rakesh gupta

Semi-circular cylinders provide better space economy than circular and other non-circular cylinders. The cylinders are frequently used in a tandem arrangement in heat transfer equipment. The present study aims to obtain the flow and heat transfer characteristics for the tandem arrangement of semi-circular cylinders. The cylinders are placed in a vertical channel with a blockage (β) of 0.2. The upward flow under the reverse gravity is considered here. The influence of various parameters such as Reynolds number (Re), Prandtl number (Pr), Richardson number (Ri), and spacing between cylinders (YC) is observed. The governing parameters are varied in a range of 1 ≤ YC ≤ 6, 1 ≤ Re ≤ 50, 0.7 ≤ Pr ≤ 50, and 0 ≤ Ri ≤ 2. The numerical results are obtained by solving governing equations using FVM (Finite volume method). The velocity field, thermal field, drag coefficient (CD), pressure coefficient (Cp), and average Nusselt number (Nuavg) are presented. The increase in Re and Pr has enhanced the Nuavg and CD, whereas Ri and YC have shown complex dependency. The obtained results show that the mutual interaction of upstream and downstream cylinders has vanished for YC > 4. The upstream and downstream cylinders have shown different behavior at identical operating conditions. The drag coefficient for the upstream cylinder varies with YC for 1 ≤ Re ≤ 10, whereas for 10 ≤ Re ≤ 50, it shows negligible change except for the case of Pr = 0.7 and Ri = 2. The drag on the downstream cylinder increases monotonically with an increase in YC. The average Nusselt number for both cylinders increased with an increase in YC except for the downstream cylinder at Re = 1 and Pr = 0.7. Overall, the complex interplay of governing parameters has been observed in the flow and thermal characteristics.

 Percutaneous nephrolithotomy (PCNL), established in the 1970s, has replaced open surgery for large stones. Extracorporeal shock wave lithotripsy (ESWL), once the preferred first-line treatment for small-to-medium-sized renal stones, has a questionable charm owing to patient reluctance for repeated treatments and hospitalizations since ESWL has a reduced stone-free rate (SFR). Flexible ureterorenoscopy, also referred to as RIRS, originally applied in the management of lower pole stones resistant to ESWL, is increasingly being used as a primary modality to manage lower pole stones, and it may potentially achieve higher SFR than ESWL and lower morbidity than PCNL for patients with low-volume stone diseases.

 Observations were made to compare ESWL, mini PCNL, and RIRS in managing lower pole renal calculi of < 1.5 cm.

 This observational study encompassed all patients with lower pole renal stones with < 1.5 cm diameter and < 1000 HU density who underwent mini PCNL, RIRS, or ESWL from January 2020 to July 2021. There were 40, 60, and 60 patients in the RIRS, mini PCNL, and ESWL groups, respectively, for all of whom preoperative CT urogram was performed. The patients were informed of the procedures, and their informed consent was obtained. The stone-free rates of the three modalities were compared, and the outcomes were statistically analyzed.

 The mean stone sizes in the present study were 12.99 × 3.56 mm in mini PCNL, 10.62 × 2.51 mm in RIRS, and 10.93 × 3.13 mm in ESWL. The mini PCNL group's SFR was significantly higher than those of other groups: 59 (98.3%) in mini PCNL, 34 (85%) in RIRS, and 46 (76.7%) in ESWL (P = 0.002). Out of the 60 patients in the mini PCNL group, only one (1.7%) required an ancillary procedure, while only six (10%) out of 40 patients in the RIRS group and 11 (18.33%) out of 60 patients in the ESWL group required the ancillary procedure (P = 0.031).

 For lower pole renal calculi < 1.5 cm, mini PCNL has the highest SFR, followed by RIRS and ESWL, in sequence. The ancillary procedure rate was 18.33% in the ESWL group, which was higher than those of mini PCNL (1.7%) and RIRS (10%).

The patient was a 61-year-old smoker male, who presented to emergency department (ED) with complaints of sudden onset of headache followed by painless blurring of vision of the right eye that was started 10 hours prior to the admission. Due to blood pressure of 190/104 mmHg at home, the patient had taken amlodipine 10mg orally. The patient reported some episodes of transient ischemic attacks in his past medical history, for which he did not take any advice from physicians. The patient was also found to be hypertensive with deranged cholesterol. On examination in ED, the patient was afebrile, and had pulse rate= 88/min, blood pressure (BP)= 130/90 mmHg, respiratory rate=22/min, and O2 Saturation=99% in room air. There was not any positive finding in systemic examination. Patient was admitted for further evaluation and management. Paraclinical lab tests were all reported in normal range. Echocardiography revealed left ventricular ejection fraction (LVEF) of 60%, with no regional wall motion abnormality (RWMA), mild concentric left ventricular hypertrophy (LVH) and normal cardiac chambers. In view of Headache, brain computed tomography (CT) scan was performed, in which, there was prominence of sulci, basal cistern, sylvian fissure and ventricular system suggestive of age-related diffuse cerebral atrophy. Ill-defined hypodensities were seen in bilateral periventricular white matter, suggestive of chronic ischemic changes. Later, brain magnetic resonance imaging (MRI) was also performed, which revealed multiple discrete and confluent areas of hyperintensity scattered in subcortical deep and periventricular white matter of both cerebral hemispheres, suggestive of nonspecific small vessel ischemic changes, likely a combination of ischemic demyelination chronic lacunar infarcts and prominent perivascular space. The ventricular system and subarachnoid space were prominent, suggestive of age-related cerebral atrophy. In the next step, cervical and brain MRI angiography was performed, which revealed 100% occlusion of right internal carotid artery at its origin, with no distal reformation of the artery in the neck and intracranial part. The right middle and anterior cerebral artery were filling via circle of Willis and were severely diffusely narrowed in calibre. There were mild atheromatous changes in the left common carotid artery and carotid bulb causing mild narrowing. Bilateral vertebral arteries were normal. There was evidence of diffuse severe narrowing and poor visualization of entire left anterior cerebral artery. Ophthalmology reference was taken and fundus examination was done. On examination, the patient was found to have finger counting close to face with no improvement with glasses. In the right eye, anterior segment examination showed relative afferent pupillary defect (RAPD), while fundus examination revealed retinal background pale white with cherry red spot in macula and absent venous pulsation in the right eye, suggestive of Central Artery Retinal Obstruction (CRAO), and thread like blood vessels and Grade II Hypertensive retinopathy. After starting the low molecular weight heparin, antiplatelet and steroid, vision improved from finger counting close to face to finger counting at 3 feet distance. Patient was later discharged under follow-up for further recovery.

Amidst corona virus disease‑2019 (COVID‑19) pandemic, disruption to the usual ways of life can lead to anxiety and feeling of being unsafe, which may be associated with self‑medication. The study was planned to investigate the prevalence of anxiety and self‑medication during COVID‑19 pandemic.

In this cross‑sectional study, data were collected through an anonymous online survey with questionnaire consisting of four sections: demographic data of the participants, validated COVID‑19 Anxiety Inventory Items, Self‑rating Anxiety Scale, and self‑medication practices during COVID‑19 pandemic. The data were organized and analyzed using Windows Microsoft excel and SPSS software (Version 21). Descriptive statistics were calculated for all patient characteristics and survey responses. Analytical analysis included relationship between various parameters using Chi‑square test.

A total of 1100 responses were received. Approximately half of the participants were worried about getting severely ill. Majority reported reduced social contact (71.3%, n = 784) and also communicated that the pandemic has influenced their use of safety measures (86.5%, n = 951). The prevalence of mild‑to‑moderate, moderate‑to severe, and extremely severe anxiety cases were 23.1%, 4.7%, and 0.54%, respectively. One‑fourth of the responders reported self‑medication, out of which 60% were found to be anxious. Nonsteroidal anti‑inflammatory drugs were most commonly used.

Rising to the present challenge will require integration across different sectors with the immediate aim of getting people safely through the pandemic. As the world focuses on containing and delaying the spread of the COVID‑19, with burdened health‑care systems, we should not miss out on people with anxiety disorders and self‑medication problem, which may worsen with the pandemic.

Although telemedicine has been used spottily in Indian health care so far, the 2020 Covid‑19 pandemic provided the nation’s health systems an unprecedented opportunity to make a concerted effort to increase access and coverage. Health‑care providers can incorporate telemedicine systems to reduce doctor‑patient visits and help in breaking the chain of transmission of infections. Anticipating the increased need of telemedicine by health‑care providers, the Medical Council of India released practice guidelines in March 2020. In this article, the literature pertinent to telemedicine and its applications with special reference to recently released practice guidelines were reviewed and summarized in a historical and current context. Telemedicine is bound to grow and be adopted by more health‑care practitioners and patients in a wide variety of forms due to ease and availability. At the same time, it cannot replace in‑person consultation or emergency medicine.

Background and Importance: Pseudomeningocele is a rare complication of spine surgery, and it is the collection of cerebrospinal fluid in paraspinal tissues. Giant pseudomeningoceles are still rare, and very few cases have been reported in literature. It is usually occult in presentation, and patients do not have any symptoms ascribable to it.
We came across two patients of symptomatic post laminectomy pseudomeningoceles in past one year at our institution.
The patients were managed with surgical closure of the dural defect. Both patients were asymptomatic post operatively and doing well on follow-up.
The reappearance of neurological symptoms in a previously operated patient of spine surgery needs careful evaluation. Rarely the symptoms of failed back surgery are seen to be arising due to a pseudomeningocele.

Background and Importance: Pseudomeningocele is a rare complication of spine surgery, and it is the collection of cerebrospinal fluid in paraspinal tissues. Giant pseudomeningoceles are still rare, and very few cases have been reported in literature. It is usually occult in presentation, and patients do not have any symptoms ascribable to it.
We came across two patients of symptomatic post laminectomy pseudomeningoceles in past one year at our institution.
The patients were managed with surgical closure of the dural defect. Both patients were asymptomatic post operatively and doing well on follow-up.
The reappearance of neurological symptoms in a previously operated patient of spine surgery needs careful evaluation. Rarely the symptoms of failed back surgery are seen to be arising due to a pseudomeningocele.