ashok kumar

The aim of this study is to find out the influence of different Segment shape optimization (SSO) parameters in radiotherapy Volumetric Modulated Arc therapy (VMAT) planning of Cervical Cancer and to find out the optimized value for cervical cancer patients. It was a retrospective study of 20 Ca cervix patients. Every patient had six plans named SL1, SL5, SL10, SL15, SL20, and NSL. In each case, the value of the shaping loop will be changed during the VMAT plan, while the other optimization parameters and constraint functions will remain the same in each case. All Dosimetric parameters have been measured and analysed for Planning Target Volume (PTV) and Organ at risk (OAR) dose, Monitor Unit (MU), memory, Plan Delivery Time (PDT), and Gamma Passing Rate (GPR) for comparison purposes. In NSL cases, the PTV dose derived from the DVH did not meet the clinical standards D95% = 86.8% (<95%) with a poorer homogeneity index (HI = 0.2). As the SL value increases, plan quality increases, monitor units increase slightly and plan delivery time decreases while there is a parallel increase in memory consumption. There is no statistical difference in target dose and OAR dose between the SL5 and SL1 plans (P > 0.05) compared with the other groups. SL5 has the least plan memory compared to other SL values. Based on the plan quality, the dose accuracy, and the efficiency of delivery, SL1 and SL5 have similar characteristics in cervical cancer cases. Both SL1 and SL5 values should recommend for cervical cancer VMAT planning.

In the present manuscript, it is our utmost aim and objective to comprehensively and extensively expound upon two highly innovative and remarkably novel information measures that have been adeptly and appropriately extended to encompass fuzzy sets. These measures have undergone a rigorous and meticulous scrutiny and examination with regard to axiomatic principles, and have evinced numerous and manifold advantageous properties, thus providing a compelling and highly persuasive validation of their reliability, credibility, and overall effectiveness. It is of paramount importance to note that the measures in question have been meticulously and painstakingly designed with the express aim and purpose of effectively quantifying the extent of information that is inextricably embedded and enmeshed within fuzzy sets, and are firmly grounded in the foundational and bedrock principles of information theory, which is an indisputably and irrefutably significant and substantial academic discipline. Our contributions to the field of study are truly and incontestably unparalleled, and offer a fresh, innovative, and unprecedented perspective on the study of fuzzy sets and their associated information content, which is of immense and inestimable value to the overall advancement and progress of the academic discipline.

This paper presents an innovative Asymmetrical Single-Phase Nine Level Inverter (ASRNLI) that stands out among various available configurations. The design achieves a staircase-like voltage pattern with the highest number of levels while utilizing a reduced number of components. Compared to conventional systems, asymmetric multilevel inverters require fewer components yet manage to create a cascade structure with multiple output levels. The ASRNLI configuration consists of two independent DC sources and 10 switches, allowing it to generate any desired level. This setup offers several advantages, including improved output voltage quality attributed to the switches' low blocking voltage. It proves particularly valuable in scenarios where asymmetric DC voltage sources are accessible, such as in modern electric vehicles and AC mini-grids powered by renewable energy sources. To generate gate pulses, the ASRNLI employs the level-shifted pulse width modulation approach. Validation of the suggested ASRNLI configuration was carried out through both MATLAB simulations and the construction of a prototype. The output waveform demonstrated a Total Harmonic Distortion (THD) of 13.50% at the highest fundamental voltage of 400V. Throughout this article, the effectiveness of the ASRNLI configuration is supported by findings from simulations and experimental tests, showcasing its potential as a promising solution for practical applications.

The results of the IABP-SHOCK II trial did not encourage the use of an intra-aortic balloon pump (IABP) in cardiogenic shock (CS) with ST-elevation myocardial infarction (STEMI). We aimed to determine whether these findings may be applicable to our population in the South Asian region, as there is a paucity of data.

In this prospective cohort study, 2 independent cohorts of STEMI patients with CS were recruited based on the utilization of IABP during revascularization. The primary endpoints of in-hospital and after 30 days of major adverse cardiac events (MACE) and the secondary endpoint of any major bleed were compared between the 2 cohorts.

In total, each cohort consisted of 130 patients. Demographic, clinical, and angiographic profiles were comparable in the 2 cohorts. In the IABP and non-IABP cohorts, the in-hospital and 30-day mortality rates were 19.2% vs 26.2%; P=0.183 and 30.8% vs 36.9%; P=0.358, respectively, while the MACE rates were 20.8% vs 26.2%; P=0.306 and 32.3% vs 36.9%; P=0.434, respectively. Cardiac catheterization laboratory death was 0.8% vs 5.4%; P=0.031 and the major bleed was 4.6% vs 3.8%; P=0.758, among patients managed with IABP and without IABP, respectively.

Our study concluded that while there was no significant difference in the overall outcome, there was a lower trend in in-hospital mortality and significantly lower cardiac catheterization laboratory death with the use of IABP. However, the in-hospital and 30-day MACE were comparable in both groups. 

With the increase in the number of new cancer cases, the number of patients receiving chemotherapy increases. The administration of chemotherapy is a very significant task. Unfortunately, the availability of a chemotherapy administration checklist still lags behind. The aim is to develop a chemotherapy administration checklist for patients receiving chemotherapy.

This study was conducted at the oncology day care and in‑patient department (IPD) wards of the All India Institute of Medical Sciences, Jodhpur, Rajasthan. Methodological research design was used in this study. It took place in five phases: preliminary phase includes literature review, focussed group discussion, assessment of current practices, generation of item pool, and preparation of preliminary draft; then its validation by modified Delphi technique, pilot testing; final try out, and evaluation phase. A total of 260 patients were enrolled.

The content validity index was 0.97. To perform factor analysis and principal component analysis KMO and Bartlett’s test of sphericity was used, which allows the data for factor analysis to yield eight components. A total of 26 items were formulated. The scoring was done dichotomously; a score of 1 is for done and 0 for not done and not applicable. Cronbach’s alpha was used to find out the internal consistency of the checklist was found to be 0.72. For interrater reliability, the Cohen kappa’s value was found to be 0.91.

Chemotherapy administration checklist was a valid and reliable checklist. This checklist is feasible and easy to incorporate into clinical practices.

 Diffuse cavernous haemangioma of rectum (DCHR) is rare in clinical practice. Rarely, DCHR may be associated with Klippel-Trenaunay syndrome and are commonly misdiagnosed, and treated as hemorrhoids. The usual presentation is with painless bleeding per rectum. Despite many diagnostic modalities available today, the correct diagnosis is difficult to arrive at. Although the management of these cases has evolved over years, it still remains a challenge for the surgeons because of the nature and extent of involvement and risk of bleeding during the surgery. The advocated surgical interventions vary from abdomino-perineal resection (APR) to sphincter preserving surgery. Recently, transarterial embolization (TAE) has been found to be useful as a nonsurgical method of treatment in select cases of DCHR. DCHR with extension upto dentate line in young patients can be managed by sphincter preserving surgery with the advent of modern staplers, avoiding the abdominoperineal resection and a permanent stoma. We present two cases of this rare entity, DCHR, managed in our department by ultralow anterior resection with stapled anastomosis, with a review of the literature emphasizing on management.

Acute coronary syndrome (ACS) is a rapidly growing concern, especially among younger urban communities. We aimed to study age-based differences in clinical and angiographic profiles and outcomes in an urban population.
This study recruited 2 independent, equal-sized cohorts of consecutive patients with ACS undergoing coronary angiography: younger and older cohorts (based on an age cutoff point of 35 years). Clinical and angiographic profiles were compared as primary endpoints, and in-hospital and 3-month major adverse cardiovascular events (MACE) were compared between the 2 cohorts as secondary endpoints.
Each cohort was composed of 103 patients. The younger cohort, compared with the older cohort, revealed higher overweight (69.9% vs 51.5%), positive family history (12.6% vs 4.9%; P=0.048),  use of gutka (smokeless tobacco) (56.3% vs 14.3%; P=0.017), smoking (41.7% vs 33%; P=0.195), total cholesterol (155.05±46.6 mg/dL vs 140.40±35.6 mg/dL; P=0.012), low-density lipoprotein cholesterol (96.74±41.23 mg/dL vs 84.14±27.25 mg/dL; P=0.010), normal/nonobstructive coronaries (15.5% vs 1.9%; P<0.001), single-vessel disease (60.2% vs 35.0%), type A lesions (36.8% vs 17.8%), left ventricular ejection fraction exceeding 40% (57.3% vs 42.7%; P=0.037), medical treatment only as the management strategy (16.5% vs 2.9%), in-hospital MACE (8.7% vs 12.6%; P=0.0367), and 3-month MACE (4.9% vs 12.6%; P=0.048), respectively.
Our younger subjects tended to have higher weight, gutka use, and positive family history than traditional risk factors with a greater frequency of single-vessel disease with type A lesions and normal or nonobstructive disease amenable to medical treatment only. (Iranian Heart Journal 2022; 23(2): 96-105)

The nationwide coronavirus (COVID‑19) pandemic and ensuing lockdown has enforced institutions crosswise India to provisionally close to inhibit the spread of the virus and started online learning for students. To measure the level of satisfaction of nursing students with online learning and to identify the barriers which restrict to online learning.

The current study adopted quantitative research approach with an online survey research design and carried out during May–June 2020. Participants were selected through a web‑based survey (Google form), in which 219 students enrolled. Self‑structured questionnaire with the Likert scale was used to measure the level of satisfaction of nursing students with online learning and identify the barriers which restrict online learning. The descriptive and inferential statistics were used for the analysis in which 219 participants were enrolled in the study of data with IBM SPSS version 20.

Majority of student’s participants 148 (67.57%) were extremely satisfied with online learning. The findings suggest that the highest barriers which restrict to online learning among nursing students is low voice and language clarity (2.16 ± 0.593), physical health barriers such as eye strain (2.43 ± 0.613), reliability and connectivity problem (2.26 ± 0.534). Among all demographic data, age is significantly associated with the level of satisfaction of online learning.

The study data indicated that maximum students were extremely satisfied the with online learning and among barriers which effect online learning is low voice and language clarity, reliability and connectivity problem, physical health barriers such as eye strain.

Mesenchymal Stem Cell (MSC) therapy in osteoarthritis has been hailed as a promising treatment for osteoarthritis dueto their unlimited potential of healing and regeneration. Existing literature regarding their proper name, optimal sources,mechanisms of action, dosage, and route of administration, efficacy, and safety is debatable. This index review articlehas tried to connect these puzzling pieces of available information and brought clarity on some of these crucial issues.The author believes that Maintenance Stem Cells (MSC) may be a more suitable term than mesenchymal stem cell ormedicinal signaling cells as their origin might not be limited to mesodermal tissue. Also, they have been shown capableof self-renewal, differentiation, and maintaining a cascade of healing & possibly regeneration at the implanted site. Onlya small percentage of implanted MSC survive and rest undergo apoptosis after releasing growth factors, cytokines, andextracellular vesicles. These surviving MSC become active due to conformational changes induced by anti-environmentstimuli and undergo limited self-renewal, proliferation, and differentiation, but only a few of them might incorporate into thehost tissues. These cells generate & maintain a momentum of series of regenerative activities to improve the function ofjoint, stabilize or possibly enhance the cartilage quality. More randomized studies with long term follow-up are required tobring clarity on their ideal source, expansion, culture technique, optimum dosage, and route of administration and longtermsafety issues.Level of evidence: V

To report a complication little reported until now: to and fro migration of the dexamethasone implant between the anterior and posterior segment (wandering Ozurdex) of sclera fixated intraocular lens (IOL) eyes and its effective management.

Two cases of to and fro migration of Ozurdex (wandering Ozurdex) in two pseudophakic patients with scleral fixated posterior chamber IOL: first, a case of Vogt Koyanagi Harada (VKH) disease and second, a case of pseudophakic cystoids macular edema (CME) were successfully managed.

Both patients were initially managed with repositioning of implants by supine posturing and use of drugs, but implants again migrated into anterior chamber and underwent surgical removal with preservation of corneal transparency.

Patients with scleral fixated posterior chamber IOL present a high risk of anterior chamber migration of the Ozurdex implant. Prompt removal of Ozurdex implant in these patients can reduce risk of endothelial decompensation. In such cases, returning the implant with positioning is not a good option.

Shell foundations are economical alternatives to the conventional flat shallow foundation, regarding material-saving technique. Shell foundation comes under the category of the shallow foundation. Concrete funicular shells of square plan, double curvature with various thicknesses are analyzed for the concentrated load. Specimens of size 680 × 680 mm are prepared using cement M30 concrete grade for which the mix design is carried by IS method. Formwork is prepared by concrete above which test specimen is prepared. The specimens are prepared with various thicknesses of 40 mm, 50 mm, 60 mm. The specimens are moist cured for 28 days before testing. The concentrated load over the column is applied, and the corresponding deflections and settlement characteristics are measured within elastic range. Beyond elastic range specimens are subjected to fail, and the ultimate loads are determined. The experimental result shows that load carrying capacity for 60 mm thick specimen (8 mm ɸ bar) is more compared to 40 mm and 50 mm thick specimen. Also by increasing the area of steel of edge beam reinforcement by 40% causes the increase in ultimate load carrying capacity by 15% and it also reduces the maximum settlement by 26%. A comparative study of the flat foundation and shell foundation shows that ultimate load carrying capacity for shell foundation increases by 50%. Finite element analysis was done using SAP 2000. Using the finite element model, a parametric study was conducted to determine the changes in stress level in the funicular shell. The magnitude of concentrated load used for the FEM analysis is same as the ultimate load of experimental work.

Immunosensor for illicit drugs have gained immense interest and have found several applications for drug abuse monitoring. This technology has offered a low cost detection of narcotics; thereby, providing a confirmatory platform to compliment the existing analytical methods.
In this minireview, we define the basic concept of transducer for immunosensor development that utilizes antibodies and low molecular mass hapten (opiate) molecules.
This article emphasizes on recent advances in immunoanalytical techniques for monitoring of opiate drugs. Our results demonstrate that high quality antibodies can be used for immunosensor development against target analyte with greater sensitivity, specificity and precision than other available analytical methods.
In this review we highlight the fundamentals of different transducer technologies and its applications for immunosensor development currently being developed in our laboratory using rapid screening via immunochromatographic kit, label free optical detection via enzyme, fluorescence, gold nanoparticles and carbon nanotubes based immunosensing for sensitive and specific monitoring of opiates.

Depressive disorder is a prevalent psychiatric disorder، which affects 21% of the world population. The presently using drugs can impose a variety of side-effects including cardiac toxicity، hypopiesia، sexual dysfunction، body weight gain، and sleep disorder. During the last decade، there is a growing interest in the therapeutic effects of natural products on mental disorders. Amaranthus spinosus was investigation for antidepressant activity. Antidepressant activity of methanolic extract of Amaranthus spinosus (MEAS) was investigated by using Forced swimming test (FST) and Tail suspension test (TST) models. Escitalopram and Imipramine were used as reference standards. It has been observed from our study that both the MEAS at higher concentration showed significant (p<0. 01) reduction in immobility in tail suspension and forced swim model of depression comparable to Escitalopram and Imipramine. However further study is needed to understand mechanism of action and to identify active component responsible for antidepressant like activity.

Gokhsuradi churna is an ayurvedic formulation, was investigate for antiurolithiatic activity. Calcium oxalate crystallization was induced by the addition of 0.01M sodium oxalate solutions in synthetic urine and nucleation method. The effect of Gokhsuradi Churna exhibited a concentration dependent inhibition of on calcium oxalate crystallization and nucleation. The present studies suggest that Gokhsuradi churna has a potential inhibition of calcium oxalate crystallization exhibited and nucleation. Gokhsuradi Churna showed potent antiurolethiatic activity.

Poaceae is the fourth largest family of the flowering plants. It includes about 700-800 genera and 11000-13000 species distributed worldwide. The family has unmatched ecological and economic importance. With its origin in the early cretaceous and major diversification in the mid Cenozoic، the family at present covers nearly a fifth of land surface and occurs in nearly all the habitats of the world. With a sub tropical ecology and an agrarian economy of Punjab، grasses comprise the most significant group in the region. Despite an overwhelming significance، taxonomic studies in grasses have not received sufficient attention in the region. It is only in the work of Sharma and Khosla (1989) that grass species have been classified into subfamilies and tribes. However، after the establishment of the Grass Phylogeny Working Group (GPWG) the world has witnessed a renaissance in grass systematics. But، India remains an ‘undercollected’ country as far as grass diversity is concerned. Our work on the exploration and systematics of the grass flora of the region is an effort to consolidate and update the information on the diversity of grasses of the studied area. The present studies have brought the cumulative species number to 192 including seven new reports. The species representation of subfamilies is: Aristidoideae (5) Arundinoideae (5) Bambusoideae (4)، Centothecoideae (1)، Chloridoideae (55) Erhartoideae (3)، Panicoideae (98) and Pooideae (21).

The aim of this study was to compare the smear layer removal efficacies of 3% sodium hypochlorite (NaOCl), 17% Ethylenediaminetetraacetic acid (EDTA), SmearClear and BioPure MTAD using a common irrigation protocol. Fifty freshly extracted human single rooted maxillary and mandibular teeth were prepared by a ProTaper rotary system up to an apical preparation file size F3. Prepared teeth were randomly divided into five groups (n=10); distilled water (Group A; negative control), EDTA (Group B), SmearClear (Group C), BioPure MTAD (Group D) and NaOCl (Group E). After final irrigation with tested irrigants the teeth were decoronated, split into two halves longitudinally and observed under a scanning electron microscope (SEM) for removal of the smear layer. The SEM images were then analyzed for the amount of smear layer present using a three score system. Data were analyzed using the Kruskal-Wallis test and Mann-Whitney U test. Intergroup comparison of groups B, C, and D showed no statistical significant differences in the coronal and middle thirds, however, in the apical third the canal surfaces were cleaner in samples from group D (P<0.05). BioPure MTAD was the most effective agent for the purpose of smear layer removal in the apical third of the root canals.

A 25-year-old female presented to the infertility OPD with complaints of secondary infertility and pain lower abdomen with watery discharge for the past five days. She had history of undergoing hysterosalpingography in a private hospital ten days back. The interventions included drainage of pyometra, endometrial biopsy for routine and AFB smear/ culture, confirmation of diagnosis by mRNA-based RT-PCR for detection of M. tuberculosis-specific 85B antigen gene, anti-tubercular therapy. Pyometra and tubo-ovarian masses disappeared and patient resumed her normal period post-treatment. Genital tuberculosis was confirmed by mRNA-based RT-PCR and the disease resolved after anti-tubercular therapy. We conclude that a combination of high degree of clinical suspicion and ‘high-precision' gene detection methods (e.g. mRNA) in culture-negative cases may be useful in diagnosis of genital tuberculosis, particularly in infertile patients presenting with pyometra post-hysterosalpingography.

Aegle marmelos leaf, seed and fruit from earlier studies is known to affect male fertility in reversible manner. However they had delayed onset and recovery was found to be prolonged. The present study was undertaken with an aim to evaluate the effect of Aegle marmelos bark extract on rats as the extract is found to be a rich source of marmin and fagarine known for reducing male fertility. Three different concentration of methanolic bark extracts of Aegle marmelos (L.) were evaluated for male antifertility activity on albino wistar rats. Methanolic bark extract of Aegle marmelos at the dose of 200, 400, and 600 mg/Kg b.w was administered orally for 60 days. Treatments were stopped thereafter and animals were sacrificed after a recovery period of 30 days. Control animal were administered vehicle (0.5% CMC for 60 days). Lonidamine was used as standard drug to compare the effect of extract. Methanolic extract causes a dose & duration dependent infertility via reducing reproductive organ weight and serum testosterone levels. Sperm analysis results showed reduction in sperm density, motility, viability and sperm acrosomal integrity without interfering libido and vital organ body weight. Histopathological studies of testes revealed exfoliation of elongated spermatids, nuclear chromatin condensation, degeneration and prominent spaces detected within the germinal epithelium signifying testicular cytotoxicity and necrosis. Time dependent complete infertility was observed in all dose levels. Animals after the withdrawal from treatment, for 30 days showed restoration of the morphological as well as physiological parameters in extract treated rats. Methanolic extract showed lipid lowering activity compared to control, suggestive good candidature of this plant for further studies. Our studies suggested Aegle marmelos barks methanolic extract as strong candidate for male contraceptive via its ability to produce complete inhibition of pregnancy, rapid restoration of fertility after withdrawal from treatment and its lipid correcting ability proving further beneficial effects.

In marine actinomycetes, carotenoid production occurs in constitutive, light-dependent or cryptic manner. The present work deals with the fermentative production of carotenoids from marine actinomycetes. Marine actinomycetes namely Streptomyces strain AQBMM35 was isolated from the marine sponge Mycale mytilorum collected from South West coast of India using ISP media. The Streptomyces isolates were characterized for their colony characteristics, morphological properties, physiological and biochemical properties and were tentatively identified. Fermentation of the strain under fluorescent white light was carried out for the production of carotenoids. UV spectrum, TLC and HPLC analysis were done for the confirmation of carotenoids. The characteristics studied strongly suggest that the strain AQBMM35 belongs to the genus Streptomyces sp. It has been found that Streptomyces strain (AQBMM35) fermenting under fluorescent white light produced carotenoids. Spectrophotometric analysis of the carotenoid fraction revealed a peak at 280 nm. TLC analysis of the carotenoid extract showed the presence of phytoene (Rf of 0.81). HPLC confirmed the production of phytoene when compared with standards. The fermenting sponge-associated Streptomyces isolate (AQBMM35) produced carotenoids namely phytoene. If this symbiotic Streptomyces strain, from which secondary metabolite like carotenoids are derived, can be cultured under light, then it can be used for mass production of precursor pigment and it can be used as an antioxidant and also as a food additive.