Acute on chronic liver failure- etiology, clinical profile, prognostic scores: experience from tertiary care centre of eastern India

Background: Acute on chronic liver failure (ACLF) is a recently recognised entity in chronic liver disease patients. Data regarding ACLF in terms of clinical presentation, etiology of underlying cirrhosis, precipitating factors, prognostic factors are lacking from eastern India. The present study was undertaken to evaluate the above factors along with the assessment of short-term mortality (4 weeks) in patients of ACLF.Methods: In this prospective observational study, 120 patients diagnosed as ACLF were included. A comparison of complications, biochemical profiles and prognostic scores was made between the survivor and non-survivor groups.Results: Of the 120 ACLF patients included, the mean age was 44.9±8.6 years and the male to female ratio was 2.5:1. Common clinical presentations were jaundice (100%), ascites (88.3%), hepatic encephalopathy (60%). The most common etiology for underlying CLD was alcohol (51.7%) followed by chronic hepatitis B (20%) and chronic hepatitis C (15%) infection. Alcohol hepatitis (40%) followed by hepatotropic viral infections (20%) and drug-induced liver injury (15%) were common identifiable precipitating agents. After a follow-up period of 4 weeks, 56 (46.6%) out of 120 patients died. The presence of sepsis, hyponatremia, renal failure, and coagulopathy was significantly associated with high mortality. Mortality was higher among patients having high Chronic liver failure consortium- acute on chronic liver failure (CLIF-ACLF) grade and closely related to the number of organ failures.Conclusions: ACLF is a rapidly progressive syndrome in chronic liver disease patients, having high short-term mortality

Bilateral floating knee: a rare case report with review of literature

Floating knee injuries are commonly seen nowadays due to increase in road traffic accidents. However, bilateral presentation of floating knee is a rare injury and challenging to orthopaedicians for a good functional outcome. We hereby present a rare case of bilateral floating knee injury in a 45 year old male treated with open reduction and internal fixation in a staged procedure. Functional assessment was done using modified Karlstrom-Olerud criteria which showed excellent outcome. Union was achieved in approximately 7 months. Decreased knee movements over left side as compared to right side was only complication seen

Residual Energy Based Cluster-head Selection in WSNs for IoT Application

Wireless sensor networks (WSN) groups specialized transducers that provide sensing services to Internet of Things (IoT) devices with limited energy and storage resources. Since replacement or recharging of batteries in sensor nodes is almost impossible, power consumption becomes one of the crucial design issues in WSN. Clustering algorithm plays an important role in power conservation for the energy constrained network. Choosing a cluster head can appropriately balance the load in the network thereby reducing energy consumption and enhancing lifetime. The paper focuses on an efficient cluster head election scheme that rotates the cluster head position among the nodes with higher energy level as compared to other. The algorithm considers initial energy, residual energy and an optimum value of cluster heads to elect the next group of cluster heads for the network that suits for IoT applications such as environmental monitoring, smart cities, and systems. Simulation analysis shows the modified version performs better than the LEACH protocol by enhancing the throughput by 60%, lifetime by 66%, and residual energy by 64%

Prevalence of chronic disease in older adults in multitier eye-care facilities in South India: Electronic medical records-driven big data analytics report

Purpose: To study the prevalence of systemic conditions in older adults, either self-reported or discovered during routine eye examinations, at multitier eye-care facilities over the past decade, and to explore their association with vision and common ocular disorders, including cataract, glaucoma, and retinopathy. Methods: Retrospective review of a large data set compiled from the electronic medical records of patients older than 60 years who presented to an eye facility of a multitier ophthalmology network located in 200 different geographical locations that included urban and rural eye-care centers spread across four states in India over a 10-year period. Results: 618,096 subjects aged 60 or older were identified as visiting an eye facility over the 10-year study period. The mean age of the study individuals was 67·28 (±6·14) years. A majority of older adults (66·96%) reported being free of systemic illnesses. Patients from lower socioeconomic status had a lower prevalence of chronic systemic disease, but the presenting vision was poorer. Hypertension (21·62%) and diabetes (18·77%) were the most commonly reported chronic conditions in patients who had concomitant systemic illness with visual concerns. Conclusion: The prevalence of chronic systemic illnesses in older adults presenting to multitier eye-care facilities is relatively low, except in those with diabetic retinopathy. These observations suggest a need to include active screening for common chronic diseases in standalone eye-care facilities to achieve a more accurate assessment of chronic disease burden in the older population

Prevalence of Age-Related Macular Degeneration and Associated Factors in Indian Cohort in a Tertiary Care Setting

PURPOSE: To report a big data analysis of risk and protective factors in patients with AMD, as well as report on the age-adjusted prevalence in a geriatric Indian cohort in a hospital setting. METHODS: This retrospective, observational study of all patients older than 60 years of age. Multiple logistic regression was performed for the binary outcome and the presence of AMD. Variables analyzed include age, gender, socioeconomic status, occupation, urban-rural-metropolitan distribution, self-reported history of diabetes mellitus (DM), hypertension (HTN), or coronary artery disease (CAD), ocular comorbidities, history of cataract surgery, and presenting VA. Odds ratios (OR) and 99% confidence intervals were calculated. RESULTS: Of the 608,171 patients over the age of 60 years who attended our clinics, 1.68% of subjects had a diagnosis of AMD (N = 10,217). Less than half (4,621 of 10,217 with AMD) of them were diagnosed to have dry AMD. Cataract, glaucoma, and diabetic retinopathy were associated with lower risk of AMD. Cataract surgery was associated with the higher risk of AMD (OR = 1.20; 99% CI 1.13-1.29). Smoking was not associated with AMD. CONCLUSION: Big data analysis from a hospital setting shows that the prevalence of AMD above the age of 60 years is low. More patients with wet AMD present for treatment compared to dry AMD. Smoking was not associated with AMD in the Indian population. Cataract surgery was associated with higher prevalence of AMD

MUSiC : a model-unspecific search for new physics in proton-proton collisions at root s=13TeV

Results of the Model Unspecific Search in CMS (MUSiC), using proton-proton collision data recorded at the LHC at a centre-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 35.9 fb(-1), are presented. The MUSiC analysis searches for anomalies that could be signatures of physics beyond the standard model. The analysis is based on the comparison of observed data with the standard model prediction, as determined from simulation, in several hundred final states and multiple kinematic distributions. Events containing at least one electron or muon are classified based on their final state topology, and an automated search algorithm surveys the observed data for deviations from the prediction. The sensitivity of the search is validated using multiple methods. No significant deviations from the predictions have been observed. For a wide range of final state topologies, agreement is found between the data and the standard model simulation. This analysis complements dedicated search analyses by significantly expanding the range of final states covered using a model independent approach with the largest data set to date to probe phase space regions beyond the reach of previous general searches.Peer reviewe

Search for new particles in events with energetic jets and large missing transverse momentum in proton-proton collisions at root s=13 TeV

A search is presented for new particles produced at the LHC in proton-proton collisions at root s = 13 TeV, using events with energetic jets and large missing transverse momentum. The analysis is based on a data sample corresponding to an integrated luminosity of 101 fb(-1), collected in 2017-2018 with the CMS detector. Machine learning techniques are used to define separate categories for events with narrow jets from initial-state radiation and events with large-radius jets consistent with a hadronic decay of a W or Z boson. A statistical combination is made with an earlier search based on a data sample of 36 fb(-1), collected in 2016. No significant excess of events is observed with respect to the standard model background expectation determined from control samples in data. The results are interpreted in terms of limits on the branching fraction of an invisible decay of the Higgs boson, as well as constraints on simplified models of dark matter, on first-generation scalar leptoquarks decaying to quarks and neutrinos, and on models with large extra dimensions. Several of the new limits, specifically for spin-1 dark matter mediators, pseudoscalar mediators, colored mediators, and leptoquarks, are the most restrictive to date.Peer reviewe

Measurement of prompt open-charm production cross sections in proton-proton collisions at root s=13 TeV

The production cross sections for prompt open-charm mesons in proton-proton collisions at a center-of-mass energy of 13TeV are reported. The measurement is performed using a data sample collected by the CMS experiment corresponding to an integrated luminosity of 29 nb(-1). The differential production cross sections of the D*(+/-), D-+/-, and D-0 ((D) over bar (0)) mesons are presented in ranges of transverse momentum and pseudorapidity 4 < p(T) < 100 GeV and vertical bar eta vertical bar < 2.1, respectively. The results are compared to several theoretical calculations and to previous measurements.Peer reviewe

Measurement of b jet shapes in proton-proton collisions at root s=5.02 TeV

We present the first study of charged-hadron production associated with jets originating from b quarks in proton-proton collisions at a center-of-mass energy of 5.02 TeV. The data sample used in this study was collected with the CMS detector at the CERN LHC and corresponds to an integrated luminosity of 27.4 pb(-1). To characterize the jet substructure, the differential jet shapes, defined as the normalized transverse momentum distribution of charged hadrons as a function of angular distance from the jet axis, are measured for b jets. In addition to the jet shapes, the per-jet yields of charged particles associated with b jets are also quantified, again as a function of the angular distance with respect to the jet axis. Extracted jet shape and particle yield distributions for b jets are compared with results for inclusive jets, as well as with the predictions from the pythia and herwig++ event generators.Peer reviewe

Combined searches for the production of supersymmetric top quark partners in proton-proton collisions at root s=13 TeV

A combination of searches for top squark pair production using proton-proton collision data at a center-of-mass energy of 13 TeV at the CERN LHC, corresponding to an integrated luminosity of 137 fb(-1) collected by the CMS experiment, is presented. Signatures with at least 2 jets and large missing transverse momentum are categorized into events with 0, 1, or 2 leptons. New results for regions of parameter space where the kinematical properties of top squark pair production and top quark pair production are very similar are presented. Depending on themodel, the combined result excludes a top squarkmass up to 1325 GeV for amassless neutralino, and a neutralinomass up to 700 GeV for a top squarkmass of 1150 GeV. Top squarks with masses from 145 to 295 GeV, for neutralino masses from 0 to 100 GeV, with a mass difference between the top squark and the neutralino in a window of 30 GeV around the mass of the top quark, are excluded for the first time with CMS data. The results of theses searches are also interpreted in an alternative signal model of dark matter production via a spin-0 mediator in association with a top quark pair. Upper limits are set on the cross section for mediator particle masses of up to 420 GeV