, even though detecting a high level of knowledge and acceptable practices and attitudes among participants, the incidence of self-medication with steroid eye drops was observed. This practice is mainly due to participants having repeated symptoms and thinking they have enough knowledge. Increasing the education level of patients on self-medication steroid eye drops practice and it is associated complications would help reduce the incidence of self-medication steroid eye drops practice.

Keywords: self-medication, ophthalmic medicine, steroid eye drop, over the counter

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Authors: Safee Chaudhary, Mahnoor Naseer Gondal, Hira Anees Awan, Abdul Rehman, Ammar Arif, Risham Hussain, Huma Khawar, Zainab Arshad, Muhammad Faizyab Ali Chaudhary, Waleed Ahmed, Muhammad Umer Sultan, Bibi Amina, Salaar Khan, Muhammad Moaz Ahmad, Osama Shiraz Shah, Hadia Hameed, Muhammad Farooq Ahmad Butt, Muhammad Ahmad, Sameer Ahmed, Fayyaz Ahmed, Omer Ishaq, Waqar Nabi, Wim Vanderbauwhede, Bilal Wajid, Huma Shehwana, Muhammad Tariq, Amir Faisal

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Cancer is a manifestation of multifactorial deregulations in biomolecular pathways. These deregulations arise from the complex multi-scale interplay between cellular and extracellular factors. Such multifactorial aberrations at gene, protein, and extracellular scales need to be investigated systematically towards decoding the underlying mechanisms and orchestrating therapeutic interventions for patient treatment. In this work, we propose ‘TISON’, a next-generation web-based multiscale modeling platform for clinical systems oncology. TISON’s unique modeling abstraction allows a seamless coupling of information from biomolecular networks, cell decision circuits, extra-cellular environments, and tissue geometries. The platform can undertake multiscale sensitivity analysis towards in silico biomarker identification and drug evaluation on cellular phenotypes in user-defined tissue geometries. Furthermore, integration of cancer expression databases such as The Cancer Genome Atlas (TCGA) and Human Proteome Atlas (HPA) facilitates in the development of personalized therapeutics. TISON is the next-evolution of multiscale cancer modeling and simulation platforms and provides a ‘zero-code’ model development, simulation, and analysis environment for application in clinical settings.

Keywords: systems oncology, cancer systems biology, cancer therapeutics, personalized therapeutics, cancer modelling

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