dinesh kumar

Neonatal mechanical ventilation has contributed to a significant decline in neonatal mortality but is associated with various complications. It is necessary to identify the prognostic factors and their management to reduce the complications in mechanically ventilated neonates. Therefore, this study was designed to investigate the common indications, complications, and predictive factors associated to immediate outcomes in neonates from rural North India who received invasive mechanical ventilation.
This study includes all neonates admitted to the neonatal intensive care unit requiring invasive mechanical ventilation for at least 12 hours. All enrolled neonates were categorized into two groups: those who were successfully extubated were labeled as survivors, while those who did not survive during ventilation were classified as non-survivors. Clinical and ventilator parameters, as well as the occurrence of complications were analyzed to identify factors associated with outcomes in ventilated neonates.
A total of 150 neonates who met the inclusion criteria were enrolled. The most frequent reason for ventilation was perinatal asphyxia. Among ventilated neonates, the mortality rate was 38.7%. When comparing survivor and non-survivor groups, a significant difference was observed in birth weight, gestational age, indication for ventilation, duration of ventilation, and blood acidosis (with a p-value < 0.05). Additionally, non-survivors experienced a higher prevalence of complications, including sepsis, shock, air leak syndrome, and pulmonary hemorrhage. Multivariate analysis revealed that gestational age less than 34 weeks, initial blood pH of 7.1 or lower, ventilation duration exceeding 72 hours, and the presence of sepsis, shock, or disseminated intravascular coagulation were significant independent predictors of mortality in ventilated neonates.
The mortality among ventilated neonates is still high in developing countries. Hospital acquired sepsis with shock is still the major complication among ventilated neonates. Early identification of risk factors for mortality and timely intervention may decrease the mortality.

The generalized $M$-series is a hybrid function of generalized Mittag-Leffler function and generalized hypergeometric function.  The principal aim of this paper is to investigate certain properties resembling those of the Mittag-Leffler and Hypergeometric functions including various differential and integral formulas associated with generalized $M$-series. Certain corollaries involving the generalized hypergeometric function are also discussed. Further, in view of Hadamard product of two analytic functions, we have represented  our main findings in Hadamard product of two known functions.

Recently fractional cable equation has been investigated by many authors who have applied it in various areas. Here we introduce and investigate a generalized space-time fractional cable equation associated with Riemann-Liouville and Hilfer fractional derivatives. By mainly applying both Laplace and Fourier transforms, we express the solution of the proposed generalized fractional cable equation as H-functions. The main results here are general enough to be specialized to yield many new and known results, only several of which are demonstrated in corollaries. Finally, we consider the moment of the Green function with its several asymptotic formulas.

A 13-year-old girl presented with fever, nausea and projectile vomiting and altered sensorium. On physical examination, the meningeal signs were presented without focal neurological deficits and Grade Ⅱ papilledema was presented on fundus examination. The patient was found to be positive for Japanese encephalitis virus in cerebrospinal fluid. Focal neurological deficit in the form of right hemiparesis was noticed at day 6 of hospitalisation. Multiple lesions with minimal enhancement with perilesional edema were observed in cerebral cortex in contrast with enhanced magnetic resonance imaging of the brain, giving rise to starry sky appearance. No tests for neurotuberculosis were found positive. Serum IgG enzyme-linked immunosorbent assay test was negative for Cysticercosis, but magnetic resonance spectroscopy was suggestive of cysticercal meningitis. During treatment, she had intermittent episodes of nausea and vomiting with waxing and waning sensorium. Subsequently, it was planned to start Albendazole after steroids coverage and anticonvulsants but the patient did not improve and succumbed to her illness.

In this 21st century, various materials like metals, alloys, and composites are available for different industrial applications. Composite materials are gaining popularity due to their enhanced mechanical properties over other materials. However, for continuous improvement in the properties of these materials, different research groups are constantly involved in it. In this research paper, the focus is to review the mechanical properties like hardness, tensile strength, flexural strength, impact strength along with surface characteristics like wear resistance of AMMC’s. As per the available literature, liquid state processing is more popular than solid-state processing due to the better dispersion of the reinforcement particles in the matrix materials. Stir casting is mostly used liquid state processing method because of its ease and the overall low cost of production. It has been noticed that the mechanical and surface characteristics of AMMC’s can be improved by adding different reinforcement particles in small percentages (usually 0.5-20%). It has been observed that hardness, tensile strength and flexural strength for mostly used AMMC’s ranges from 38-99.6 HV, 100-478 MPa and 199.52-430 MPa respectively. The research paper also included the influence of various working parameters on the wear rate of AMMC’s. It is noticed that wear loss for AMMC’s generally varies from 0.0050-0.004 g. The impact resistance is a crucial parameter in the study of AMMC’s used for aerospace and automotive applications and it has been noticed that its value for popular AMMC’s varies from 3.6-38 J.

Nitrogen (N) losses from the N sources such as manures, fertilizers etc. applied to crops are considered as the largest non-point source of nitrogen-nitrate pollution in surface and groundwater bodies. The extent of water bodies polluted with N is worsening day by day, worldwide, with its severe impact on the quality of drinking water. This necessitates the development of crop specific N management practices to reduce N losses from crop systems. Improvements in agronomic and recovery efficiency of nitrogen in crops are regarded as promising techniques to reduce N losses. With the hypothesis that precise N supply in maize employing LCC or CCM under a critical threshold value will augment the yield performances and Nitrogen Use Efficiency (AEN and REN) of maize, while reducing N losses, a two year study was conducted at Anand, India. Fifty percent reduction in basal N application and subsequent N applications based on LCC critical value 5 resulted in 12.30 and 12.25% increment in maize grain yield over recommended practices during the year 2015 and 2016, respectively. Significant improvement for total biological yield, grain protein accumulation in maize and total N uptake by crop was observed in the direction of N application using LCC threshold point 5, CCM threshold point 40 and recommended practice. Applying nitrogen at whatever the times LCC critical point drops ≤ 5 also recorded 4.09 and 4.17 kg gain in grain produced (over recommended practice) kg−1 of N supplied (AEN), 0.16 and 0.17 kg gain in N uptake (over recommended practice) kg−1 of N supplied (REN) during 2015 and 2016, respectively and a total reduction of 51.14 kg N loss ha−1 (over recommended practice) for the entire study period. The study reveal that compared to blanket application, N fertilizers can be more efficiently managed with LCC threshold value 5 or CCM threshold value 40 for guiding N application with higher yield, NUE and reduced N losses in maize crop.

The myocardium is vulnerable to ischemic injury in acute perinatal asphyxia. Asphyxial cardiomyopathy increases mortality. Clinical assessment alone is not sufficient to evaluate myocardial injury.

This study was conducted over 2 years on neonates at the gestational age of 34 weeks or more with perinatal asphyxia. Electrocardiographic (ECG) and echocardiographic changes were studied with clinical details.

The study population comprised 57 neonates. Among them, 33 (57.9%) were male, 23 (40.4%) were born by cesarean section, and 3 (5.3%) were delivered via assisted vaginal delivery. Twenty-six neonates (45.6%) were intubated in the delivery room, and 15 (26.3%) required bag-and-mask ventilation at birth. The mean birth weight was 2679 g (461 g), and the mean gestation period was 38.4 weeks (1.6 wk).Central nervous system, hepatic, and renal involvement was observed in 53 (93%), 35 (61.4%), and 26 (45.6%) cases, respectively. Cardiac dysfunction was observed in 30 neonates (52.6%). Twenty cases (35.1%) required mechanical ventilation.ECG changes were observed in 44 neonates (77.1%). Grade I changes were observed in 10 cases (17.5%), Grade II in 14 (24.6%), and Grade III in 20 (35.1%). In 13 cases, ECG was normal. Twenty-six neonates (45.6%) had echocardiographic changes. Tricuspid regurgitation was observed in 8 cases (14%) and pulmonary artery hypertension with tricuspid regurgitation in 16 (28.1%). Mitral regurgitation with global hypokinesia was observed in 2 neonates, who eventually succumbed.

Our results demonstrated thatECG changes occurred in about three-fourths of asphyxiated neonates, and nearly half of the asphyxiated neonates had echocardiographic changes. Mitral regurgitation with global hypokinesia was associated with the worst outcome. (Iranian Heart Journal 2021; 22(2): 51-57)

Peer observation is one method of honing teaching skills by evaluating the presentation skills of others with a two-way process of improvement based on critical reflection.Structuring the process of peer observation helps identify gaps where individual students may err while teaching. The main aim of this initiative is to evaluate the quality of teaching among postgraduate students in one department using the principles of peer, near-peer, and faculty observation.

Structured peer observation of postgraduate seminars was conducted where students’teaching skills were critically commented upon by peers, near-peers, and faculty. Measurements included perceived confidence of students in the feedback process, self-appraisal of competence in selected teaching behaviours and participants’ attitude towards the process of observation using quantitative methodologies. The results were analysed using descriptive statistical methods and expressed as measures of central tendency.

Overall outcomes were highly positive in terms of confidence and appraisal abilities of students in the feedback process. The attitudinal perceptions of students were also positive.

Using feedback from peer and near-peer evaluation, students can develop the teaching skills which will later manifest as beneficial teaching practices in long run. By repeatedly observing and then enacting teaching practices, the gap existing between the current state and the desired state of performance can be reduced.

There is an increased prevalence of extended‑spectrum beta‑lactamase producing Klebsiella pneumoniae (ESBL‑KP) worldwide including India, which is a major concern for the clinicians, especially in intensive care units and pediatric patients. This study aims to determine the prevalence of ESBL‑KP and antimicrobial sensitivity profile to plan a proper hospital infection control program to prevent the spread of resistant strains.

KP isolates obtained from various clinical samples were evaluated to detect the production of ESBL by phenotypic methods. Antimicrobial susceptibility profile was also determined of all the isolates.

Of 223 nonduplicate isolates of K. pneumoniae, 114 (51.1%) were ESBL producer and antimicrobial susceptibility profile showed the isolates were uniformly sensitive to imipenem and highly susceptible to beta‑lactamase inhibitor combination drugs(67–81%) and aminoglycosides (62–76%), but less susceptible to third generation cephalosporins (14–24%) and non‑β‑lactam antibiotics such as nitrofurantoin (57%), fluoroquinolones (29–57%), piperacillin (19–23%), and aztreonam (15–24%).

This study found that beta‑lactamase inhibitor combinations are effective in treatment of such infections due to ESBL‑KP thus these drugs should be a part of the empirical therapy and carbapenems should be used when the antimicrobial susceptibility tests report resistance against inhibitors combinations.

In response to the evolving needs and reports on medical education, many medical schools have been pursuing curricular integration. Contrary to Abraham Flexner who persuaded that teaching of medical sciences, from basic to clinical, should be a critical component of the discipline based curriculum, ‘integration’, in its purest sense unifies separate areas of knowledge which quenches the needs of adult learners. However, most medical schools struggle with integrating their curricula owing to the confusion derived from diverse definitions and multiple learning theories. A common criticism of integrated curriculum is that students will not see the relevance of basic sciences and this significantly minimizes the role of basic sciences in medical education. The crux of integration is achieving the balance of clinical and basic sciences in a manner that best serves the student to maximize student engagement and knowledge retention. In this paper, we made an attempt to address the contextual issues existing in medical schools, the changing role of basic sciences in present day medical education and the optimal strategy to achieve effective integration of basic sciences. We propose that a dynamic interconnectedness happening at various levels is more important to achieve effective integration rather than mere deliberate unification of individual disciplines.

The concept of the journal club is a time-tested collaborative learning activity to keep health professionals abreast of current literature and improve their confidence in reading literature.Being equipped with the skills to critically analyse a peer-reviewed scientific manuscript is equally as important as carrying out research and publishing papers. Most published literature related to the concept of journal club examines only the core critical appraisal skills and leaves behind potential factors which could significantly influence the effective pursuit of a journal club. In this practical advice paper, the author highlights 12 steps for conducting an effective journal club and the practical difficulties associated with each step.

Although mentoring has been regarded as an essential component in the developmental phase of medical students, it is the nature of hierarchical relationship and the quality of emotional exchange which determine its sustainability. With great enthusiasm, we had launched our mentoring program for the new entrants of our medical school. After an initial faculty development workshop on mentoring, we framed our guidelines for implementing the program. To measure the relationship satisfaction on both sides and self-efficacy, we used relationship satisfaction scales. As the winds offered us the beginner’s fortune, our program went on well for the first six months. Slowly, the colour of the mentorship program began to fade. Students began to find excuses for not meeting their mentors and the sessions truncated into a “hay- how do you do – bye” meetings. Through this commentary, we would like to introspect the factors which would have dampened the interest. Would it be the asynchronous agency support or lack of motivation / self-efficacy or roadblocks in Communication Bridge or lack of adequate matching or lack of need? The outcomes of our introspection would be of help for others who run the mentorship programs or who wish to install in their own institutes.

Drawing can be a useful tool to elicit student thinking and is a widely-used method for communicating scientific ideas. The task of drawing requires students to identify and recall necessary pieces of information they assimilated over a period of time and construct a mental model. However, millennial generation learners, owing to their immersion in 3D technologies, lack interest in practicing and learning from diagrams. This impairs learning and retention of visually-oriented subjects. In this perspective, we reflect on the cognitive and metacognitive processes associated with drawing to emphasize the important role of drawing in present day anatomy education.

Conventional pedagogies for case-based learning are designed with the intention of helping the student appreciate the relevance of content they learn and kindle their curiosity. However, these pedagogies embody certain shortcomings which inhibit them from reaching the intended objectives. The main aim of our initiative is to improve traditional case-based learning using the principles of clinical reasoning. A priori, two sessions were conducted in which two vignettes were administered to first-year medical students. We obtained the perceived acceptance which was equivalent to Kirkpatrick level 1 learning outcomes. Overall outcomes were highly positive in terms of acceptability, fostering curiosity, increasing the relevance of learned content, and helping students learn to think in a logical way. With the increasing need for incorporating clinical reasoning skills in medical education, it is imperative that these skills are taught beginning with the preclinical years of medical education.

Workplace acts as an effcient target for health promotion activities. Pedometer can act as a motivator and monitor of physical activity. The aim of the study was to assess the effect of pedometer usage in increasing physical activity and the level of adherence among employees of a software company in Puducherry. An interventional study was conducted with a prepost design. A single group of software company employees (n = 46), age ≥30 years selected by simple random sampling, was included in the study. Intervention consisted of health education program on physical activity, goal setting, and instructions regarding the use of pedometers for 1 week. Physical activity levels were measured at baseline and endline using global physical activity questionnaire. Out of the 46 participants, 93% of the participants used the pedometer for at least 6 days. The difference between maximum observed step count during the week (median 9834 steps) and at baseline (6963 steps) was signifcant. Overall, 93.5% found pedometers to be useful for improving physical activity. Proportion of individuals with adequate physical activity based on  Metabolic equivalents (MET) minutes increased from 41.3% (n = 19) at baseline to 69.6% at endline (n = 32) (P = 0.004). This study shows that a pedometer‑driven walking intervention in the workplace setting is feasible and effective in increasing physical activity over a short term. Further research is required to test the effect of supportive strategies and long‑term effectiveness of pedometer use.

Dear Editor With increasing emphasis on publications for
faculty recruitment, career advancement
and obtaining research grants, the issues related
to author kinship and academic nepotism have
grown significantly and these probably reflect
the inflationary growth rather than the optimal
growth warranted due to increasing research
complexity. Allesina S (1) measured the full
magnitude of nepotism in the Italian academia
and found that this pervasive problem was a
blemish that undercuts the quality of advanced
education over there. According to her, this
process of showing favouritism towards close
relatives incentivize illegal hiring practices and
guarantees their career advancement regardless
of their merit. Even though the analysis of
shared last names cannot be considered a valid
tool for measuring the diffusion of nepotism in
any organization (2), we cannot deny its sheer
existence.
An analysis of 12,772 papers published in PLOS
ONE showed that 48% of the listed co-authors did
not fulfil the criteria for authorship, as their role
was meagre or absent in drafting the manuscript
(3). If we extrapolate these data to any settings,
we could enunciate that a substantial amount of
papers hoist the name of an expert (preferably
the kin of primary investigator) belonging to an
entirely different specialty or giving an authorship
instead of mere acknowledgement. Prosperi M et
al. (4) analyzed more than 21 million MEDLINE/
PubMed-indexed papers and documented that kin
authorship is a big menace for India, Italy and
Poland. Measuring nepotism is highly unlikely
in India, owing to the facts that Indian women in
academia prefer to maintain their maiden names
and wide usage of surnames. Number of cases
involving their spouses, lovers and domestic
partners would largely go underestimated,
thereby causing the statistical models to fail.
In the past, the recruitment and promotion
mechanisms were tacit, which had measured the
educational and research qualities in an informal
manner. This, on one hand gave rise to negative
connotations regarding nepotism and, on the
other hand, led to the formation of “academic
dynasties” in Indian medical academia. Since
the evolution of “publish or perish” culture,
the hiring/promotion process was replaced by
a formal, explicit and individually measurable
index. The existing scenario can be crosssectioned
by a participant’s comment in the study
conducted by Anderson et al. (5), “You can fail
to do everything else as long as you have lots and
lots of papers.” In the process of conferring the
aggregate output or research productivity, which
is a mere ‘pseudo-halo’, accomplished researchers
or clinicians sometimes promulgate their spouses
or get involved in reciprocal co-authorship, which
is yet another version of academic nepotism. In
a latest paper, Rivera H (6) proposes a 3 step
scheme for validating the genuine collaboration
and calls for a focused evaluation of research productivity.
In summary, I wish to address the least
signified and unintended consequence of the
present day evaluation/appraisal mechanism
whereby a scholar is potentially assessed by the
number of publications he/she has. Considering
the fact that history of research in global arena
had witnessed conjoint efforts from egalitarian
couples, blanket recommendations are difficult to
be made. Nevertheless, we should not forget the
fact that academic nepotism often depresses the
health care professionals and adversely affects
their morale. I wish to conclude that academic
nepotism is yet another ethical dilemma,
which every administrator/selection committee
member needs to face and at times of making
crucial decisions (like hiring for a job) it is the
responsibility of them to uphold the legitimate
interests of the organization, more than personal
affiliations

Faculty development programs are essential for the advancement of faculty competence and organizational vitality. This is a multidimensional, daunting task because it involves transforming early career faculty with newer professional competencies such as educators, researchers and leaders. To get accustomed to these newer roles and responsibilitiesin medical education, faculty development programs must be modified and upgraded over time.However, a number of quintessential themes required for contemporary medical education practices are not routinely being addressed, particularly in medical schools in developing countries. This narrative review explores some practical complications in the existing faculty development programs and describes six areas to consider as the field of faculty development moves forward: incorporation of faculty identity, faculty vitality, barriers to faculty mentoring,breaking down silos, missing the grounds of evaluation, and importance of phronesis (that is,good character and good judgment). By exploring frequently encountered challenges in designing and implementing faculty development activities, this article asks medical educators to advance faculty development programs beyond formal activities and situate these in a wider context to aid collaboration between colleagues.

Holt-Oram syndrome is an autosomal dominant disorder, characterised by skeletal abnormalities of the upper limb associated with congenital heart defect, mainly atrial and ventricular septal defects. Skeletal defects exclusively affect the upper limbs in the preaxial radial ray distribution and are bilateral and asymmetrical. They range from clinodactyly, absent or digitalised thumb, hypoplastic or absent radii, and first metacarpal to hypoplastic ulna and carpal bone anomalies. Cardiac involvement ranges from asymptomatic conduction disturbances to multiple structural defects. Structural defects are seen in 75% of the cases and include both atrial and ventricular septal defect. More complex cardiac lesions such as Tetrology of Fallot, endocardial cushion defects, double outlet right ventricle, and total anomalous pulmonary venous return are observed uncommonly. An aneurysm of the interatrium septum is an infrequent finding in infants. It has been speculated that atrial septal aneurysm (ASA) is a direct source of thrombus formation. Paradoxical embolism of venous thrombi across a right to left shunt is possibly responsible for the cryptogenic stroke in a patient with ASA. However, coagulopathy associated with cyanotic congenital heart defect may also be contributory. Our patient had a rare association of complex cardiac lesion (tricuspid atresia, pulmonary stenosis, atrial septal aneurysm) with cardiac conductive defects and left parietal infarct along with the usual skeletal abnormalities.

The object of this paper is to establish certain generalized fractional integration and differentiation involving generalized Mittag-Leffler function defined by Salim and Faraj [25]. The considered generalized fractional calculus operators contain the Appell's function F3[2, p.224] as kernel and are introduced by Saigo and Maeda [23]. The Marichev-Saigo-Maeda fractional calculus operators are the generalization of the Saigo fractional calculus operators. The established results provide extensions of the results given by Gupta and Parihar [3], Saxena and Saigo [30], Samko et al. [26]. On account of the general nature of the generalized Mittag-Leffler function and generalized Wright function, a number of known results can be easily found as special cases of our main results.

In this paper, Wavelet Collocation Method has been used to solve nonlinear fin problem with temperature dependent thermal conductivity and heat transfer coefficient. Thermal conductivity of fin materials varies any type so that we consider thermal conductivity as the general function of temperature. Here we consider three particular cases, where we assume that thermal conductivity is constant, linear and exponential function oftemperature. In each case efficiency of fin is evaluated. The whole analysis is presented in dimensionless form and the effect of variability of fin parameter, exponent and thermal conductivity parameter on temperature distribution and fin efficiency is shown graphically and discussed in detail.

Female sand flies of subgenus Adlerius are considered as probable vectors of visceral leishmaniasis in Iran. The objective of this study was to determine the morphological and genotypic variations in the populations of this subgenus in the country. Sand flies collected using sticky traps from 17 provinces during 2008–2010. The morphometric measure­ments were conducted with a Ocular Micrometer. Data was analyzed by SPSS. The Cytb gene was used to estimate population genetic diversity and identify the female specimens. UPGMA phenetic tree was used for DNA haplotypes of Cytb gene. Six species of subgenus Adlerius identified from which one species, P. (Adlerius) kabulensis, is new record. The identification key is provided for males. Results revealed the molecular systematic in the species of subgenus Adlerius and determine the relationship of three females of P. comatus, P. balcanicus and P. halepensis. The positions of three females and the males in the UPGMA tree are correct and the similarities among them confirm our results. The branches of each species are not genetically distinct which justify the overlapping morphological characters among them. Molecular sequencing of Cytb-mtDNA haplotypes can be used for female identification for different species of subgenus Adlerius in Iran.