A REVIEW ON JANPADODHWANSA - CONCEPT OF ANNIHILATION IN AYURVEDA

Janpadodhwansa is one among the unique concept described in Ayurveda treatises which literally means demolition or annihilation of people or community. There are four factors that has been described which are common and essential for every living being i.e. Vayu (air), Jala (water), Desha (land) and Kaala (season). Any abnormal alteration in these four factors can significantly influence individual or community or environment or all of them together. Vitiation of these four common factors is the cause for Janpadodhwansa. Foremost reason for Janpadodhwansa has been described as Adharma (immorality) and the root cause of Adharma is said to be Prajnaparadha (delinquency of wisdom). Considering the noteworthiness of Janpadodhwansa, a whole chapter has been depicted in Charak Samhita illustrating its onset, causes, peculiar features and management. On the basis of characteristics features of vitiated four factors in Ayurveda classics, catastrophe conditions like cyclones, earthquakes, endemic/epidemic or pandemic disease outbreak etc., may simulate with Janpadodhwansa. Restrained utilisation of natural, man-made resources, adoption of Ayurveda dietetics and lifestyle, Panchakarma therapies, Rasayana therapies may effectively contribute to prevent and manage these situations especially like disease outbreak. This review article primarily focussed on the need of understanding the topic of Janpadodhwansa in current scenario

The study of clinical and endoscopic spectrum of upper gastrointestinal manifestations in HIV patients

Background: Opportunistic disorders are the most frequent GI complications of HIV infection and remain a major cause of morbidity and mortality in these patients. These disorders account for high prevalence of upper gastrointestinal symptoms such as dysphagia, odynophagia, retrosternal chest pain, abdominal pain and upper GI bleeding. Hence an attempt is being made to study clinical, endoscopic and biopsy changes in HIV patients with upper GI symptoms which helps us to make early diagnosis of upper GI disorders in HIV patients.Methods: HIV positive patients above 14 yrs diagnosed on the basis of recent NACO criteria having Upper G.I. symptoms, attending OPD of Department of Medicine admitted in Wards. All fifty three patients with upper G.I. symptoms were subjected to detail history, thorough clinical examination, routine and special investigations and Upper G.I Endoscopy.Results: Out of fifty three patients, nineteen (35.8%) cases had normal endoscopy. The most common finding was Antral Gastritis in fourteen (26.4%), followed by Candida esophagitis in twelve (22.6%), esophagitis in three (5.7%), candida esophagitis with antral gastritis in two (3.8%), duodenitis, varices and mass (ulcerated growth) in II part of Duodenum seen in one (1.9%) each.Conclusions: The evaluation of specific gastrointestinal complaints must be based on an assessment of degree of immunosuppression. With the progression of immunodeficiency, EGD becomes a useful diagnostic modality for the early diagnosis of these opportunistic infections and other inflammatory conditions

Study of anaemia in type 2 diabetes mellitus

Background: Anaemia is increasingly recognized entity in the patients with diabetes mellitus and constitutes an additional burden in patients. The prevalence of anaemia in the patients with diabetes is two or three times higher than in patients with comparable renal impairment and iron stores in the general population. As India is foreseen a diabetic capital of the world, it becomes imperative to recognize co-morbidities such as anaemia at the earliest. Hence this study is being conducted with the aim to determine the prevalence and various causes of anaemia in diabetics.Methods: After obtaining informed written consent, all diabetics patients were subjected to detailed history, through clinical examination and investigation with CBC, Renal function test including creatinine clearance. The difference of mean between anaemic and non anaemic diabetic patients was evaluated by unpaired student t test. Finally, correlation between the level of haemoglobin and index of renal damage (albumin-creatinine ratio) was accessed by Pearson correlation. Statistical software of SPSS 10 ver. and EXCEL (office 9) was used to analyse the data.Results: In the present study, nearly two third patients of type 2 diabetes mellitus were anaemic. The maximum number of anaemic patients with type 2 diabetes mellitus had microcytic hypochromic type of anaemia.Conclusions: It is therefore concluded that anaemia is a prevalent finding in patients with type 2 diabetes mellitus and represents significant unrecognised burden. The anaemia may be attributed to variable contribution of iron deficiency state and chronic inflammation as result of the disease itself

RF Sputtered MoO3 Thin Film on Si (100) for Gas Sensing Applications

Molybdenum Trioxide (MoO3) films are grown on Si(100) substrates by reactive RF magnetron sputtering in plasma containing a mixture of Argon and Oxygen, using a pure Molybdenum target. In this paper, we report the deposition of (MoO3) films on Si(100) substrates under varying gas flow (O2 + Ar gas) (20 sccm to 30 sccm with the duration of deposition~ 1hr) by RF reactive magnetron sputtering at room temperature. To get crystalline MoO3 films annealing in O2 environment at 500 °C for 4 h is done. Phase formation and orientation of the film is characterized by Glancing incidence X-ray diffraction (GIXRD). The identification of the orthorhombic MoO3 phase is investigated by XRD and Raman spectroscopy. Raman lines at 819 cm-1 and 995 cm-1 are due to the (A1g, B1g) symmetric stretching (Mo-O–Mo) bond and asymmetric stretching band (Mo=O) respectively. Surface morphology and cross-sectional image of the deposited thin films were investigated by FE-SEM image. UV-Visible reflectance and cross-sectional FE-SEM image confirm the thickness of the MoO3 films with oxygen-rich and oxygen deficient phase formation occur. Reverse leakage current density of 20 sccm 1hr sample is low (1×10-6 mA/cm2) as compared to 30 sccm 1hr sample (1×10-3 mA/cm2). The higher leakage is due to crack formation during the ex-situ annealing of MoO3 films. This MoO3 films can be used in Gas sensing and switching devices

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Swift-BAT GUANO follow-up of gravitational-wave triggers in the Third LIGO–Virgo–KAGRA Observing Run

We present results from a search for X-ray/gamma-ray counterparts of gravitational-wave (GW) candidates from the third observing run (O3) of the LIGO–Virgo–KAGRA network using the Swift Burst Alert Telescope (Swift-BAT). The search includes 636 GW candidates received with low latency, 86 of which have been confirmed by the offline analysis and included in the third cumulative Gravitational-Wave Transient Catalogs (GWTC-3). Targeted searches were carried out on the entire GW sample using the maximum-likelihood Non-imaging Transient Reconstruction and Temporal Search pipeline on the BAT data made available via the GUANO infrastructure. We do not detect any significant electromagnetic emission that is temporally and spatially coincident with any of the GW candidates. We report flux upper limits in the 15–350 keV band as a function of sky position for all the catalog candidates. For GW candidates where the Swift-BAT false alarm rate is less than 10−3 Hz, we compute the GW–BAT joint false alarm rate. Finally, the derived Swift-BAT upper limits are used to infer constraints on the putative electromagnetic emission associated with binary black hole mergers

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

BackgroundImmediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy.MethodsConsecutive women undergoing mastectomy ± IBR for breast cancer July-December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored.ResultsA total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays.ConclusionsIBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

The new data-driven enterprise architecture for e-healthcare: Lessons from the Indian public sector

Healthcare delivery is a complex issue and better planning of resources is important. The Indian Government suggested the requirement of developing a healthcare framework for providing easily accessible, affordable healthcare and universal health coverage to all citizens in India. The Health Management Information System (HMIS) at Tamil Nadu was conceptualized in response to this requirement as a case of architectural correction from the manual to a unified healthcare system covering more than 74 million people and 2000 plus healthcare institutions in the state. The system consolidates state-level data in real time, links all health institutions, and makes it possible to track individual health indices. This data is used for planning healthcare, managing drug inventory, and planning health initiatives at the state level. We study the modified enterprise architecture (EA) of Tamil Nadu Health Management Information Systems (TNHMIS) and its comparison to existing EA approaches and operating models. We also discuss the high-level core diagram, the key elements of business processes, IT infrastructure, shared data and customer interfaces and how they are linked. We suggest an EA based approach to managing healthcare