HIV Patient with Mucous Membrane Pemphigoid: A Case Report

Background: Mucous Membrane Pemphigoid, a new denomination of cicatricial pemphigoid, encompasses a group of chronic subepithelial autoimmune blistering diseases that predominantly affect the oral cavity and the eyes (conjunctivitis and symblepharon).Case Details: A rare case of Mucous Membrane Pemphigoid (MMP) in a human immunodeficiency virus (HIV) positive patient is discussed with clinicohistopathological presentation.Conclusion: Since our patient was HIV-positive and had lesions restricted to the oral mucosa with ocular involvement, only topical and intralesional steroids were preferred as the first line of treatment. Systemic corticosteroid therapy raises a concern regarding immunosuppression.Keywords: HIV, MMP, Cicatricial pemphigoid

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

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Not AvailableStudies on reproductive biology in jamun (Syzygium cuminii L.) revealed that period of flowering ranged from 3rd week of February and continued till 2nd week of March under sub-tropical conditions. The tree canopy had 5–13 panicles per shoot, the number of buds panicle−1 ranged from 19 to 73 in different directions of canopy, panicle size had clear relation with number of flowering buds. The total flowering phase culminating in fruit set and later ripening lasted for 119 to 126 days with long phase of flower bud initiation, lasting for 45–50 days. Natural pollen transfer in the species was efficient and fruit set following open-pollination was quite high. Inspite of synchronous nature of anther dehiscence and stigmatic receptivity, selfing in a flower was found to coexist in nature with cross-pollination due to pollinator efficiency and pollen grain size. Selfing was promoted by geitonogamous mode and the species was suited to insect and wind pollination. It was found that reproductive phenology in jamun under Lucknow conditions was largely governed by seasonal climatic variables.Not Availabl

Coordinated Multilayer Control for Energy Management of Grid-Connected AC Microgrids

This paper proposes a coordinated multilayer control strategy for the energy management (EM) of grid-connected ac microgrids. The strategy predicts the customer's load demand and the photovoltaics (PV) power generation for a day-ahead EM. It utilizes the PV power generations and the bidirectional energy transactions from electric vehicles and battery storage to provide a combined response for load support. The system also predicts any uncertainties in customers demand and power generations and implements day-ahead precautionary measures to tackle that uncertainty. Two different prediction strategies are used, autoregressive moving average and artificial neural networks, and their performances for a day-ahead EM are investigated. The reference power from the tertiary layer EM is sent to the local controllers for power regulation at the inverter level. Additionally, the varying power output reference obtained from a day-ahead EM is classified into the slow, medium, and fast variations. The performance of the local controller employed in the interfacing grid-connected three-phase inverter is tested during the above-mentioned power reference variations. The total harmonic distortion incorporating a moving window technique is calculated for the ac output current during each class of power variations over a day

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Not AvailableMahua (Bassia latifolia Roxb.) is a characteristic spontaneous crop species found scattered throughout the tropics and subtropics of the Indian subcontinent. Categorized as an underutilized fruit crop, there is considerable scope to evaluate and characterize the available diverse germplasm in natural stands for promoting its utilization on commercial scale. Keeping the importance of variability in view, 24 accessions collected from different diversity hot spots of the country during 2006-2010 were asexually propagated on seedling rootstocks, planted in the field gene bank and evaluated for flower biology, physicochemical and nutraceutical parameters of the fruit. Approach herkogamy demonstrated by spatial separation of sex organs, existed in the species as an out-crossing mechanism allowing gene flow and genetic introgression in natural stands that contributed to the prevailing diversity. The pollen was 45-55 µm in size, anemophily coexisting with geitonogamy appeared to be the mechanism of pollen transfer. Thus, the flower biology demonstrated floral attributes that accounted for cross pollination resulting in genetic introgression and generation of appreciable diversity in natural stands, emphasizing needs of its characterization for profitable utilization. Based on the attributes, CISH M-4, CISH M-3 and CISH M-8 showed promise in respect of different fruit quality parameters. CISH M-4 outscored others with regard to juice content (65.42 %), pomace (37.94), TSS (26.40 0Brix), Total sugar (23.497 %), Vit C content (64.163 mg/100g) and antioxidant value (44.483 mg AEAC/g). Lack of improved cultivars for commercial utilization, can thus be attended by focused evaluation of mahua germplasm accessions for the fruit quality parameters and their exploitation in further crop improvement programmes.Not Availabl

Communication-less primary and secondary control in inverter-interfaced AC microgrid: An overview

Inverters in microgrids (MGs) face significant challenges during their parallel operations, such as accurate power sharing, deviations in system voltage magnitude and frequency, and imbalance between generation and load demand. To solve these technoeconomic challenges, hierarchical control structures are implemented in MGs. The structure consists of three layers as primary, secondary, and tertiary controls. The control approach can be either communication-based or communication-less at the various layers. The use of communication at primary and secondary layers faces problems, such as communication latency, data drop-up, and expense issues. On the other hand, improved decentralized control techniques being communication-less can avoid the disadvantages of using communication. This article presents an insight into the limitations with the communication-based approach by briefing about the centralized and distributed control techniques at the secondary control layer. Subsequently, the communication-less control techniques and algorithms to achieve accurate power sharing along with the restoration of MG voltage and frequency are described. A comparison among different decentralized droop-based power sharing methods in the primary control layer is done based on review and simulations. In addition, improved communication-less secondary restoration techniques are explained. Finally, future research directions in these areas are listed, aiming to improve the reviewed techniques

Dirac surface plasmons in photoexcited bismuth telluride nanowires: Optical pump-terahertz probe spectroscopy

Collective excitation of Dirac plasmons in graphene and topological insulators has opened new possibilities of tunable plasmonic materials ranging from THz to mid-infrared regions. Using time resolved Optical Pump-Terahertz Probe (OPTP) spectroscopy, we demonstrate the presence of plasmonic oscillations in bismuth telluride nanowires (Bi2Te3 NWs) after photoexcitation using an 800 nm pump pulse. In the frequency domain, the differential conductivity (Δσ = σpump on - σpump off) spectrum shows a Lorentzian response where the resonance frequency (ωp), attributed to surface plasmon oscillations, shifts with photogenerated carrier density (n) as. This dependence establishes the absorption of THz radiation by the Dirac surface plasmon oscillations of the charge carriers in the Topological Surface States (TSS) of Bi2Te3 NWs. Moreover, we obtain a modulation depth, tunable by pump fluence, of ∼40% over the spectral range of 0.5 to 2.5 THz. In addition, the time evolution of Δσ(t) represents a long relaxation channel lasting for more than 50 ps. We model the decay dynamics of Δσ(t) using coupled second order rate equations, highlighting the contributions from surface recombination as well as from trap mediated relaxation channels of the photoinjected carriers. This journal i