Craniovertebral Junction Koch spine – an unusual presentation treated with a novel approach: case report and review of literature

The retropharyngeal space lies in the posterior pharyngeal wall between the middle and deep layers of the deep cervical fascia. It extends from the base of the skull to the mediastinum and frequently serves as a conduit for spread of disease from the neck into the chest. Spinal tuberculosis is the commonest extra pulmonary manifestation of tuberculosis. Clinical findings of cervical tuberculosis includes neck pain, restricted neck movements, quadriparesis, radicular manifestations, kyphosis, and sensory disturbance. It should be suspected in an adult person who presents with a destructive lesion of the cervical vertebra and retro-pharyngeal mass. Early diagnosis and treatment are necessary to prevent the serious complications of the disease. We present here a 46 years old female who presented to a tertiary care setup with acute onset dyspnea and quadriplegia with bladder bowel involvement managed with trans oral incision and drainage of retropharyngeal abscess followed by posterior occipitocervical fusion supplemented with Anti Koch Therapy with a good follow up

Managed aquifer recharge at a farm level : evaluating the performance of direct well recharge structures

A field study evaluated the performance of direct well recharge structures (DWRS) in order to harvest and filter farm runoff and its discharge into open dug wells to augment groundwater recharge. This was undertaken between 2016 and 2018 using a total of 11 wells in the Dharta watershed, situated in a semi-arid hardrock region of Udaipur district, Rajasthan, India. The depth to water level in each DWRS well was monitored weekly for 1 to 3 years before and after the DWRS was established, and water samples were taken for water quality analysis (pH, electrical conductivity (EC), total dissolved solids (TDS), turbidity, fluoride, and Escherichia coli) before and during the monsoon period. For each DWRS well, two control wells in close proximity were also monitored and sampled. Five of the DWRS established in 2018 also had flow meters installed in order to measure discharge from the filter to the well. The volume of water recharged through DWRS into individual wells during the 2018 monsoon ranged from 2 to 176 m3 per well. Although the mean rise in water levels over the monsoon was higher in DWRS wells than in nearby control wells, the difference was not significant. Values of pH, EC, TDS, and F decreased in DWRS and control wells as each monsoon progressed, whereas the turbidity of wells with DWRS increased slightly. There was no significant difference between DWRS and control wells for pH, EC/TDS, turbidity, or fluoride. The presence of E. coli in DWRS wells was higher than in control wells, however, E. coli exceeded drinking water guidelines in all sampled wells. On the basis of this study, it is recommended that rural runoff should not be admitted to wells that are used for, or close to, wells used for drinking water supplies, even though salinity and fluoride concentrations may be reduced. For this study, none of the 11 DWRS wells produced sufficient additional recharge to potentially increase dry season irrigation supplies to justify expenditure on DWRS. This even applies to the DWRS well adjacent to a small ephemeral stream that had a significantly larger catchment area than those drawing on farmers’ fields alone. An important and unexpected finding of this study was that no sampled open dug well met drinking water standards. This has led to a shift in local priorities to implement well-head water quality protection measures for wells used for drinking water supplies. It is recommended that parapet walls be built around the perimeter of such dug wells, as well as having covers be installed

Hydrologic and cost-benefit analysis of multiple check dams in catchments of ephemeral streams, Rajasthan, India

Investment in the small-scale enhancement of groundwater recharge through check dams and other recharge structures in rural India is on the order of USD 1 billion/year. However, for any catchment, the optimal capacity of check dams is unknown, and the impacts on downstream flows are rarely determined. This paper describes a method that can be applied to plan recharge augmentation in catchments that have at least one monitored check dam. It was applied in the Dharta catchment of the Aravalli Hills in Udaipur district, Rajasthan, India, where four check dams in an ephemeral stream were monitored by farmers over seven years. For the last three years of this study, the hydrology of two of these check dams was affected by 19 new check dams established upstream. A basic hydrologic model, WaterCress, was calibrated on monitored check-dam storages and used to assess the impacts of the new structures on recharge from those downstream. Then, the model was rerun with a range of capacities of upstream check dams to determine the effects of check-dam capacity on (1) the recharge from the downstream check dam, (2) the total recharge from all check dams, and (3) the frequency of spill from the downstream check dam. Using the available economic information, the benefit–cost ratio was calculated for a range of check-dam capacities. This showed a decline in economic efficiency with each new check dam and defined the optimal capacity. Monsoon size was found to be consequential to results, and longer hydrological records yield more reliable results. The study showed that monitoring check dams, rainfall, and groundwater levels is key to deciding whether additional check dams are economically beneficial

Diagnostic utility of lung ultrasound in predicting the need for surfactant therapy in preterm neonates with respiratory distress

BackgroundLung ultrasound is an accurate and early predictor for surfactant replacement therapy in respiratory distress syndrome (RDS) as compared to clinical parameters and chest x-ray. However, lung pathologies for respiratory distress at birth have overlapping symptomatology and low middle-income countries have a higher incidence of congenital pneumonia, in addition to RDS, making the immediate diagnosis difficult. Thus, there is a need for assessing a cutoff for lung ultrasound scores in the given setting.ObjectivesThe primary objective was to determine the diagnostic accuracy of the lung ultrasound score (LUS) in predicting the need for surfactant therapy in preterm neonates with respiratory distress. Secondary objectives were to correlate LUS with corresponding oxygen saturation to the fraction of inspired oxygen ratio (SpO2/FiO2), arterial/Alveolar oxygen pressure ratio (a/A), and chest x-ray (CXR) findings.MethodologyA prospective observational study was carried out at a tertiary-level neonatal intensive care unit in India in 2022 enrolling 100 neonates <34 weeks gestational age with respiratory distress at birth. After initial stabilization of the neonate, LUS was performed and baseline parameters were noted. Surfactant was administered as per the 2019 European Consensus guidelines and LUS was repeated after 6 h of therapy.ResultsThe mean gestation of enrolled neonates was 31.06 ± 2.12 weeks and the mean birthweight was 1,412 ± 391 g. Approximately 58% were diagnosed with RDS and 30% had congenital pneumonia. Surfactant was administered to 40% of neonates. The cutoff LUS for surfactant therapy was 7 [area under the curve (AUC) 0.977; 95% CI, 0.947–1; P < 0.001; with sensitivity 92.5%, specificity 96.67%, PPV 94.87%, and NPV 95.08%] and the cutoff LUS for the second dose of surfactant was 10 (AUC 0.964; 95% CI, 0.913–1; P < 0.001). The score decreased by 3.24 (2.44–4.05) after 6 h of the first dose and correlated significantly with SpO2/FiO2 ratio (−0.750), a/A ratio (−0.650), and CXR findings (0.801).ConclusionThe study predicted an optimal LUS cutoff of 7 and 10 for the need for the first dose of surfactant and re-treatment, respectively, in neonates <34 weeks gestational age with respiratory distress

USG grading of fatty liver with lipid profile in south Indian population

The article is dealing with one of the important diseases in the modern era and people from all over the world are suffering from it. The study demonstrates the severe condition of South Indian people of India; they are enduring the pain of this disease. The main characterization of the disease is fat deposition or it can also be known as the “spectrum of liver steatosis”, “inflammation “or “fibrosis”. In India, people are suffering from fatty liver disease and the rate is 15% to 30%. Doctors are utilizing the Ultrasonography method to detect the images of fatty liver and after that, they prescribe medicines to treat the disease. In this context, it is necessary to conduct a lipid profile test for the patient to detect the find out threat of cardiovascular disease. The article also discusses the ultimate goal of the study and also the materials uses for the study. The result and discussion part of the study will clearly demonstrate the importance of the article and also the preventive measures for the disease. In recent years, Fatty liver can be seen as a common disease affecting human beings' lives and it can also be known as “hepatic steatosis”.&nbsp

Surface Composite Fabrication by Friction Stir Processing: A Review

Newer materials with unique properties are needed to cater the ever-increasing industrial demands to meet new challenges concerning technological advancements. Quest for special materials and processes is prevalent as conventional materials fail to level up. Composite materials promisingly bridge this gap by providing controllable properties at reasonable costs. Their scope of application can further be drastically enhanced by subjecting them to special surface processing treatments. Friction stir processing (FSP) is one such promising process that can meet the stringent applicational demands. Composites are increasingly being used in industries for properties like high strength to weight ratio, increased hardness, stiffness, ductility, corrosion resistance, etc. FSP, a solid-state material modification technique, has proved its caliber in surface composite fabrication. Some attention-seeking advantages of FSP include peerless efficiency, less tool wear rate, and ability to modify material locally are some of many attention-seeking advantages. Despite being cost-effective FSP also manages to eliminate the drawbacks of the conventional manufacturing process. FSP reinforces a special material into the parent material surface to attain specific properties. Properties so developed depend on parameters like: tool geometry, traverse speed, rotation speed, number of passes etc. The present paper aims to review comprehensive information on fabrication of surface composites by FSP, process parameters, properties, industrial applications, and future scope. Key Words: Friction stir processing surface processing treatments surface composites material modification process parameters

Solubility enhancement of cefixime trihydrate by solid dispersions using hydrotropic solubilization technique and their characterization

The aqueous solubility of cefixime trihydrate (a water insoluble drug) using different hydrotropic agents was determined and solid dispersions of cefixime trihydrate were prepared by hydrotropic solubilization technique. The drugs content were determined. The aqueous solubility of v was increased many fold in presence of sodium acetate trihydrate as hydrotropic agent. This hydrotropic agent was used to prepare solid dispersion of cefixime trihydrate. Cefixime trihydrate and sodium acetate trihydrate were accurately weighed and taken in a 200 mL beaker. Distilled water 10-15 mL was taken to dissolve hydrotropic agent using heat (48-50 °C). The drug was then added to it and magnetically stirred till whole mass get viscous. The solid dispersions of cefixime trihydrate were characterized by XRD, DSC and IR studies. DSC thermogram, XRD and Infra-Red spectra were studied. Solid dispersions, thus prepared, showed faster release of the drug as compared to pure drug and physical mixture

Experimental and computational investigation of the formation, transformation and reactivity of iron oxides in wastewater treatment

Iron salts are frequently added in wastewater treatment for the purpose of enhancing removal of phosphorus. Removal of this troublesome wastewater contaminant is induced by its adsorption to amorphous ferric oxides (AFO) that form following addition of the iron salt to the wastewater at typically circumneutral pH. Difficulties can arise however as a result of the change in form and associated adsorptive capacity of the AFO following its initial formation. The transformation of AFO and likely implications to phosphorus removal are investigated in this study with the thesis divided into two parts. In the first part, the change in reactivity of AFO with time (a process commonly referred to as ‘aging’) was studied in three different types of model systems by conducting a series of experiments in order to elucidate our current understanding of AFO aging in the presence and absence of organic materials. In the second part, the knowledge of AFO aging was utilized to develop a fully functional dynamic physiochemical model in order to optimize phosphorus removal performance of wastewater systems.AFO aging was investigated in three different solutions, namely, inorganic (containing only inorganic reagents), alginate (containing alginate as a model polysaccharide) and supernatant (obtained from a bench scale MBR unit processing a real wastewater mass) through reductive dissolution of AFO formed in these systems using ascorbate as reductant. It was observed that, in the inorganic system, aging was due to reduction in available surface sites as a result of aggregation while the presence of organics stabilized the AFO nanoparticles and prevented aggregation in the two systems containing organics.For development of the fully functional AFO aging model, a simplified two-dimensional version of the laboratory scale beaker-magnet system with well-defined hydrodynamics was considered. The velocity field and species transport were solved using COMSOL Multiphysics while the associated chemical transformations were modelled using the geochemical speciation tool PHREEQC. A MATLAB code was used to couple the hydrodynamic and chemical aspects of the model with particular development required to describe the turbulent mixing conditions typical of these fast moving systems and the associated rapid chemical transformations occurring within them.AFO aging models appropriate to dosing of both ferric and ferrous salts were developed. In the former case, the model only involved one time scale corresponding to formation of AFO while in the latter case two significantly different time scales were involved – one corresponding to oxidation of Fe(II) (slow) and the other corresponding to AFO formation (very fast). In both cases, the model is able to predict the distribution of AFO successfully. An application of this model was demonstrated by incorporating phosphorus removal following addition of Fe(II). The model was subsequently used to examine the impact of changing various design and operating parameters, including number of inlets, mixing intensity, and dosing pattern, on the phosphorus removal capacity of the system

Adaptive Mixing of Auxiliary Losses in Supervised Learning

In many supervised learning scenarios, auxiliary losses are used in order to introduce additional information or constraints into the supervised learning objective. For instance, knowledge distillation aims to mimic outputs of a powerful teacher model; similarly, in rule-based approaches, weak labeling information is provided by labeling functions which may be noisy rule-based approximations to true labels. We tackle the problem of learning to combine these losses in a principled manner. Our proposal, AMAL, uses a bi-level optimization criterion on validation data to learn optimal mixing weights, at an instance-level, over the training data. We describe a meta-learning approach towards solving this bi-level objective, and show how it can be applied to different scenarios in supervised learning. Experiments in a number of knowledge distillation and rule denoising domains show that AMAL provides noticeable gains over competitive baselines in those domains. We empirically analyze our method and share insights into the mechanisms through which it provides performance gains. The code for AMAL is at: https://github.com/durgas16/AMAL.git