Government Medical College

Sir, Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East respiratory syndrome (MERS)-CoV and severe acute respiratory syndrome (SARS)-CoV1. On December 31, 2019, China informed the World Health Organization (WHO) about cases of pneumonia of unknown aetiology detected in Wuhan city, Hubei province of China. From December 31, 2019 to January 3, 2020, a total of 44 patients with pneumonia of unknown aetiology were reported to the WHO by the national authorities in China2. During this period, the causal agent was not identified. The cases initially identified had a history of exposure to the Huanan Seafood Wholesale Market3. The most common clinical features of the early clinical cases from Wuhan, China, were fever (98.6%), fatigue (69.6%) and dry cough (59.4%)4. The second meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (2005) regarding the outbreak of novel coronavirus 2019 in the People's Republic of China on January 30, 2020, declared COVID-19 outbreak as Public Health Emergency of International Concern (PHEIC)5. As on February 17, 2020, except China, 25 other countries have been affected by COVID-19 outbreak with 70,635 confirmed cases and 1,772 deaths in China. Outside China, 794 cases were reported with three deaths6. We present here the first case of COVID-19 infection reported in Kerala, India. On January 27, 2020, a 20 yr old female presented to the Emergency Department in General Hospital, Thrissur, Kerala, with a one-day history of dry cough and sore throat. There was no history of fever, rhinitis or shortness of breath. She disclosed that she had returned to Kerala from Wuhan city, China, on January 23, 2020 owing to COVID-19 outbreak situation there. She was asymptomatic between January 23 and 26. On the 27th morning, she felt a mild sore throat and dry cough. She did not give a history of contact with a person suspected or confirmed with COVID-19 infection. She did not visit the Huanan Seafood Wholesale Market, however, she gave a history of travel from Wuhan to Kunming by train where she noticed people with respiratory symptoms in railway station and train. She received the instructions from the Kerala State authorities to visit a healthcare facility if she develops any symptoms because of the travel history to China. In the Emergency department in General Hospital, she was afebrile with a pulse rate of 82/min, blood pressure 130/80 mmHg, temperature 98.5°F and oxygen saturation 96 per cent while the patient was breathing ambient air. Lung auscultation revealed normal breath sounds with no adventitious sounds. In view of her travel history from Wuhan, the district rapid response team decided to admit her in an isolation room which was designated for the corona epidemic. An oropharyngeal swab was obtained and was sent to the ICMR-National Institute of Virology (NIV), Pune, for the detection of viral respiratory pathogens on January 27, 2020. Three millilitres each of EDTA blood and plain blood samples were also collected and sent to NIV, Pune, where COVID-19 was diagnosed using real time reverse transcription PCR. Specimen collection was done on day 0 (admission) and every alternate day. Urine and stool samples were also sent for detailed evaluation. She was started on azithromycin (500 mg), cetirizine (10 mg) and saline gargle. Over the next three days, her symptoms improved. Her oropharyngeal swab result was reported by the NIV, Pune, to District Control Cell on January 30, 2020 as positive for COVID-19 infection. The details of basic laboratory investigations done on days 3, 7 and 20 of illness are shown in the Table. On day 1 of illness, the total white blood cell count was towards the low normal side, but on days 5 and 20, the count showed a rise which was consistent with a viral infection. Erythrocyte sedimentation rate was highest on day 7. The rest of the investigations were normal. She was referred to the Government Medical College, Thrissur, Kerala on January 31, 2020, and was admitted in isolation block designated for corona infection. By this time, the outbreak monitoring unit of the institution had brought out a detailed policy regarding the standard operating procedures including infection control measures to be followed in the isolation block. On presentation, she had only mild sore throat and rhinitis. She was conscious, oriented, afebrile, with pulse rate 76/min, blood pressure 100/70 mmHg, respiratory rate 12/min and oxygen saturation 97 per cent in the ambient air. General examination revealed no significant findings. She was started on oseltamivir and symptomatic measures. She gradually improved over the three days and became asymptomatic on February 3, 2020 and became negative for COVID-19 infection on day 19 of her illness. The oropharyngeal swabs for diagnosis of COVID-19 infection were collected on days 1, 4, 5, 7 and every alternate day, i.e. days 9, 11, 13 and so on after the onset of illness. The initial swabs remained positive till day 17 after which the swabs on days 19, 21 and 23 were negative and the patient was discharged. She was discharged from the hospital on February 20, 2020.Table: Clinical laboratory report of the patientA detailed contact tracing was done by the Community Medicine department of the Government Medical College, Thrissur, with the District Health Authorities. Those identified were followed up for 28 days for any symptoms. All healthcare workers in the isolation block also were followed up for 14 days.

Magnetite nanoparticles synthesized in the laboratory were used for the removal of Hexavalent chromium (Cr (VI)) from synthetically prepared wastewater. The synthesized particles were characterized using scanning electron microscopy equipped with energy dispersive X-Ray spectroscopy, X ray diffraction and thermogravimetric analyzer. Batch adsorption studies were conducted to study the effects of pH, magnetite dosage, time and initial concentration on Cr (VI) removal. Adsorption isotherm study was also conducted. Optimum pH for the present work was 3.0 and all the other studies were done at this pH. The adsorption followed Freundlich isotherm model.UV-VIS spectrophotometer was used to measure the concentration of Hexavalent chromium in water.

BACKGROUND: For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. METHODS: The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. FINDINGS: Total numbers of global DALYs grew 6·1% (95% UI 4·0-8·1), from 2·64 billion (2·46-2·86) in 2010 to 2·80 billion (2·57-3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0-14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31-1·61) global DALYs in 2010, increasing to 1·80 billion (1·63-2·03) in 2023, alongside a concurrent 4·1% (1·9-6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90·2 million [75·2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0-107·5]), depressive disorders (26·3% [11·6-42·9]), and diabetes (14·9% [7·5-25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25·8% (22·6-28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7-61·0) for diarrhoeal diseases, 42·9% (38·0-48·0) for HIV/AIDS, and 42·2% (23·6-56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6-22·0) and 24·8% (7·4-36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7-19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18-1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8·4% (6·9-10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8-37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0-11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54·4% (38·7-65·3) for unsafe sanitation, 50·5% (33·3-63·1) for unsafe water source, and 45·2% (25·6-72·0) for no access to handwashing facility, and by 44·9% (37·3-53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [-2·7 to 15·6]; non-significant). INTERPRETATION: Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. FUNDING: Gates Foundation and Bloomberg Philanthropies.

Zinc oxide can be called a multifunctional material thanks to its unique physical and chemical properties. The main objective of this paper is the preparation of zinc oxide nanoparticles using conventional methods and the preparation using surfactant. The first part of this paper presents the different methods of preparation of Zinc oxide nanoparticles using different precursors and its surface modification using Poly Vinyl Alcohol (PVA). The next part of this paper deals with characterization of the prepared zinc oxide using Scanning Electron Microscopy (SEM) and X-Ray Diffraction in order to determine which method is more feasible in terms of particle agglomeration, particle size, particle separation.

OBJECTIVES: To develop and evaluate the effectiveness of a home based intervention in reducing caregiver burden, promoting caregiver mental health and reducing behavioural problems in elderly persons with dementia. METHODOLOGY AND PRINCIPAL FINDINGS: This was a randomised controlled trial in which the person with dementia-caregiver dyad was randomly allocated either to receive the intervention immediately or to a waiting list group which received the intervention after 6 months. It was carried out in communities based in two talukas (administrative blocks) in Goa, India. Mild to moderate cases with dementia (diagnosed using the DSM IV criteria and graded using the Clinical Dementia Rating scale) and their caregivers were included in the trial. Community based intervention provided by a team consisting of Home Care Advisors who were supervised by a counselor and a psychiatrist, focusing on supporting the caregiver through information on dementia, guidance on behaviour management, a single psychiatric assessment and psychotropic medication if needed. We measured caregiver mental health (General Health Questionnaire), caregiver burden (Zarit Burden Score), distress due to behavioural disturbances (NPI-D), behavioural problems in the subject (NPI-S) and activities of daily living in the elder with dementia (EASI). Outcome evaluations were masked to the allocation status. We analysed each outcome with a mixed effects model. 81 families enrolled in the trial; 41 were randomly allocated to the intervention. 59 completed the trial and 18 died during the trial. The intervention led to a significant reduction of GHQ (-1.12, 95% CI -2.07 to -0.17) and NPI-D scores (-1.96, 95%CI -3.51 to -0.41) and non-significant reductions in the ZBS, EASI and NPI-S scores. We also observed a non-significant reduction in the total number of deaths in people with dementia in the intervention arm (OR 0.34, 95% CI 0.01 to 1.03). CONCLUSION: Home based support for caregivers of persons with dementia, which emphasizes the use of locally available, low-cost human resources, is feasible, acceptable and leads to significant improvements in caregiver mental health and burden of caring. ClinicalTrials.gov NCT00479271.

BACKGROUND: Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations. METHODS: GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds. FINDINGS: The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6-47·0) in 1990 to 63·4 years (63·1-63·7) in 2023. For males, mean age increased from 45·4 years (45·1-45·7) to 61·2 years (60·7-61·6), and for females it increased from 48·5 years (48·1-48·8) to 65·9 years (65·5-66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9-81·0) and for males 74·8 years (74·8-74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5-38·4) for females and 35·6 years (35·2-35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean age at death lower than the expected value. INTERPRETATION: We examined global mortality patterns over the past three decades, highlighting-with enhanced estimation methods-the impacts of major events such as the COVID-19 pandemic, in addition to broader trends such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition. This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and deepening our understanding of where targeted resources could be applied to further reduce preventable sources of mortality. We provide essential insights into global and regional health disparities, identifying locations in need of targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease, particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are affecting all nations, albeit at different paces and scales. FUNDING: Gates Foundation.

Purpose The relevance of small and medium enterprises (SMEs) in contributing to the economy and social development is increasingly felt in the current business environment. Focusing on sustainable development, SMEs have also implemented many acting strategies of large-scale enterprises such as lean and green practices. The purpose of this paper is to investigate the linkage between lean manufacturing practices (LMPs) in SMEs and their sustainability performances. Further, this study explores the relationship between the triple bottom line sustainability performances. Design/methodology/approach The study is based on a survey conducted and data collected from 252 manufacturing SMEs in India. The hypothesized relationships are then analyzed with structural equation modeling. Findings The outcome of the analysis shows that LMPs are positively associated with various sustainability performances categorized as economic, environmental, and social performances. Further, this study shows that environmental sustainability is correlated with economic and social sustainability performances. Research limitations/implications The study conducted was limited to a particular state in India. Moreover, the study uses the data from a cross-sectional survey from single respondents. Practical implications The findings of the study become an added advantage for the managers to convince their various stakeholders for implementing LMPs in SMEs. Originality/value The research findings provide theoretical and practical insights to derive the importance of LMPs in maximizing sustainability performances. It gives an enhanced perspective of the importance of LMPs on the sustainability performance of SMEs.

Aluminium silicon carbide metal matrix composites are used in various fields like aerospace, aircrafts, underwater, automobile, substrate in electronics, golf clubs, turbine blades, brake pads etc. Several fabrication techniques are available for the production of aluminium silicon carbide metal matrix composites (Al-SiC MMC). Among the various methods, stir casting route is simple, less expensive, and used for mass production. The main limitations of stir cast Al-SiC MMC are improper distribution of SiC reinforcement in matrix and less wettablity of SiC reinforcement particle with molten Al. Literature survey indicate that various properties of stir cast Al-SiC MMC depends upon fabrication method, volume fraction, shape, size of particles and distribution and properties of constituents. Since metal matrix composites (MMC) lack structural simplicity its analytical modeling is complex. Further, the involvement of several parameters which affect composite properties, makes the experiments difficult. This review paper contemplates the need of simulation or numerical methods for the prediction of mechanical characteristics of Al-SiC MMC.

BACKGROUND: Dementia is a rapidly growing problem in all parts of the developing world. Such societies are characterised by low levels of awareness regarding dementia as a chronic degenerative brain syndrome, and by an absence of supportive health and welfare services. There is reliance upon families as the cornerstone of support and care. However, surprisingly little is known of the care arrangements for people with dementia and the strain experienced by their family caregivers. METHOD: In a qualitative study of 17 caregivers of people with Alzheimer's disease identified through an innovative case-finding program in Thrissur, South India, we obtained information on the range of care arrangements, attitudes towards care giving roles and sources of strain. RESULTS: The majority of caregivers were young women, often daughters-in-law of women with dementia. The principal sources of caregiver strain were behavioural problems associated with the dementia syndrome, and incontinence. Strain was exacerbated by the lack of supportive response by local health services, and by lack of support and, sometimes, criticism from other family members. Family conflict was commonly encountered. The majority of caregivers experienced significant deterioration in their mental health. One caregiver unfortunately committed suicide after the death of her husband. CONCLUSIONS: There is a clear need for more education, advice and support for families affected by dementia. Community services in developing countries should consider training existing domiciliary outreach services, the community-based multi-purpose health workers, to identify and support family caregivers.

Abstract In general, the photovoltaic (PV) is considered as the best selection among renewable energy resources due to its nonpolluted operation and good flexibility condition. The PV system is affected because of the partial shading conditions (PSCs), which reduce the generated power. During steady‐state operating conditions, there occurs a time delay in tracking the Global maximum power point (GMPP) and Local maximum power point (LMPP) under PSCs using the perturb and observe (P&O) method. In order to overcome such shortcomings, this paper proposed a hybrid algorithm with a P&O technique to improve the maximum power point tracking (MPPT) for the PV system under PSC. In addition to this, the P&O technique is utilized to achieve the LMPP in the first section, and the hybrid algorithm is utilized to achieve the GMPP in the second section. Here, the hybrid technique is the integration of Cauchy preferential crossover (CC) with the flower pollination algorithm (FPA). Furthermore, the exploitation ability of the FPA is enhanced by the CC, and the combined hybrid algorithm has the ability to produce the optimal duty cycle for the DC–DC boost converter for MPPT. Then the proposed method will be executed in MATLAB/Simulink model, and it is contrasted with the existing methods such as CC, current sensorless (CS), and FPA, respectively. The experimental results and analysis reveal that the proposed approach provides better performances when compared with several other metaheuristic algorithms.

After cardiovascular disease, cancer is the leading cause of death worldwide with devastating health and economic consequences, particularly in developing countries. Inter-patient variations in anti-cancer drug responses further limit the success of therapeutic interventions. Therefore, personalized medicines approach is key for this patient group involving molecular and genetic screening and appropriate stratification of patients to treatment regimen that they will respond to. However, the knowledge related to adequate risk stratification methods identifying patients who will respond to specific anti-cancer agents is still lacking in many cancer types. Recent advancements in three-dimensional (3D) bioprinting technology, have been extensively used to generate representative bioengineered tumor in vitro models, which recapitulate the human tumor tissues and microenvironment for high-throughput drug screening. Bioprinting process involves the precise deposition of multiple layers of different cell types in combination with biomaterials capable of generating 3D bioengineered tissues based on a computer-aided design. Bioprinted cancer models containing patient-derived cancer and stromal cells together with genetic material, extracellular matrix proteins and growth factors, represent a promising approach for personalized cancer therapy screening. Both natural and synthetic biopolymers have been utilized to support the proliferation of cells and biological material within the personalized tumor models/implants. These models can provide a physiologically pertinent cell-cell and cell-matrix interactions by mimicking the 3D heterogeneity of real tumors. Here, we reviewed the potential applications of 3D bioprinted tumor constructs as personalized in vitro models in anticancer drug screening and in the establishment of precision treatment regimens.

Chitosan is a biopolymer, which is an amino polysaccharide derived from the N-deacetylation of chitin. It is a natural polymer because of the presence of degradable enzyme Chitosan. Chitosan is blended with synthetic polymer PVA with formaldehyde enhances the thermal stability. Thermogravimetric analysis was conducted to measure the weight loss of the above mentioned blend systems at a heating rate 10oCmin-1 in nitrogen atmosphere. It is evident that formaldehyde is acting as a cross linker for Chitosan-PVA blend which have high thermal degradation or high thermal stability when compared with Chitosan-PVA-glycerol and Chitosan-PVA blends. The presence of cross linking agents like formaldehyde decreases the solubility to certain extent, and also increases the thermal stability due to the presence of aldehyde (-CHO-) group in the formaldehyde, forming cross links with amine(-NH2-) group present in the Chitosan. This reaction is based on the Schiff's base mechanism. Various compositions of Chitosan-PVA blends have been studied for its thermal and mechanical properties. The mean tensile strength and percentage elongation of Chitosan-PVA blends decreases with decrease in PVA content. But on addition of glycerol on to the blends of Chitosan-PVA, the percentage elongations increase and mean tensile strength decreases.

BACKGROUND: There are no recent data on prevalence of coronary artery disease (CAD) in Indians. The last community based study from Kerala, the most advanced Indian state in epidemiological transition, was in 1993 that reported 1.4% definite CAD prevalence. We studied the prevalence of CAD and its risk factors among adults in Kerala. METHODS: In a community-based cross sectional study, we selected 5167 adults (mean age 51 years, men 40.1%) using a multistage cluster sampling method. Information on socio-demographics, smoking, alcohol use, physical activity, dietary habits and personal history of hypertension, diabetes, and CAD was collected using a structured interview schedule. Anthropometry, blood pressure, electrocardiogram, and biochemical investigations were done using standard protocols. CAD and its risk factors were defined using standard criteria. Comparisons of age adjusted prevalence were done using two tailed proportion tests. RESULTS: The overall age-adjusted prevalence of definite CAD was 3.5%: men 4.8%, women 2.6% (p < 0.001). Prevalence of any CAD was 12.5%: men 9.8%, women 14.3% (p < 0.001). There was no difference in definite CAD between urban and rural population. Physical inactivity was reported by 17.5 and 18% reported family history of CAD. Other CAD risk factors detected in the study were: overweight or obese 59%, abdominal obesity 57%, hypertension 28%, diabetes 15%, high total cholesterol 52% and low level of high density lipoprotein cholesterol 39%. Current smoking was reported only be men (28%). CONCLUSION: The prevalence of definite CAD in Kerala increased nearly three times since 1993 without any difference in urban and rural areas. Most risk factors of CAD were highly prevalent in the state. Both population and individual level approaches are warranted to address the high level of CAD risk factors to reduce the increasing prevalence of CAD in this population.

In this correspondence, we present an accurate Magnetic Resonance (MR) image Super-Resolution (SR) method that uses a Very Deep Residual network (VDR-net) in the training phase. By applying 2D Stationary Wavelet Transform (SWT), we decompose each Low Resolution (LR)-High Resolution (HR) example image pair into its low-frequency and high-frequency subbands. These LR-HR subbands are used to train the VDR-net through the input and output channels. The trained parameters are then used to generate residual subbands of a given LR test image. The obtained residuals are added with their LR subbands to produce the SR subbands. Finally, we attempt to maintain the intrinsic structure of images by implementing the Gaussian edge-preservation step on the SR subbands. Our extensive experimental results show that the proposed MR-SR method outperforms the existing methods in terms of four different objective metrics and subjective quality.

Alzheimer's disease (AD) is a progressive condition that affects cognition, function, and behavior. Approximately 60-90% of patients with AD develop neuropsychiatric symptoms (NPS) such as hallucinations, delusions, agitation/aggression, dysphoria/depression, anxiety, irritability, disinhibition, euphoria, apathy, aberrant motor behavior, sleep disturbances, appetite and eating changes, or altered sexual behavior. These noncognitive behavior changes are thought to result from anatomical and biochemical changes within the brain, and have been linked, in part, to cholinergic deficiency. Cholinesterase inhibitors may reduce the emergence of NPS and have a role in their treatment. These agents may delay initiation of, or reduce the need for, other drugs such as antipsychotics. This article summarizes the effects of donepezil, a cholinesterase inhibitor, on the NPS of dementia with emphasis on AD and dementia with Lewy bodies.

The 143 low- and middle-income countries (LMICs) of the world constitute 80% of the world's population or roughly 5.86 billion people with much variation in geography, culture, literacy, financial resources, access to health care, insurance penetration, and healthcare regulation. Unfortunately, their burden of cardiovascular disease in general and acute ST-segment-elevation myocardial infarction (STEMI) in particular is increasing at an unprecedented rate. Compounding the problem, outcomes remain suboptimal because of a lack of awareness and a severe paucity of resources. Guideline-based treatment has dramatically improved the outcomes of STEMI in high-income countries. However, no such focused recommendations exist for LMICs, and the unique challenges in LMICs make directly implementing Western guidelines unfeasible. Thus, structured solutions tailored to their individual, local needs, and resources are a vital need. With this in mind, a multicountry collaboration of investigators interested in LMIC STEMI care have tried to create a consensus document that extracts transferable elements from Western guidelines and couples them with local realities gathered from expert experience. It outlines general operating principles for LMICs focused best practices and is intended to create the broad outlines of implementable, resource-appropriate paradigms for management of STEMI in LMICs. Although this document is focused primarily on governments and organizations involved with improvement in STEMI care in LMICs, it also provides some specific targeted information for the frontline clinicians to allow standardized care pathways and improved outcomes.

BACKGROUND: Dementia care in developing countries will continue to be provided by co-resident caregivers at home. Behavioral and Psychological Symptoms of Dementia (BPSD) are difficult to manage at home. Interventions leading to reduction or remission of reduction or remission of BPSD will be of immense help in the management of these patients. MATERIALS AND METHODS: The nature and prevalence of BPSD in a community sample of patients with dementia was assessed by a clinician. The impact of these symptoms on the caregiver was assessed by measures of burden of care and the psychological well being of the caregiver. Another rater carried out these assessments independently. RESULTS: Prevalence of BPSD was very high and they were more common in patients with Alzheimer's Disease than patients with Vascular Dementia. They were rated as troubling to most caregivers. Caregiver burden was associated with adverse effects on the mental health of the carer. CONCLUSIONS: To be effective, dementia care services in developing countries need to focus on management of BPSD at home. Development of a low cost, effective and sustainable dementia care service should be given due importance by the policy makers in the developing world.

The hydromagnetic flow of magnetite–water nanofluid due to a rotating stretchable disk has been numerically assessed. The nanofluid flow has been modeled utilizing the adapted Buongiorno model that considers the volume fraction-dependent effective nanofluid properties and the major slip mechanisms. In addition, experimentally gleaned functions of effective dynamic viscosity and effective thermal conductivity are deployed. The modeled equations are transformed into a first-order ODEs scheme employing Von Kármán’s similarity conversions and then resolved via the Runge–Kutta algorithm through the shooting technique. The impact of pertinent terms over the physical quantities, nanoliquid temperature and nanoliquid concentration is explained with the support of graphs. Results show that rising volume fraction of magnetite nanoparticles (NPs) and magnetic field term enhance the drag force. Mass transport rate is demoted with augmenting values of magnetic field parameter whereas is promoted with increase in Schmidt number. Further, it is detected that the changes in stretching strength parameter are directly proportional to Nusselt number and inversely proportional to the thermal field. The findings of this numerical analysis have applications in spin coating, rotating disk reactors, storage devices for computers, food processing, and rotating heat exchangers.

The significance and need of demand response (DR) programs is realized by the utility as a means to reduce the additional production cost imposed by the accelerating energy demand. With the development in smart information and communication systems, the price-based DR programs can be effectively utilized for controlling the loads of smart residential buildings. Nowadays, the use of stochastic renewable energy sources like photovoltaic (PV) by a small domestic consumer is increasing. In this paper, a generalized model for the residential load scheduling or load commitment problem (LCP) in the presence of renewable sources for any type of tariff is presented. Reinforcement learning (RL) is an efficient tool that has been used to solve the decision making problem under uncertainty. An RL-based approach to solve the LCP is also proposed. The novelty of this paper lies in the introduction of a comprehensive model with implementable solution considering consumer comfort, stochastic renewable power, and tariff. Simulation experiments are conducted to test the efficacy and scalability of the proposed algorithm. The performance of the algorithm is investigated by considering a domestic consumer with schedulable and nonschedulable appliances along with a PV source. Guidelines are given for choosing the parameters of the load.

BACKGROUND: Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are a group of severe life threatening drug reactions. The drugs commonly implicated as the cause of these drug reactions vary depending on host factors and the prescription pattern of drugs in that particular area. AIM: The aim of the study was to find the drugs implicated as the cause of SJS/TEN in the patients admitted in the dermatology ward at the Medical College, Thrissur and to find the clinical outcome. METHODS: It was a retrospective study of 7 years from 1997 to 2004. The case records of all patients with a clinical diagnosis of TEN or SJS were studied in detail regarding the drugs implicated as the cause, the management and the clinical outcome. RESULTS: During the study period, 41 patients in the age group ranging from 12 to 72 years were treated as inpatients, of which 20 were males and 21 were females. The commonest drug implicated as the cause of SJS/TEN was carbamazepine (44%). The indication for carbamazepine was control of pain in more than 50% of the cases. Presence of a major systemic disease before the onset of SJS/TEN was associated with a bad prognosis. CONCLUSION: The increased use of carbamazepine, especially for control of pain, may be the reason for the increased incidence of SJS/TEN due to the same drug. Awareness about the drugs implicated in life threatening drug reactions will help physicians in preventing them by judicious use of the drugs.