Clean Technology : Limit and Limitation

The limiting of pollutant emissions from COREX and Romelt processes, non-recovery coke ovens and coke less cupola have been calculated using equilibrium analysis. The results show that main pollutants present after full utilization of the exit gases from all the processes are sulfur dioxide and nitric oxide. The former is dependent on the volatile sulfur present in the fuel and later depends on temperature of combustion and amount of air used for combustion. Lowering of combustion temperature and closer control of combustion can reduce NO load signi-cantly

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Impact des caractéristiques du scanner TEP préclinique sur la qualité globale de l'image

Positron Emission Tomography (PET) is one of the nuclear imaging techniques, used in the field of oncology, cardiology and neurology as a functional imaging modality. During the last three decades, advancement of PET modality and the development of animal models of human disease have lead to the development of PET technology dedicated to small animals. Due to the size difference between humans and mice, small animal scanners require improved spatial resolution. Due to the improved spatial resolution, the voxel size decreases significantly thereby, reducing the number of signals from a voxel. Higher the detected counts, higher the signal-to-noise ratio (SNR), thus improvement in the detection efficiency also plays an important role. Our objective is to study the impact of PET scanner characteristics on the overall image quality. To achieve this, we have simulated four different scanner designs. The idea behind the selected scanner designs studied in this thesis is to progressively add an extra dimension in the estimated position of interaction of the gamma photon, i.e., going from 2D detection to 3D detection. We demonstrated that it is possible to decouple the spatial resolution and detection efficiency, improving both simultaneously. Further, we characterized that improving spatial resolution results in improved Recovery Coefficient (RC). Detection efficiency impacts the SNR, which further impacts the estimated error in the RC values. However, there are other factors such as image reconstruction approach and normalization corrections that degrade these error values. Thus, it is important to not only improve the performance parameters of the scanners but also to accurately implement the image reconstruction process, so as to correctly quantify the improvement in the image quality.La tomographie par émission de positrons (TEP) est l’une des techniques d’imagerie nucléaire utilisées dans les domaines de l’oncologie, de la cardiologie et de la neurologie en tant que modalité d’imagerie fonctionnelle. Au cours des trois dernières décennies, les progrès de la modalité PET et le développement de modèles animaux de maladies humaines ont conduit au développement de la technologie PET dédiée aux petits animaux. En raison de la différence de taille entre l’homme et la souris, les scanners pour petits animaux nécessitent une résolution spatiale améliorée. En raison de l’amélioration de la résolution spatiale, la taille du voxel diminue de manière significative, réduisant ainsi le nombre de signaux d’un voxel. Plus le nombre détecté est élevé, plus le rapport signal sur bruit (SNR) est élevé ; l’amélioration de l’efficacité de la détection joue donc également un rôle important. Notre objectif est d’étudier l’impact des caractéristiques du scanner PET sur la qualité globale de l’image. Pour ce faire, nous avons simulé quatre modèles de scanneurs différents. L’idée des conceptions de scanner sélectionnées dans cette thèse est d’ajouter progressivement une dimension supplémentaire dans la position estimée de l’interaction du photon gamma, c’est-à-dire en passant de la détection 2D à la détection 3D. Nous avons démontré qu’il était possible de découpler la résolution spatiale et l’efficacité de la détection, en améliorant les deux simultanément. En outre, nous avons caractérisé le fait que l’amélioration de la résolution spatiale entraîne l’amélioration du coefficient de récupération (RC). L’efficacité de la détection a un impact sur le RSB, ce qui a également un impact sur l’erreur estimée dans les valeurs de RC. Cependant, d’autres facteurs, tels que l’approche de reconstruction d’image et les corrections de normalisation, dégradent ces valeurs d’erreur. Il est donc important non seulement d’améliorer les paramètres de performance des scanners, mais également de mettre en œuvre avec précision le processus de reconstruction d’image, afin de quantifier correctement l’amélioration de la qualité de l’image

Facial colliculus syndrome

A male patient presented with horizontal diplopia and conjugate gaze palsy. Magnetic resonance imaging (MRI) revealed acute infarct in right facial colliculus which is an anatomical elevation on the dorsal aspect of Pons. This elevation is due the 6th cranial nerve nucleus and the motor fibres of facial nerve which loop dorsal to this nucleus. Anatomical correlation of the clinical symptoms is also depicted in this report

Reversible myelopathy: An uncommon accompaniment of hypothyroidism

Atypical neurological presentations of hypothyroidism include myelopathy which has been seldom reported as presenting feature in patients. This case was one of those atypical presentations of hypothyroidism in which patient presented with neurological complication viz myelopathy which was timely diagnosed and treated. The symptoms including neurological findings reversed with thyroxin replacement. The case highlights the varied and vivid manifestations of hypothyroidism which treating physicians should be aware of while treating patients

Prevention of relapse in drug sensitive pulmonary tuberculosis patients with and without vitamin D3 supplementation: A double blinded randomized control clinical trial.

BackgroundThe immunomodulatory effects of vitamin D are widely recognized and a few studies have been conducted to determine its utility in the treatment of tuberculosis, with mixed results. This study was conducted to see if vitamin D supplementation in patients with active pulmonary tuberculosis (PTB) in the Indian population contributed to sputum smear and culture conversion as well as the prevention of relapse.MethodsThis randomized double-blind placebo-controlled trial was conducted in three sites in India. HIV negative participants aged 15-60 years with sputum smear positive PTB were recruited according to the Revised National Tuberculosis Control Program guidelines and were randomly assigned (1:1) to receive standard anti-tubercular treatment (ATT) with either supplemental dose of oral vitamin D3 (60,000 IU/sachet weekly for first two months, fortnightly for next four months followed by monthly for the next 18 months) or placebo with same schedule. The primary outcome was relapse of PTB and secondary outcomes were time to conversion of sputum smear and sputum culture.ResultsA total of 846 participants were enrolled between February 1, 2017 to February 27, 2021, and randomly assigned to receive either 60,000 IU vitamin D3 (n = 424) or placebo (n = 422) along with standard ATT. Among the 697 who were cured of PTB, relapse occurred in 14 participants from the vitamin D group and 19 participants from the placebo group (hazard risk ratio 0.68, 95%CI 0.34 to 1.37, log rank p value 0.29). Similarly, no statistically significant difference was seen in time to sputum smear and sputum culture conversion between both groups. Five patients died each in vitamin D and placebo groups, but none of the deaths were attributable to the study intervention. Serum levels of vitamin D were significantly raised in the vitamin D group as compared to the placebo group, with other blood parameters not showing any significant difference between groups.ConclusionsThe study reveals that vitamin D supplementation does not seem to have any beneficial effect in the treatment of PTB in terms to the prevention of relapse and time to sputum smear and culture conversion.Trial registrationCTRI/2021/02/030977 (ICMR, Clinical trial registry-India)

Impact of the 2017 ACC/AHA guidelines on the prevalence of hypertension among Indian adults: Results from a cross-sectional survey

BackgroundThe impact of the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for diagnosis and management of hypertension on the prevalence of hypertension in India is unknown.MethodsWe analyzed data from the Cardiac Prevent 2015 survey to estimate the change in the prevalence of hypertension. The JNC8 guidelines defined hypertension as a systolic blood pressure of ≥140 ​mmHg or diastolic blood pressure of ≥90 ​mmHg. The 2017 ACC/AHA guidelines define hypertension as a systolic blood pressure of ≥130 ​mmHg or diastolic blood pressure of ≥80 ​mmHg. We standardized the prevalence as per the 2011 census population of India. We also calculated the prevalence as per the World Health Organization (WHO) World Standard Population (2000-2025).ResultsAmong 180,335 participants (33.2% women), the mean age was 40.6 ​± ​14.9 years (41.1 ​± ​15.0 and 39.7 ​± ​14.7 years in men and women, respectively). Among them, 8,898 (4.9%), 99,791 (55.3%), 35,694 (11.9%), 23,084 (12.8%), 9,989 (5.5%) and 2,878 (1.6%) participants belonged to age group 18-19, 20-44, 45-54, 55-64, 65-74 and ​≥ ​75 years respectively. The prevalence of hypertension according to the JNC8 and 2017 ACC/AHA guidelines was 29.7% and 63.8%, respectively- an increase of 115%. With the 2011 census population of India, this suggests that currently, 486 million Indian adults have hypertension according to the 2017 ACC/AHA guidelines, an addition of 260 million as compared to the JNC8 guidelines.ConclusionAccording to the 2017 ACC/AHA guidelines, 3 in every 5 Indian adults have hypertension

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was coprioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. Results: In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion: This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries