Search results for: Ajay Sidana

Authors: Lokendra Kumar Devangan, Ajay Mishra

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This paper describes the implementation of a large-scale SAS/OR model with significant pre-processing, scenario analysis, and post-processing work done using SAS. A large cement manufacturer with ten geographically distributed manufacturing plants for two variants of cement, around 400 warehouses serving as transshipment points, and several thousand distributor locations generating demand needed to optimize this multi-echelon, multi-modal transport supply chain separately for planning and allocation purposes. For monthly planning as well as daily allocation, the demand is deterministic. Rail and road networks connect any two points in this supply chain, creating tens of thousands of such connections. Constraints include the plant’s production capacity, transportation capacity, and rail wagon batch size constraints. Each demand point has a minimum and maximum for shipments received. Price varies at demand locations due to local factors. A large mixed integer programming model built using proc OPTMODEL decides production at plants, demand fulfilled at each location, and the shipment route to demand locations to maximize the profit contribution. Using base SAS, we did significant pre-processing of data and created inputs for the optimization. Using outputs generated by OPTMODEL and other processing completed using base SAS, we generated several reports that went into their enterprise system and created tables for easy consumption of the optimization results by operations.

Keywords: production planning, mixed integer optimization, network model, network optimization

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Authors: Himanshi Rathore, Shalinee Prasad, Satyawati Sharma, Ajay Singh Yadav

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Medicinal mushrooms are acceptable all over the world not only because they have a unique flavour and texture but also due to the presence of great nutritional, nutraceutical and functional properties. High content of physiologically active substances like ergosterol, vitamin D, phenolic compounds, triterpenoids and steroids make these medicinal mushrooms a key source of nutraceuticals. Calocybe indica is a popular medicinal mushroom of India which is known to possess high amount of secondary metabolites including ergosterol (vitamin D2). The ergosterol gets converted to vitamin D in the presence of UV rays by a photochemical reaction. In lieu of the above facts the present study was undertaken to investigate the effect of UV-B light treatment on the vitamin D2 concentration, phenolic content and non volatile compounds in Calocybe indica. For this study, UV-B light source of intensity 5.3w/m2 was used to expose mushrooms for the time period of 0min, 30min, 60min and 90 min. It was found that the vitamin D2 concentration increased with the time duration i.e. 85±0.15 (0 min), 182±1.6 (30 min), 187±0.4 (60 min) and 182 ±0.8 (90 min) μg/g (dry weight). Highest concentration of vitamin D2 was found at 60 min duration. No discoloration in sliced mushrooms was observed during the exposure time. The results revealed that the exposure of mushrooms for a minimum of 30 min duration under UVB source can be a novel, convenient and cheapest way to increase the vitamin D content in mushrooms. This can be one of richest source to fulfil the recommended dietary allowances of vitamin D in our daily diets. The paper provides information on the enhancement of vitamin D content by UV lights and its effects on the non volatile (soluble sugars, free amino acids, 5′-nucleotides and phenolics) compounds will also be presented.

Keywords: Calocybe indica, ergosterol, nutraceutical, phenolics

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Authors: Anish Desai, Reshmi Pillai, Nilesh Mahajan, Hitesh Chopra, Vishal Mahajan, Ajay Grover, Ashish Kohli

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Surgical Site Infection (SSI) is hospital acquired infection of growing concern. This study presents the efficacy and cost-effectiveness of triclosan-coated suture, in reducing the burden of SSI in India. Methodology: A systematic literature search was conducted for economic burden (1998-2018) of SSI and efficacy of triclosan-coated sutures (TCS) vs. non-coated sutures (NCS) (2000-2018). PubMed Medline and EMBASE indexed articles were searched using Mesh terms or Emtree. Decision tree analysis was used to calculate, the cost difference between TCS and NCS at private and public hospitals, respectively for 7 surgical procedures. Results: The SSI range from low to high for Caesarean section (C-section), Laparoscopic hysterectomy (L-hysterectomy), Open Hernia (O-Hernia), Laparoscopic Cholecystectomy (L-Cholecystectomy), Coronary artery bypass graft (CABG), Total knee replacement (TKR), and Mastectomy were (3.77 to 24.2%), (2.28 to 11.7%), (1.75 to 60%), (1.71 to 25.58%), (1.6 to 18.86%), (1.74 to 12.5%), and (5.56 to 25%), respectively. The incremental cost (%) of TCS ranged 0.1%-0.01% in private and from 0.9%-0.09% at public hospitals across all surgical procedures. Cost savings at median efficacy & SSI risk was 6.52%, 5.07 %, 11.39%, 9.63%, 3.62%, 2.71%, 9.41% for C-section, L-hysterectomy, O-Hernia, L-Cholecystectomy, CABG, TKR, and Mastectomy in private and 8.79%, 4.99%, 12.67%, 10.58%, 3.32%, 2.35%, 11.83% in public hospital, respectively. Efficacy of TCS and SSI incidence in a particular surgical procedure were important determinants of cost savings using one-way sensitivity analysis. Conclusion: TCS suture led to cost savings across all 7 surgeries in both private and public hospitals in India.

Keywords: cost Savings, non-coated sutures, surgical site infection, triclosan-coated sutures

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Authors: Anit S. Malhotra, Ajay Duseja, Neelam Chadha

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Endothelial dysfunction is a precursor to atherosclerosis, and flow-mediated dilatation (FMD) in the brachial artery is the commonest method to evaluate endothelial function in humans. Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver disorders encountered in clinical practice. An earlier meta-analysis had quantitatively assessed the degree of endothelial dysfunction using FMD. However, the largest study investigating the relation of FMD with NAFLD was published after that meta-analysis. In addition, that meta-analysis did not include some studies, including one from our centre. Therefore, an updating the previous meta-analysis was considered important. We searched PubMed, Cochrane Library, Embase, Scopus, SCI, Google Scholar, conference proceedings, and references of included studies till June 2017 to identify observational studies evaluating endothelial function using FMD in patients with non-alcoholic fatty liver disease. Data was analyzed using MedCalc. Fourteen studies were found eligible for inclusion in the meta-analysis. Patients with NAFLD had lower brachial artery FMD as compared to controls, standardized mean difference (random effects model) being –1.279%; 95% confidence interval (CI), –1.478 to –0.914. The effect size became smaller after addition of the recent study with the largest sample size was included compared with the earlier meta-analysis. In conclusion, patients with NAFLD had low FMD values indicating that they are at a higher risk of cardiovascular disease although our results suggest the effect size is not as large as reported previously.

Keywords: endothelial dysfunction, flow-mediated dilatation, meta-analysis, non-alcoholic fatty liver disease

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Authors: Ajay Kumar Yadav, Masum Paudel, Ritesh Chaudhary

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Background: Understanding the diagnosis and the treatment plan is very important for the patient which reflects the effectiveness of the patient care as well as counseling. Large groups of patients do not understand their emergency care plan or their discharge instructions. With only a little more than 2/3ʳᵈ of the adult population is literate and poorly distributed health service institutions in Nepal, exploring the current status of patient understanding of their diagnosis and treatment would help identify interventions to improve patient compliance with the provided care and the treatment outcomes. Objectives: This study was conducted to identify and describe the areas of patients’ understanding and confusion regarding emergency care and discharge instructions at the Emergency ward of B. P. Koirala Institute of Health Sciences teaching hospital, Dharan, Nepal. Methods: A cross-sectional study was conducted among 426 patients discharged from the emergency unit of BPKIHS. Cases who are leaving against medical advice absconded cases and those patients who came just for vaccination are excluded from the study. Patients’ understanding of the treatment plan and diagnosis was measured. Results: There were 60% men in this study. More than half of the participants reported not being able to read English. More than 90% of the respondents reported they could not read their prescription at all. While patient could point out their understanding of their diagnosis at discharge, most of them could not tell the names and the dosage of all the drugs prescribed to them at discharge. More than 95% of the patients could not tell the most common side effects of the drugs that they are prescribed. Conclusions: There is a need to further explore the factors influencing the understanding of the patients regarding their treatment plan. Interventions to understand the health literacy needs and ways to improve the health literacy of the patients are needed.

Keywords: discharge instruction, emergency ward, health literacy, treatment plan

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Authors: Ajay Kumar, Shamily Jaggi

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In developing countries like India development of modern technologies has been a key determinant in accelerating industrialization and urbanization. But in the pursuit of rapid economic growth, development is considered a top priority, while environmental protection is not given the same importance. Thus, a number of industries sited haphazardly have been established, leading to a deterioration of natural resources like water, soil and air. As a result, environmental pollution is tremendously increasing due to industrialization and mechanization that are serving to fulfill the demands of the population. With the increasing population, demand for bricks for construction work is also increasing, establishing the brick industry as a growing industry. Brick production requires two main resources; water as a source of life, and soil, as a living environment. Water and soil conservation is a critical issue in areas facing scarcity of water and soil resources. The purpose of this review paper is to provide a brief overview of the theoretical frameworks used in the analysis of the adoption and/or acceptance of soil and water conservation practices in the brick industry. Different frameworks and models have been used in the analysis of the adoption and/or acceptance of new technologies and practices; these include the technology acceptance model, motivational model, theory of reasoned action, innovation diffusion theory, theory of planned behavior, and the unified theory of acceptance and use of technology. However, every model has some limitations, such as not considering environmental/contextual and economic factors that may affect the individual’s intention to perform a behavior. The paper concludes that in comparing other models, the UTAUT seems a better model for understanding the dynamics of acceptance and adoption of water and soil conservation practices.

Keywords: brick kiln, water conservation, soil conservation, unified theory of acceptance and use of technology, technology adoption

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Authors: Alok Shiomurti Tripathi, Ajay Kumar Timiri, Papiya Mitra Mazumder, Anil Chandewar

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The present study evaluates the possible drug interaction between glimepiride (GLIM) and sildenafil citrate (SIL) in streptozotocin (STZ) induced in diabetic nephropathic (DN) animals and also postulates the possible mechanism of interaction by molecular modeling studies. Diabetic nephropathy was induced by single dose of STZ (60 mg/kg, ip) and confirms it by assessing the blood and urine biochemical parameters on 28th day of its induction. Selected DN animals were used for the drug interaction between GLIM (0.5mg/kg, p.o.) and SIL (2.5 mg/kg, p.o.) after 29th and 70th day of protocol. Drug interaction were assessed by evaluating the plasma drug concentration using HPLC-UV and also determine the change in the biochemical parameter in blood and urine. Mechanism of the interaction was postulated by molecular modeling study using Maestro module of Schrodinger software. DN was confirmed as there was significant alteration in the blood and urine biochemical parameter in STZ treated groups. The concentration of SIL increased significantly (p<0.001) in rat plasma when co administered with GLIM after 70th day of protocol. Molecular modelling study revealed few important interactions with rat serum albumin and CYP2C9.GLIM has strong hydrophobic interaction with binding site residues of rat serum albumin compared to SIL. Whereas, for CYP2C9, GLIM has strong hydrogen bond with polar contacts and hydrophobic interactions than SIL. Present study concludes that bioavailability of SIL increases when co-administered chronically with GLIM in the management of DN animals and mechanism has been supported by molecular modeling studies.

Keywords: diabetic nephropathy, glimepiride, sildenafil citrate, pharmacokinetics, homology modeling, schrodinger

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Authors: Ajay Krishnamurthy, Mariyappan Mahesh Kumar, Sellamuthu Periyar Selvam

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Fruits are considered as functional foods due to the presence of various bioactive compounds available such as polyphenols, which are beneficial to health when consumed as part of our diet. The primary objective of this study was to analyze the various functional groups present in ethanolic extracts of Hylocereus undatus and Garcinia indica and also measure their antibacterial and antioxidant potential respectively thereby affirming its nutraceutical potential. To fulfill our objective, a Fourier - transform Infrared Spectroscopy (FTIR) was conducted for functional group analysis, Total Phenolic Content and DPPH free radical scavenging activity for measuring it anti-oxidant potential and agar-well diffusion assay for antibacterial potential. On careful observation and analysis of the spectrum it was found that both the fruit extracts contain similar compounds viz. Phenols, Alkanes, Alkenes, Aldehydes, Ketones, Carboxylic Acid and Amines. Total phenolic content of H.undatus and G.indica was estimated to be (26.85 ± 1.84 mg GAE/100g) and (32.84 ± 1.63 mg GAE/100g) respectively which corresponds to an inhibition of 84% and 81% respectively. H.undatus shows an inhibition of (3.4 ± 2.1mm) in gram-positive and (4.2 ± 2.24mm) in gram-negative organism on the other hand G.indica shows (2.1 ± 0.98mm) in gram-positive and (3.1 ± 1.44mm) in gram negative. The presence of such diverse compounds in the fruits helps us to understand the necessity for the inclusion of fruits in our daily diet and also helps the pharmaceutical industry in realizing the importance of exotic fruits as a potential nutraceutical.

Keywords: DPPH, fourier-transform infrared spectroscopy (FTIR), Hylocereus undatus, Garcinia indica

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Authors: Ajay Kumar, Satwinderjeet Kaur

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Onosma bracteata Wall. (Boraginaceae), is known to be a medicinal plant, useful in the treatment of body swellings, abdominal pain and urinary calculi, etc. The present study focused on the radical scavenging and cancer growth inhibitory properties of isolates from O. bracteata. Obea fraction demonstrated noticeable free radical scavenging ability along with antiproliferative activity in human osteosarcoma MG-63, human neuroblastoma IMR-32, and human lung cancer A549 cell lines using MTT assay with GI50 values of 88.56, 101.61 and 112.7 μg/ml, respectively. The scanning electron and confocal microscopy studies showed morphological alterations including nuclear condensation and formation of apoptotic bodies in osteosarcoma MG-63 cells. Obea fraction in osteosarcoma MG-63 cells augmented the reactive oxygen species (ROS) level and decreased the mitochondrial membrane potential. Flow cytometry analysis revealed the Obea treated cells to be arrested in the G0/G1 phase in a dose dependent manner supported by the observed increase in the early apoptotic cell population. Western blotting analysis showed that the expression of p-NF-kB, COX-2, p-Akt, and Bcl-xL decreased whereas, the expression of GSK-3β, p53, caspase-3 and caspase-9 proteins increased. The downregulation of Bcl-2, Cyclin E, CDK2 and mortalin gene expression and upregulation of p53 genes was unfolded in RT-qPCR studies. The presence of catechin, kaempferol, Onosmin A and epicatechin, as revealed in high-performance liquid chromatography (HPLC) studies, contributes towards the chemopreventive potential of O. bracteata which can be tapped for chemotherapeutic use.

Keywords: apoptosis, confocal microscopy, HPLC, mitochondria membrane potential, reactive oxygen species

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Authors: Roopa Singh, Anurag Singh, Ajay

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Agriculture contributes a major share in the national economy of India. A major portion of Indian economy (about 70%) depends upon agriculture as it forms the main source of income. About 43% of India’s geographical area is used for agricultural activity which involves 65-75% of total population of India. The given work deals with the Fast moving Consumer Goods (FMCG) industries and their inventories which use agricultural produce as their raw material or input for their final product. Since the beginning of inventory practices, many developments took place which can be categorised into three phases, based on the review of various works. The first phase is related with development and utilization of Economic Order Quantity (EOQ) model and methods for optimizing costs and profits. Second phase deals with inventory optimization method, with the purpose of balancing capital investment constraints and service level goals. The third and recent phase has merged inventory control with electrical control theory. Maintenance of inventory is considered negative, as a large amount of capital is blocked especially in mechanical and electrical industries. But the case is different in food processing and agro-based industries and their inventories due to cyclic variation in the cost of raw materials of such industries which is the reason for selection of these industries in the mentioned work. The application of electrical control theory in inventory control makes the decision-making highly instantaneous for FMCG industries without loss in their proposed profits, which happened earlier during first and second phases, mainly due to late implementation of decision. The work also replaces various inventories and work-in-progress (WIP) related errors with their monetary values, so that the decision-making is fully target-oriented.

Keywords: control theory, inventory control, manufacturing sector, EOQ, feedback, FMCG sector

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Authors: Ashneel Ajay Singh, Kazumi Sakuramoto, Naoki Suzuki, Kalla Alok, Nath Paras

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Bluefin (Thunnus orientalis) tuna is one of the most economically valuable tuna species in the world. In recent years the stock has been observed to decline. It is suspected that the stock-recruitment relationship and population structure is influenced by environmental and climatic variables. This study was aimed at investigating the influence of environmental and climatic conditions on the trajectory of the different life stages of the North Pacific bluefin tuna. Exploratory analysis was performed for the North Pacific sea surface temperature (SST) and Pacific Decadal Oscillation (PDO) on the time series of the bluefin tuna cohorts (age-0, 1, 2,…,9, 10+). General Additive Modeling (GAM) was used to reconstruct the recruitment (R) trajectory. The spatial movement of the SST was also monitored from 1953 to 2012 in the distribution area of the bluefin tuna. Exploratory analysis showed significance influence of the North Pacific Sea Surface temperature (SST) and Pacific Decadal Oscillation (PDO) on the time series of the age-0 group. Other age group (1, 2,…,9, 10+) time series did not exhibit any significant correlations. PDO showed most significant relationship in the months of October to December. Although the stock-recruitment relationship is of biological significance, the recruits (age-0) showed poor correlation with the Spawning Stock Biomass (SSB). Indeed the most significant model incorporated the SSB, SST and PDO. The results show that the stock-recruitment relationship of the North Pacific bluefin tuna is multi-dimensional and cannot be adequately explained by the SSB alone. SST and PDO forcing of the population structure is of significant importance and needs to be accounted for when making harvesting plans for bluefin tuna in the North Pacific.

Keywords: pacific bluefin tuna, Thunnus orientalis, cohorts, recruitment, spawning stock biomass, sea surface temperature, pacific decadal oscillation, general additive model

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Authors: Anil Sharma, Ajay Kumar Mahur, R. G. Sonkawade, A. C. Sharma, R. Prasad

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In coal fired thermal power stations, large amount of fly ash is produced after burning of coal. Fly ash is spread and distributed in the surrounding area by air and may be deposited on the soil of the region surrounding the power plant. Coal contains increased levels of these radionuclides and fly ash may increase the radioactivity in the soil around the power plant. Radon atoms entering into the pore space from the mineral grain are transported by diffusion and advection through this space until they in turn decay or are released into the atmosphere. In the present study, Soil samples were collected from the region around a Kasimpur Thermal Power Plant, Kasimpur, Aligarh (U.P.). Radon activity, radon surface exhalation and mass exhalation rates were measured using “sealed can technique” using LR 115-type II nuclear track detectors. Radon activities vary from 92.9 to 556.8 Bq m-3 with mean value of 279.8 Bq m-3. Surface exhalation rates (EX) in these samples are found to vary from 33.4 to 200.2 mBq m-2 h-1 with an average value of 100.5 mBq m-2 h-1 whereas, Mass exhalation rates (EM) vary from 1.2 to 7.7 mBq kg-1 h-1 with an average value of 3.8 mBq kg-1 h-1. Activity concentrations of radionuclides were measured in these samples by using a low level NaI (Tl) based gamma ray spectrometer. Activity concentrations of 226Ra 232Th and 40K vary from 12 to 49 Bq kg-1, 24 to 49 Bq kg-1 and 135 to 546 Bq kg-1 with overall mean values of 30.3 Bq kg-1, 38.5 Bq kg-1 and 317.8 Bq kg-1, respectively. Radium equivalent activity has been found to vary from 80.0 to 143.7 Bq kg-1 with an average value of 109.7 Bq kg-1. Absorbed dose rate varies from 36.1 to 66.4 nGy h-1 with an average value of 50.4 nGy h-1 and corresponding outdoor annual effective dose varies from 0.044 to 0.081 mSv with an average value of 0.061 mSv. Values of external and internal hazard index Hex, Hin in this study vary from 0.21 to 0.38 and 0.27 to 0.50 with an average value of 0.29 and 0.37, Respectively. The results will be discussed in light of various factors.

Keywords: natural radioactivity, radium equivalent activity, absorbed dose rate, gamma ray spectroscopy

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Authors: Ashneel Ajay Singh, Naoki Suzuki, Kazumi Sakuramoto, Swastika Roshni, Paras Nath, Alok Kalla

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Albacore tuna (Thunnus alalunga) is one of the commercially important species of tuna in the North Pacific region. Despite the long history of albacore fisheries in the Pacific, its ecological characteristics are not sufficiently understood. The effects of changing climate on numerous commercially and ecologically important fish species including albacore tuna have been documented over the past decades. The objective of this study was to explore and elucidate the relationship of environmental variables with the stock parameters of albacore tuna. The relationship of the North Pacific albacore tuna recruitment (R), spawning stock biomass (SSB) and recruits per spawning biomass (RPS) from 1970 to 2012 with the environmental factors of sea surface temperature (SST), Pacific decadal oscillation (PDO), El Niño southern oscillation (ENSO) and Pacific warm pool index (PWI) was construed. SST and PDO were used as independent variables with SSB to construct stock reproduction models for R and RPS as they showed most significant relationship with the dependent variables. ENSO and PWI were excluded due to collinearity effects with SST and PDO. Model selections were based on R2 values, Akaike Information Criterion (AIC) and significant parameter estimates at p<0.05. Models with single independent variables of SST, PDO, ENSO and PWI were also constructed to illuminate their individual effect on albacore R and RPS. From the results it can be said that SST and PDO resulted in the most significant models for reproducing North Pacific albacore tuna R and RPS time series. SST has the highest impact on albacore R and RPS when comparing models with single environmental variables. It is important for fishery managers and decision makers to incorporate the findings into their albacore tuna management plans for the North Pacific Oceanic region.

Keywords: Albacore tuna, El Niño southern oscillation, Pacific decadal oscillation, sea surface temperature

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Authors: Ankush M. Dewle, Suditi Bhattacharya, Prachi R. Abhang, Savita Datar, Ajay J. Jog, Rupesh K. Srivastava, Geetanjali Tomar

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Objectives: The aim of this study was to investigate the quality of mesenchymal stem cells (MSCs) obtained from ageing gingival tissues, in order to suggest their potential role in autologous stem cell therapy for old individuals. Methods: MSCs were isolated from gingival tissues of young (18-45 years) and old (above 45 years) donors by enzymatic digestion. MSCs were analysed for cfu-f, surface marker expression by flow-cytometry and multilineage differentiation potential. The angiogenic potential was compared in a chick embryo yolk sac membrane model. The aging and differentiation markers including SA-β-galactosidase and p21 respectively were analysed by staining and flow-cytometry analysis. Additionally, osteogenic markers such as glucocorticoid receptor (GR), vitamin D receptor (VDR) were measured by flow-cytometry and RT-qPCR was performed for quantification of osteogenic gene expression. Alizarin Red S and alkaline phosphatase (ALP) activity were also quantitated. Results: Gingival MSCs (GMSCs) from both the age groups were similar in their morphology and displayed cfu-f. They had similar expression of MSC surface markers and p21, comparable rate of proliferation and differentiated to all the four lineages. GMSCs from young donors had a higher adipogenic differentiation potential as compared to the old GMSCs. Moreover, these cells did not display a significant difference in ALP activity probably due to comparable expression of GR, VDR, and osteogenic genes. Conclusions: Ageing of GMSCs occurs at a much slower rate than stem cells from other sources. Thus we suggest GMSCs as an excellent candidate for autologous stem cell therapy in degenerative diseases of elderly individuals. Clinical Significance: GMSCs could help overcome the setbacks in clinical implementation of autologous stem cell therapy for regenerative medicine in all age group of patient.

Keywords: bone regeneration, cell therapy, senescence, stem cell

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Authors: Ajay Gogia, Svs Deo, Dn Sharma, Atul Batra, Ashutash Mishra

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Background and Aims: Breast cancer in women aged less than 25 years (defined as very young breast cancer, VYBC) is rare and accounts for 0.25% of all breast cancer in the West. There is no data available on VYBC from developing countries. The aim of this study was to analyze the clinical, pathological, and prognostic factors and outcomes in VYBC. Methods: This retrospective analysis was performed on 80 patients aged 25 years or less (screened 8000 files of female BC) who were registered at All India Institute of Medical Sciences (AIIMS), New Delhi, India, over a 15-year period between 2011 and 2023. Results: The median age was 21.5 years (range 16-25). A positive family history (siblings and parents) was elicited in 30% of cases, and breast cancer gene (BRCA1/2) mutation was found in 33% of cases patients. Ten patients (12.5%) patients have pregnancy-associated breast cancer (BC detected during pregnancy or 1 year after postpartum period). The TNM stage distribution was Stage I was 0, stage II -30%, stage III –60% and Stage IV -10 %patients. Seventy percent of tumors were high grade, and 90% had pathological node-positive disease. Estrogen, Progesterone, and human epidermal growth factor receptor 2 (HER2)/neu positivity were 25%,25% and 35%, respectively. Triple-negative breast cancer constituted 40% of patients. With a median follow-up of 42 months, 3 years, relapse-free survival (nonmetastatic disease), progression-free survival (metastatic disease) and overall survival were 30%, 15% and 50%, respectively. Conclusions: Very young women constituted 1% of all breast cancer cases. Advanced disease at presentation and high-risk pathological features result in poor outcomes. One-third of VYBCs are associated with BRCA mutation, which requires genetic counseling and risk reduction surgery if required. Due to the aggressive behavior of BC in this age group, need early diagnosis and prompt treatment

Keywords: very young, breast cancer, outcome, developing country, India

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Authors: Ashneel Ajay Singh, Anish Maharaj, Havish Naidu, Michelle Kumar

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Mangrove patches are the foundation species located in the estuarine land areas. These patches provide a nursery, food source and protection for numerous aquatic, intertidal and well as land-based organisms. Mangroves also help in coastal protection, maintain water clarity and are one of the biggest sinks for blue carbon sequestration. In the Pacific Island countries, numerous coastal communities have a heavy socioeconomic dependence on coastal resources and mangroves play a key ecological and economical role in structuring the availability of these resources. Fiji has a large mangrove patch located in the Votua area of the Ba province. Globally, mangrove population continues to decline with the changes in climatic conditions and anthropogenic activities. Baseline information through wetland maps and time series change are essential references for development of effective mangrove management plans. These maps reveal the status of the resource and the effects arising from anthropogenic activities and climate change. In this study, we used remote sensing and GIS tools for mapping and temporal change detection over a period of >20 years in Votua, Fiji using Landsat imagery. Landsat program started in 1972 initially as Earth Resources Technology Satellite. Since then it has acquired millions of images of Earth. This archive allows mapping of temporal changes in mangrove forests. Mangrove plants consisted of the species Rhizophora stylosa, Rhizophora samoensis, Bruguiera gymnorrhiza, Lumnitzera littorea, Heritiera littoralis, Excoecaria agallocha and Xylocarpus granatum. Change detection analysis revealed significant reduction in the mangrove patch over the years. This information serves as a baseline for the development and implementation of effective management plans for one of Fiji’s biggest mangrove patches.

Keywords: climate change, GIS, Landsat, mangrove, temporal change

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Authors: Akhil Raj Pushparajan, Ranjit Ramachandran, Jijimole Gopi Reji, Ajay Kumar Ramakrishnan

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Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), is one of the leading causes of death by an infectious disease. In spite of the availability of effective drugs and a vaccine, TB is a major health concern and was declared a global emergency by the World Health Organization (WHO). The success of intracellular pathogens like Mtb depends on its ability to overcome the challenging environment in the host. Gene regulation controlled by transcriptional regulators (TRs) plays a crucial role for the bacteria to adapt to the host environment. In vitro studies on gene regulatory mechanisms during dormancy and reactivation have provided insights into the adaptations employed by Mtb to survive in the host. Here we present our efforts to functionally characterize Rv1019, a putative TR of Mtb H37Rv which was found to be present at significantly varying levels during dormancy and reactivation in vitro. The expression of this protein in the dormancy-reactivation model was validated by qRT-PCR and western blot. By DNA- protein interaction studies and reporter assays we found that under normal laboratory conditions of growth this protein behaves as an auto-repressor and tetracycline was found to abrogate this repression by interfering with its ability to bind DNA. Further, by cDNA analysis, we found that this TR is co-transcribed with its downstream genes Rv1020 (mfd) and Rv1021 (mazG) which are involved in DNA damage response in Mtb. Constitutive expression of this regulator in the surrogate host M. smegmatis showed downregulation of the orthologues of downstream genes suggested that Rv1019 could negatively regulate these genes. Our finds also show that M. smegmatis expressing Rv1019 is sensitive to DNA damage suggests the role of this protein in regulating DNA damage response induced by oxidative stress. Because of its role in regulating DNA damage response which may help in the persistence of Mtb, Rv1019 could be used as a prospective target for therapeutic intervention to fight TB.

Keywords: auto-repressor, DNA repair, mycobacterium smegmatis, mycobacterium tuberculosis, tuberculosis

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Authors: Kumar Gular, Viswanathan S., Mastour Saeed Alshahrani, Ravi Shankar Reddy, Jaya Shanker Tedla, Snehil Dixit, Ajay Prasad Gautam, Venkata Nagaraj Kakaraparthi, Devika Rani Sangadala

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Background: Despite trunk control’s significant contribution to improving various functional activity components, the independent effect of trunk performance on quality of life is yet to be estimated in stroke survivors. Ascertaining the correlation between trunk control and self-reported quality of life while evaluating the effect of demographic and clinical characteristics on their relationship will guide concerned healthcare professionals in designing ideal rehabilitation protocols during the late sub-acute stroke stage of recovery. The aims of the present research were to (1) investigate the associations of trunk performance with self-rated quality of life and (2) evaluate if age, body mass index (BMI), and clinical characteristics mediate the relationship between trunk motor performance and perceived quality of life in the sub-acute stroke population. Methods: Trunk motor functions and quality of life among the late sub-acute stroke population aged 57.53 ± 6.42 years were evaluated through the trunk Impairment Scale (TIS) and Stroke specific quality of life (SSQOL) questionnaire, respectively. Pearson correlation coefficients and mediation analysis were performed to elucidate the relationship of trunk motor function with quality of life and determine the mediation impact of demographic and clinical characteristics on their association, respectively. Results: The current study observed significant correlations between trunk motor functions (TIS) and quality of life (SSQOL) with r=0.68 (p<0.001). Age, BMI, and type of stroke were detected as potential mediating factors in the association between trunk performance and quality of life. Conclusion: Validated associations between trunk motor functions and perceived quality of life among the late sub-acute stroke population emphasize the importance of comprehensive evaluation of trunk control. Rehabilitation specialists should focus on appropriate strategies to enhance trunk performance anticipating the potential effects of age, BMI, and type of stroke to improve health-related quality of life in stroke survivors.

Keywords: sub-acute stroke, quality of life, functional independence, trunk control

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Authors: Ajay Kumar Sinha, Sharad Singh, Anukriti Sinha

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Passive energy dissipation method for earthquake protection of structures is undergoing developments for improved performance. Combined use of different types of damping mechanisms has shown positive results in the near past. Different supplemental damping methods like viscous damping, frictional damping and metallic damping are being combined together for optimum performance. The conventional method of connecting passive dampers to structures is a parallel connection between the damper unit and structural member. Researchers are investigating coupling effect of different types of dampers. The most popular choice among the research community is coupling of viscous dampers and frictional dampers. The series and parallel coupling of these damping units are being studied for relative performance of the coupled system on response control of structures against earthquake. In this paper an attempt has been made to couple Fluid Viscous Dampers and Frictional Dampers in series and parallel to form a single unit of damping system. The relative performance of the coupled units has been studied on three dimensional reinforced concrete framed structure. The current theories of structural dynamics in practice for viscous damping and frictional damping have been incorporated in this study. The time history analysis of the structural system with coupled damper units, uncoupled damper units as well as of structural system without any supplemental damping has been performed in this study. The investigations reported in this study show significant improved performance of coupled system. A higher natural frequency of the system outside the forcing frequency has been obtained for structural systems with coupled damper units as against the other cases. The structural response of the structure in terms of storey displacement and storey drift show significant improvement for the case with coupled damper units as against the cases with uncoupled units or without any supplemental damping. The results are promising in terms of improved response of the structure with coupled damper units. Further investigations in this regard for a comparative performance of the series and parallel coupled systems will be carried out to study the optimum behavior of these coupled systems for enhanced response control of structural systems.

Keywords: frictional damping, parallel coupling, response control, series coupling, supplemental damping, viscous damping

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Authors: Jitendar Kumar Tiwari, Ajay Mandal, N. Sathish, A. K. Srivastava

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Since the last decade, graphene achieved great attention toward the progress of multifunction metal matrix composites, which are highly demanded in industries to develop energy-efficient systems. This study covers the two advanced aspects of the latest scientific endeavor, i.e., graphene as reinforcement in metallic materials and additive manufacturing (AM) as a processing technology. Herein, high-quality graphene and AlSi10Mg powder mechanically mixed by very low energy ball milling with 0.1 wt. % and 0.2 wt. % graphene. Mixed powder directly subjected to the powder bed fusion process, i.e., an AM technique to produce composite samples along with bare counterpart. The effects of graphene on porosity, microstructure, and mechanical properties were examined in this study. The volumetric distribution of pores was observed under X-ray computed tomography (CT). On the basis of relative density measurement by X-ray CT, it was observed that porosity increases after graphene addition, and pore morphology also transformed from spherical pores to enlarged flaky pores due to improper melting of composite powder. Furthermore, the microstructure suggests the grain refinement after graphene addition. The columnar grains were able to cross the melt pool boundaries in case of the bare sample, unlike composite samples. The smaller columnar grains were formed in composites due to heterogeneous nucleation by graphene platelets during solidification. The tensile properties get affected due to induced porosity irrespective of graphene reinforcement. The optimized tensile properties were achieved at 0.1 wt. % graphene. The increment in yield strength and ultimate tensile strength was 22% and 10%, respectively, for 0.1 wt. % graphene reinforced sample in comparison to bare counterpart while elongation decreases 20% for the same sample. The hardness indentations were taken mostly on the solid region in order to avoid the collapse of the pores. The hardness of the composite was increased progressively with graphene content. Around 30% of increment in hardness was achieved after the addition of 0.2 wt. % graphene. Therefore, it can be concluded that powder bed fusion can be adopted as a suitable technique to develop graphene reinforced AlSi10Mg composite. Though, some further process modification required to avoid the induced porosity after the addition of graphene, which can be addressed in future work.

Keywords: graphene, hardness, porosity, powder bed fusion, tensile properties

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Authors: Ashneel Ajay Singh, Naoki Suzuki, Kazumi Sakuramoto,

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The North Pacific albacore (Thunnus alalunga) is a temperate tuna species distributed in the North Pacific which is of significant economic importance to the Pacific Island Nations and Territories. Despite its importance, the stock dynamics and ecological characteristics of albacore still, have gaps in knowledge. The stock-recruitment relationship of the North Pacific stock of albacore tuna was investigated for different density-dependent effects and a regime shift in the stock characteristics in response to changes in environmental and climatic conditions. Linear regression analysis for recruit per spawning biomass (RPS) and recruitment (R) against the female spawning stock biomass (SSB) were significant for the presence of different density-dependent effects and positive for a regime shift in the stock time series. Application of Deming regression to RPS against SSB with the assumption for the presence of observation and process errors in both the dependent and independent variables confirmed the results of simple regression. However, R against SSB results disagreed given variance level of < 3 and agreed with linear regression results given the assumption of variance ≥ 3. Assuming the presence of different density-dependent effects in the albacore tuna time series, environmental and climatic condition variables were compared with R, RPS, and SSB. The significant relationship of R, RPS and SSB were determined with the sea surface temperature (SST), Pacific Decadal Oscillation (PDO) and multivariate El Niño Southern Oscillation (ENSO) with SST being the principal variable exhibiting significantly similar trend with R and RPS. Recruitment is significantly influenced by the dynamics of the SSB as well as environmental conditions which demonstrates that the stock-recruitment relationship is multidimensional. Further investigation of the North Pacific albacore tuna age-class and structure is necessary for further support the results presented here. It is important for fishery managers and decision makers to be vigilant of regime shifts in environmental conditions relating to albacore tuna as it may possibly cause regime shifts in the albacore R and RPS which should be taken into account to effectively and sustainability formulate harvesting plans and management of the species in the North Pacific oceanic region.

Keywords: Albacore tuna, Thunnus alalunga, recruitment, spawning stock biomass, recruits per spawning biomass, sea surface temperature, pacific decadal oscillation, El Niño southern oscillation, density-dependent effects, regime shift

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Authors: Karan Sharma, Ajay Kumar

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Epileptic seizure is a type of disease due to which electrical charge in the brain flows abruptly resulting in abnormal activity by the subject. One percent of total world population gets epileptic seizure attacks.Due to abrupt flow of charge, EEG (Electroencephalogram) waveforms change. On the display appear a lot of spikes and sharp waves in the EEG signals. Detection of epileptic seizure by using conventional methods is time-consuming. Many methods have been evolved that detect it automatically. The initial part of this paper provides the review of techniques used to detect epileptic seizure automatically. The automatic detection is based on the feature extraction and classification patterns. For better accuracy decomposition of the signal is required before feature extraction. A number of parameters are calculated by the researchers using different techniques e.g. approximate entropy, sample entropy, Fuzzy approximate entropy, intrinsic mode function, cross-correlation etc. to discriminate between a normal signal & an epileptic seizure signal.The main objective of this review paper is to present the variations in the EEG signals at both stages (i) Interictal (recording between the epileptic seizure attacks). (ii) Ictal (recording during the epileptic seizure), using most appropriate methods of analysis to provide better healthcare diagnosis. This research paper then investigates the effects of a noninvasive healing therapy on the subjects by studying the EEG signals using latest signal processing techniques. The study has been conducted with Reiki as a healing technique, beneficial for restoring balance in cases of body mind alterations associated with an epileptic seizure. Reiki is practiced around the world and is recommended for different health services as a treatment approach. Reiki is an energy medicine, specifically a biofield therapy developed in Japan in the early 20th century. It is a system involving the laying on of hands, to stimulate the body’s natural energetic system. Earlier studies have shown an apparent connection between Reiki and the autonomous nervous system. The Reiki sessions are applied by an experienced therapist. EEG signals are measured at baseline, during session and post intervention to bring about effective epileptic seizure control or its elimination altogether.

Keywords: EEG signal, Reiki, time consuming, epileptic seizure

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Authors: Soumita Banerjee

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The State of West Bengal is mostly watered by innumerable rivers, and they are different in nature in both the northern and the southern part of the state. The southern part of West Bengal is mainly drained with the river Bhagirathi-Hooghly, and its major distributaries and tributaries have divided this major river basin into many subparts like the Ichamati-Bidyadhari, Pagla-Bansloi, Mayurakshi-Babla, Ajay, Damodar, Kangsabati Sub-basin to name a few. These rivers basically drain the Districts of Bankura, Burdwan, Hooghly, Nadia and Purulia, Birbhum, Midnapore, Murshidabad, North 24-Parganas, Kolkata, Howrah and South 24-Parganas. West Bengal has a huge number of flood-prone blocks in the southern part of the state of West Bengal, the responsible factors for flood situation are the shape and size of the catchment area, its steep gradient starting from plateau to flat terrain, the river bank erosion and its siltation, tidal condition especially in the lower Ganga Basin and very low maintenance of the embankments which are mostly used as communication links. Along with these factors, DVC (Damodar Valley Corporation) plays an important role in the generation (with the release of water) and controlling the flood situation. This year the whole Gangetic West Bengal is being flooded due to high intensity and long duration rainfall, and the release of water from the Durgapur Barrage As most of the rivers are interstate in nature at times floods also take place with release of water from the dams of the neighbouring states like Jharkhand. Other than Embankments, there is no such structural measures for combatting flood in West Bengal. This paper tries to analyse the reasons behind the flood situation this year especially with the help of climatic data collected from the Indian Metrological Department, flood related data from the Irrigation and Waterways Department, West Bengal and GPM (General Precipitation Measurement) data for rainfall analysis. Based on the threshold value derived from the calculation of the past available flood data, it is possible to predict the flood events which may occur in the near future and with the help of social media it can be spread out within a very short span of time to aware the mass. On a larger or a governmental scale, heightening the settlements situated on the either banks of the river can yield a better result than building up embankments.

Keywords: dam failure, embankments, flood, rainfall

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Authors: Surinder Pal, Ajay Gupta, Johny Khajuria

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Casting simulation helps visualize mold filling and casting solidification; predict related defects like cold shut, shrinkage porosity and hard spots; and optimize the casting design to achieve the desired quality with high yield. Flow and solidification of molten metals are, however, a very complex phenomenon that is difficult to simulate correctly by conventional computational techniques, especially when the part geometry is intricate and the required inputs (like thermo-physical properties and heat transfer coefficients) are not available. Simulation software is based on the process of modeling a real phenomenon with a set of mathematical formulas. It is, essentially, a program that allows the user to observe an operation through simulation without actually performing that operation. Simulation software is used widely to design equipment so that the final product will be as close to design specs as possible without expensive in process modification. Simulation software with real-time response is often used in gaming, but it also has important industrial applications. When the penalty for improper operation is costly, such as airplane pilots, nuclear power plant operators, or chemical plant operators, a mockup of the actual control panel is connected to a real-time simulation of the physical response, giving valuable training experience without fear of a disastrous outcome. The all casting simulation software has own requirements, like magma cast has only best for crack simulation. The latest generation software Auto CAST developed at IIT Bombay provides a host of functions to support method engineers, including part thickness visualization, core design, multi-cavity mold design with common gating and feeding, application of various feed aids (feeder sleeves, chills, padding, etc.), simulation of mold filling and casting solidification, automatic optimization of feeders and gating driven by the desired quality level, and what-if cost analysis. IIT Bombay has developed a set of applications for the foundry industry to improve casting yield and quality. Casting simulation is a fast and efficient solution for process for advanced tool which is the result of more than 20 years of collaboration with major industrial partners and academic institutions around the world. In this paper the process of casting simulation is studied.

Keywords: casting simulation software’s, simulation technique’s, casting simulation, processes

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Authors: Ajay Mandal, Jitendar Kumar Tiwari, N. Sathish, A. K. Srivastava

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A fundamental investigation is performed on the development of graphene (Gr) reinforced stainless steel 316L (SS 316L) metal matrix composite via selective laser melting (SLM) in order to improve specific strength and wear resistance property of SS 316L. Firstly, SS 316L powder and graphene were mixed in a fixed ratio using low energy planetary ball milling. The milled powder is then subjected to the SLM process to fabricate composite samples at a laser power of 320 W and exposure time of 100 µs. The prepared composite was mechanically tested (hardness and tensile test) at ambient temperature, and obtained results indicate that the properties of the composite increased significantly with the addition of 0.2 wt. % Gr. Increment of about 25% (from 194 to 242 HV) and 70% (from 502 to 850 MPa) is obtained in hardness and yield strength of composite, respectively. Raman mapping and XRD were performed to see the distribution of Gr in the matrix and its effect on the formation of carbide, respectively. Results of Raman mapping show the uniform distribution of graphene inside the matrix. Electron back scatter diffraction (EBSD) map of the prepared composite was analyzed under FESEM in order to understand the microstructure and grain orientation. Due to thermal gradient, elongated grains were observed along the building direction, and grains get finer with the addition of Gr. Most of the mechanical components are subjected to several types of wear conditions. Therefore, it is very necessary to improve the wear property of the component, and hence apart from strength and hardness, a tribological property of composite was also measured under dry sliding condition. Solid lubrication property of Gr plays an important role during the sliding process due to which the wear rate of composite reduces up to 58%. Also, the surface roughness of worn surface reduces up to 70% as measured by 3D surface profilometry. Finally, it can be concluded that SLM is an efficient method of fabricating cutting edge metal matrix nano-composite having Gr like reinforcement, which was very difficult to fabricate through conventional manufacturing techniques. Prepared composite has superior mechanical and tribological properties and can be used for a wide variety of engineering applications. However, due to the unavailability of a considerable amount of literature in a similar domain, more experimental works need to perform, such as thermal property analysis, and is a part of ongoing study.

Keywords: selective laser melting, graphene, composite, mechanical property, tribological property

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Authors: Kamal Kaushik, Dandpani Epili, Ajay G. V., Ashutosh, S. Pradhaan

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Introduction: Radiation therapy has come a long way over a period of decades, from 2-dimensional radiotherapy to intensity-modulated radiation therapy (IMRT) or VMAT. For advanced radiation therapy, we need better patient position reproducibility to deliver precise and quality treatment, which raises the need for better image guidance technologies for precise patient positioning. This study presents a two tattoo simulation with roll correction technique which is comparable to other advanced patient positioning techniques. Objective: This is a site-specific study is aimed to perform a comparison between various treatment positioning techniques used for the treatment of patients of Ca- Breast undergoing radiotherapy. In this study, we are comparing 5 different positioning methods used for the treatment of ca-breast, namely i) Vacloc with 3 tattoos, ii) Breast board with three tattoos, iii) Thermoplastic cast with three fiducials, iv) Breast board with a thermoplastic mask with 3 tattoo, v) Breast board with 2 tattoos – A roll correction method. Methods and material: All in one (AIO) solution immobilization was used in all patient positioning techniques for immobilization. The process of two tattoo simulations includes positioning of the patient with the help of a thoracic-abdomen wedge, armrest & knee rest. After proper patient positioning, we mark two tattoos on the treatment side of the patient. After positioning, place fiducials as per the clinical borders markers (1) sternum notch (lower border of clavicle head) (2) 2 cm below from contralateral breast (3) midline between 1 & 2 markers (4) mid axillary on the same axis of 3 markers (Marker 3 & 4 should be on the same axis). During plan implementation, a roll depth correction is applied as per the anterior and lateral positioning tattoos, followed by the shifts required for the Isocentre position. The shifts are then verified by SSD on the patient surface followed by radiographic verification using Cone Beam Computed Tomography (CBCT). Results: When all the five positioning techniques were compared all together, the produced shifts in Vertical, Longitudinal and lateral directions are as follows. The observations clearly suggest that the Longitudinal average shifts in two tattoo roll correction techniques are less than every other patient positioning technique. Vertical and lateral Shifts are also comparable to other modern positioning techniques. Concluded: The two tattoo simulation with roll correction technique provides us better patient setup with a technique that can be implemented easily in most of the radiotherapy centers across the developing nations where 3D verification techniques are not available along with delivery units as the shifts observed are quite minimal and are comparable to those with Vacloc and modern amenities.

Keywords: Ca. breast, breast board, roll correction technique, CBCT

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Authors: Ajay Das, Sandip Basu

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Introduction: There is increasing recognition that diverse streams of knowledge can often be recombined in novel ways to generate new knowledge. However, knowledge recombination theory has not been applied to examine the effects of collaborator diversity on the quality of knowledge such collaborators produce. This is surprising because one would expect that a collaborative team with certain aspects of diversity should be able to recombine process elements related to knowledge development, which are relatively tacit, but also complementary because of the collaborator’s varying backgrounds. Theory and Hypotheses: We propose to examine two aspects of diversity in the environments of collaborative teams to try and capture such potential recombinations of relatively tacit, process knowledge. The first aspect of diversity in team members’ environments is geographical. Collaborators with more geographical distance between them (perhaps working in different countries) often have more autonomy in the processes they adopt for knowledge development. In the absence of overt monitoring, such collaborators are likely to adopt differing approaches to knowledge development. The sharing of such varying approaches among collaborators is likely to result in greater quality of the common collaborative pursuit. The second aspect is diversity in the work backgrounds of team members. Such diversity can also increase the potential for knowledge recombination. For example, if one or more members are from a manufacturing center (versus all of them being from a purely R&D center), such members will provide unique perspectives on the implementation of innovative ideas. Again, knowledge that has been evaluated from these diverse perspectives is likely to be of a higher quality. In addition to the above aspects of environmental diversity among team members, we also plan to examine the extent to which individual collaborators are in different environments from the primary innovation center of their employing firms. Proposed Methods: We will test our model on a sample of firms in the semiconductor industry. Our level of analysis will be individual patents generated by these firms and the teams involved in the generation of these. Information on manufacturing activities of our sample firms will be obtained from SEMI, a proprietary database of the semiconductor industry, as well as company 10-K reports. Conclusion: We believe that our results will represent a preliminary attempt to understand how various forms of diversity in collaborative teams impact the knowledge development process. Our dependent variable of knowledge quality is important to study since higher values of this variable can not only drive firm performance but the broader development of regions and societies through spillover impacts on future innovation. The results of this study will, therefore, inform future research and practice in innovation, geographical location, and vertical integration.

Keywords: innovation, manufacturing strategy, knowledge, diversity

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Authors: Petr Daniel Kovarik, Matt Kennedy, James Adams, Ajay Wilson, Andy Burns, Charles Kelly, Malcolm Jackson, Rahul Patil, Shahid Iqbal

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Introduction: Osteoradionecrosis (ORN) is a recognised toxicity of radiotherapy (RT) for head and neck cancer (HNC). Existing literature lacks any generally accepted definition and staging system for this toxicity. Objective: The objective is to analyse the outcome of the surgical and nonsurgical treatments of ORN. Material and Method: Data on 2303 patients treated for HNC with radical or adjuvant RT or RT-chemotherapy from January 2010 - December 2021 were retrospectively analysed. Median follow-up to the whole group of patients was 37 months (range 0–148 months). Results: ORN developed in 185 patients (8.1%). The location of ORN was as follows; mandible=170, maxilla=10, and extra oral cavity=5. Multiple ORNs developed in 7 patients. 5 patients with extra oral cavity ORN were excluded from treatment analysis as the management is different. In 180 patients with oral cavity ORN, median follow-up was 59 months (range 5–148 months). ORN healed in 106 patients, treatment failed in 74 patients (improving=10, stable=43, and deteriorating=21). Median healing time was 14 months (range 3-86 months). Notani staging is available in 158 patients with jaw ORN with no previous surgery to the mandible (Notani class I=56, Notani class II=27, and Notani class III=76). 28 ORN (mandible=27, maxilla=1; Notani class I=23, Notani II=3, Notani III=1) healed spontaneously with a median healing time 7 months (range 3–46 months). In 20 patients, ORN developed after dental extraction, in 1 patient in the neomandible after radical surgery as a part of the primary treatment. In 7 patients, ORN developed and spontaneously healed in irradiated bone with no previous surgical/dental intervention. Radical resection of the ORN (segmentectomy, hemi-mandibulectomy with fibula flap) was performed in 43 patients (all mandible; Notani II=1, Notani III=39, Notani class was not established in 3 patients as ORN developed in the neomandible). 27 patients healed (63%); 15 patients failed (improving=2, stable=5, deteriorating=8). The median time from resection to healing was 6 months (range 2–30 months). 109 patients (mandible=100, maxilla=9; Notani I=3, Notani II=23, Notani III=35, Notani class was not established in 9 patients as ORN developed in the maxilla/neomandible) were treated conservatively using a combination of debridement, antibiotics and Pentoclo. 50 patients healed (46%) with a median healing time 14 months (range 3–70 months), 59 patients are recorded with persistent ORN (improving=8, stable=38, deteriorating=13). Out of 109 patients treated conservatively, 13 patients were treated with Pentoclo only (all mandible; Notani I=6, Notani II=3, Notani III=3, 1 patient with neomandible). In total, 8 patients healed (61.5%), treatment failed in 5 patients (stable=4, deteriorating=1). Median healing time was 14 months (range 4–24 months). Extra orally (n=5), 3 cases of ORN were in the auditory canal and 2 in mastoid. ORN healed in one patient (auditory canal after 32 months. Treatment failed in 4 patients (improving=3, stable=1). Conclusion: The outcome of the treatment of ORN remains in general, poor. Every effort should therefore be made to minimise the risk of development of this devastating toxicity.

Keywords: head and neck cancer, radiotherapy, osteoradionecrosis, treatment outcome

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Authors: Sarika Gupta, Harshika Khanna, Ajay K Verma, Surya Kant

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Background: Drug-resistant tuberculosis (DR-TB) is a growing health challenge to global TB control efforts. Pediatric DR-TB is one of the neglected infectious diseases. In our previously published report, we have notified an increased prevalence of DR-TB in the pediatric population at a tertiary health care centre in North India which was estimated as 17.4%, 15.1%, 18.4%, and 20.3% in (%) in the year 2018, 2019, 2020, and 2021. Limited evidence exists about a pattern of drug resistance, side effect profile and programmatic outcomes of Paediatric DR-TB treatment. Therefore, this study was done to find out the pattern of resistance, side effect profile and treatment outcome. Methodology: This was a prospective cohort study conducted at the nodal drug-resistant tuberculosis centre of a tertiary care hospital in North India from January 2021 to December 2022. Subjects included children aged between 0-18 years of age with a diagnosis of DR-TB, on the basis of GeneXpert (rifampicin [RIF] resistance detected), line probe assay and drug sensitivity testing (DST) of M. tuberculosis (MTB) grown on a culture of body fluids. Children were classified as monoresistant TB, polyresistant TB (resistance to more than 1 first-line anti-TB drug, other than both INH and RIF), MDR-TB, pre-XDR-TB and XDR-TB, as per the WHO classification. All the patients were prescribed DR TB treatment as per the standard guidelines, either shorter oral DR-TB regimen or a longer all-oral MDR/XDR-TB regimen (age below five years needed modification). All the patients were followed up for side effects of treatment once per month. The patient outcomes were categorized as good outcomes if they had completed treatment and cured or were improving during the course of treatment, while bad outcomes included death or not improving during the course of treatment. Results: Of the 50 pediatric patients included in the study, 34 were females (66.7%) and 16 were male (31.4%). Around 33 patients (64.7%) were suffering from pulmonary TB, while 17 (33.3%) were suffering from extrapulmonary TB. The proportions of monoresistant TB, polyresistant TB, MDR-TB, pre-XDR-TB and XDR-TB were 2.0%, 0%, 50.0%, 30.0% and 18.0%, respectively. Good outcome was reported in 40 patients (80.0%). The 10 bad outcomes were 7 deaths (14%) and 3 (6.0%) children who were not improving. Adverse events (single or multiple) were reported in all the patients, most of which were mild in nature. The most common adverse events were metallic taste 16(31.4%), rash and allergic reaction 15(29.4%), nausea and vomiting 13(26.0%), arthralgia 11 (21.6%) and alopecia 11 (21.6%). Serious adverse event of QTc prolongation was reported in 4 cases (7.8%), but neither arrhythmias nor symptomatic cardiac side effects occurred. Vestibular toxicity was reported in 2(3.9%), and psychotic symptoms in 4(7.8%). Hepatotoxicity, hypothyroidism, peripheral neuropathy, gynaecomastia, and amenorrhea were reported in 2 (4.0%), 4 (7.8%), 2 (3.9%), 1(2.0%), and 2 (3.9%) respectively. None of the drugs needed to be withdrawn due to uncontrolled adverse events. Conclusion: Paediatric DR TB treatment achieved favorable outcomes in a large proportion of children. DR TB treatment regimen drugs were overall well tolerated in this cohort.

Keywords: pediatric, drug-resistant, tuberculosis, adverse events, treatment

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Authors: Hitesh Kshayap, Shantanu Arya, Ajay Basod, Sachin Sakhuja

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This study was undertaken to measure the overall noise levels in different locations/zones and to estimate the prevalence of Noise induced hearing loss in Hawkers & Shopkeepers in Mumbai, India. The Hearing Test developed by American Academy Of Otolaryngology, translated from English to Hindi, and validated is used as a screening tool for hearing sensitivity was employed. The tool is having 14 items. Each item is scored on a scale 0, 1, 2 and 3. The score 6 and above indicated some difficulty or definite difficulty in hearing in daily activities and low score indicated lesser difficulty or normal hearing. The subjects who scored 6 or above or having tinnitus were made to undergo hearing evaluation by Pure tone audiometer. Further, the environmental noise levels were measured from Morning to Evening at road side at different Location/Hawking zones in Mumbai city using SLM9 Agronic 8928B & K type Digital Sound Level Meter) in dB (A). The maximum noise level of 100.0 dB (A) was recorded during evening hours from Chattrapati Shivaji Terminal to Colaba with overall noise level of 79.0 dB (A). However, the minimum noise level in this area was 72.6 dB (A) at any given point of time. Further, 54.6 dB (A) was recorded as minimum noise level during 8-9 am at Sion Circle. Further, commencement of flyovers with 2-tier traffic, sky walks, increasing number of vehicular traffic at road, high rise buildings and other commercial & urbanization activities in the Mumbai city most probably have resulted in increasing the overall environmental noise levels. Trees which acted as noise absorbers have been cut owing to rapid construction. The study involved 100 participants in the age range of 18 to 40 years of age, with the mean age of 29 years (S.D. =6.49). 46 participants having tinnitus or have obtained the score of 6 were made to undergo Pure Tone Audiometry and it was found that the prevalence rate of hearing loss in hawkers & shopkeepers is 19% (10% Hawkers and 9 % Shopkeepers). The results found indicates that 29 (42.6%) out of 64 Hawkers and 17 (47.2%) out of 36 Shopkeepers who underwent PTA had no significant difference in percentage of Noise Induced Hearing loss. The study results also reveal that participants who exhibited tinnitus 19 (41.30%) out of 46 were having mild to moderate sensorineural hearing loss between 3000Hz to 6000Hz. The Pure tone Audiogram pattern revealed Hearing loss at 4000 Hz and 6000 Hz while hearing at adjacent frequencies were nearly normal. 7 hawkers and 8 shopkeepers had mild notch while 3 hawkers and 1 shopkeeper had a moderate degree of notch. It is thus inferred that tinnitus is a strong indicator for presence of hearing loss and 4/6 KHz notch is a strong marker for road/traffic/ environmental noise as an occupational hazard for hawkers and shopkeepers. Mass awareness about these occupational hazards, regular hearing check up, early intervention along with sustainable development juxtaposed with social and urban forestry can help in this regard.

Keywords: NIHL, noise, sound level meter, tinnitus

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