Challenges in establishing waste-to-energy projects in developing countries with a case study from India

Municipal solid waste (MSW) management and its scientific disposal is a major concern for the local municipal authorities of all major Indian cities. Under the "Clean India Mission", the Ministry of Urban Development (MoUD) of India is investing US $9 Billion to clean up 75 largest cities in India. Waste to Energy (WTE) plants will be a key to its implementation. Currently, open air burning and landfilling are the most common practices of wase disposal in India. Landfilling is considered the least favourable option for cities as these sites occupy significant land areas in already crowded urban areas. WTE plants or incinerators are considered the most viable solution for safe disposal of MSW all over the world. In India, however, WTE projects have had mixed results and outright failures. Currently, only eight such plants are operational in the country. This is due to several technical, economic, environmental, social and policy factors involved. This study investigates the feasibility of a proposed state-of-the art WTE plant in Delhi which will set an example for other cities to follow. It reviews the various challenges involved in the implementation of such a project and suggests mitigating solutions to overcome these challenges

Unusual clinical presentation and complications following preoperative embolization of a large adrenal tumor

Authors present a case of a young female presenting with secondary amenorrhea which on further investigation revealed a large intra-abdominal mass, likely arising from the left adrenal gland. As the tumor was highly vascular with large feeders, she was referred for pre-operative embolization to reduce the blood loss during surgery. Post embolization, the patient suffered from an unusual complication of tumor rupture along with excessive secretion of catecholamines resulting in myocarditis and myocardial infarction. Patient ultimately died of the myocardial infarction. Preoperative embolization of a large, hypervascular adrenal mass lesion is not devoid of unusual complications like tumor rupture and subsequent cardiovascular complications even if the tumor is hormonally inactive. This complication is extremely rare and has never been reported in adrenal tumors after embolization

Prevalence of depression and health related quality of life among patients with diabetes mellitus and hypertension attending a secondary care hospital in district Faridabad, Haryana

Background:  Diabetes mellitus (DM) and hypertension (HT) have significant effect on the mental health of the patient. and. We aimed to estimate the prevalence of depression, and the quality of life among patients with diabetes mellitus and hypertension who attended a secondary care hospital. Methods: A cross-sectional study was carried out among 618 patients who had DM and/or HT.  PHQ-9 and WHO-BREF QOL questionnaire were administered to assess depression and health related quality of life respectively. Results: More than 2/3rd of patients had depression. Among those who had depression, nearly half (46%) had moderate depression and 2.1% had severe depression. The proportion of severely depressed patients was higher in diabetes mellitus group compared to the hypertension group.   Patients that were depressed had poorer quality of life compared to non-depressed, and the difference was statistically significant. Conclusion: Patients with diabetes mellitus and hypertension may be screened for depression and managed accordingly

A study of knowledge beliefs and attitudes regarding aids and human sexuality among medical college, engineering college and university Undergraduates of gorakhpur.

Research Problem: i) What is the level of knowledge and altitude of undergraduates about AIDS and human sexuality? ii) What arc the preferred modes of obtaining such knowledge?. Objectives: To assess the knowledge, beliefs and attitudes of undergraduate students regarding AIDS and human sexuality. Study Design: Self administered questionnaire. Setting and Participants: 1289 undergraduates from B.R.D. Medical College., M. M. M. Engineering College and University of Gorakhpur. Study Variables: Knowledge, beliefs and attitudes regarding AIDS and sexuality. Outcome Variables: Proportion of students having correct knowledge and positive attitudes. Statistical Analysis: By proportions. Result: l.evcl of knowledge about AIDS was generally high. Most of the students obtained knowledge about it through mass media. Few students had misconceptions about transmission of 1IIV infection. Knowledge about sex was obtained mainly from friends (36%) and books (31.31%). Most of the students preferred doctors (44.15%) and friends (43.66%) for asking something about sex. and not their parents (4.37%) or teachers (4.61%). 59.13% of boys and 34.49% of girls thought that students of their age had sex. Conclusion and Recommendations: The most peculiar fact in (his study is that students have no reliable means of obtaining correct information about subjects related to sex. Medical profession contributed very little in providing such knowledge. Most of them relied on their friends for such information. So. emphasis is to be given on recommending proper education material for the youth

Epidemiology and Clinicopathological Profile of Renal Cell Carcinoma: A Review from Tertiary Care Referral Centre

Renal cell carcinoma (RCC) accounts for 3% of all adult cancers and 85% of all kidney tumours. Incidence of RCC is lower in Asian region, particularly in India, probably due to lack of reporting. Most of the data about RCC are from Western countries; and data from India are scarce, especially regarding para-neoplastic syndromes. We sought to determine the epidemiology, clinicopathological profile and management of RCCin a tertiary care centre in Western India. This was a retrospective study that involved data analysis of records of RCC patients who presented to our institution from April 2016 to February 2020. Laboratory investigations, including tests for paraneoplastic syndrome (PNS), and relevant radiologic investigations were performed and treatment was offered according to the stage, patient factors and available modalities. A total 142 RCC patients were included in the study. The median age of presentation was 58 years. Most of the patients (67%) were symptomatic, and 33% of the patients were asymptomatic, and the RCC was diagnosed incidentally. A large number of patients (56.3%) had PNS. The most common histopathologic type of RCC was clear cell carcinoma (68.8%), followed by papillary (20%) and chromophobe (8%) carcinoma. 40% of carcinomas with sarcomatoid differentiation were seen in patients under 50 years of age. Two cases of multicystic RCC were both seen in patients less than 50 years of age. 65.5% of the patients presented at Stage 1 and 2. Most surgeries (71.2%) were done in a minimally invasive manner. A significant number of patients were asymptomatic, in which RCC was detected incidentally. The age of presentation was earlier, yet the patients had a higher tumour stage. More than half of the patients had PNSs. Despite growing trend towards Western data, the significantly higher number of patients with PNSs and early age of presentation suggest inherent differences in tumour biology, possibly related to differences in genetic and environmental factors

Household transmission investigation for Corona Virus Disease 2019 (COVID-19) in a rural and urban population of north India.

BackgroundTransmissibility within closed settings, such as households, can provide a strategic way to characterize the virus transmission patterns because the denominator can be well defined. We aimed to characterize the household transmission of Severe Acute Respiratory Syndrome Coronavirus (SARS CoV-2) and its associated risk factors.MethodsThis prospective case-ascertained study was conducted among the household contacts of laboratory-confirmed SARS CoV-2 cases residing in Ballabgarh, Haryana. We enrolled 148 index cases and their 645 household contacts between December 16, 2020 and June 24, 2021. We defined household contact as any person who had resided in the same household as a confirmed COVID-19 case. Baseline data collection and sample collection for real time- reverse transcriptase polymerase chain reaction (RT-PCR) and IgM/IgG against SARS CoV-2 were done on day 1 visit, and followed for a period of 28 days. RT-PCR was repeated on day 14 or whenever the contact is symptomatic and blood sample for serology was repeated on day 28. We estimated household secondary infection rate (SIR) and other epidemiological indicators-median incubation period and serial interval. We employed binomial logistic regression to quantify risk factors associated with infection.ResultsThe household SIR was 30.5% (95% CI: 27.1-34.1%). The secondary clinical attack rate was 9.3% (95% CI: 7.2-11.8). The risk factors that showed higher susceptibility to infection were household contacts who were the primary care giver of the case, whose index cases were symptomatic, those with underlying medical conditions, those living in overcrowded households, who were sharing toilet with the index cases and also who were not wearing a mask when coming in contact with the case. The median (IQR) incubation period was 4 days (4, 5), mean (SD) serial interval 6.4 (±2.2) days, and median (IQR) serial interval 5 days (5, 7).ConclusionHouseholds favour secondary transmission of SARS CoV- 2, hence, index cases are recommended to self-isolate and wear masks; and household contacts to follow strict COVID infection control measures within households when a family member is infected

Author correction: global dietary quality in 185 countries from 1990 to 2018 show wide differences by nation, age, education, and urbanicity

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Nutrition, atherosclerosis, arterial imaging, cardiovascular risk stratification, and manifestations in COVID-19 framework: a narrative review.

Background: Atherosclerosis is the primary cause of the cardiovascular disease (CVD). Several risk factors lead to atherosclerosis, and altered nutrition is one among those. Nutrition has been ignored quite often in the process of CVD risk assessment. Altered nutrition along with carotid ultrasound imaging-driven atherosclerotic plaque features can help in understanding and banishing the problems associated with the late diagnosis of CVD. Artificial intelligence (AI) is another promisingly adopted technology for CVD risk assessment and management. Therefore, we hypothesize that the risk of atherosclerotic CVD can be accurately monitored using carotid ultrasound imaging, predicted using AI-based algorithms, and reduced with the help of proper nutrition. Layout: The review presents a pathophysiological link between nutrition and atherosclerosis by gaining a deep insight into the processes involved at each stage of plaque development. After targeting the causes and finding out results by low-cost, user-friendly, ultrasound-based arterial imaging, it is important to (i) stratify the risks and (ii) monitor them by measuring plaque burden and computing risk score as part of the preventive framework. Artificial intelligence (AI)-based strategies are used to provide efficient CVD risk assessments. Finally, the review presents the role of AI for CVD risk assessment during COVID-19. Conclusions: By studying the mechanism of low-density lipoprotein formation, saturated and trans fat, and other dietary components that lead to plaque formation, we demonstrate the use of CVD risk assessment due to nutrition and atherosclerosis disease formation during normal and COVID times. Further, nutrition if included, as a part of the associated risk factors can benefit from atherosclerotic disease progression and its management using AI-based CVD risk assessment

Cardiovascular/Stroke Risk Stratification in Diabetic Foot Infection Patients Using Deep Learning-Based Artificial Intelligence: An Investigative Study

A diabetic foot infection (DFI) is among the most serious, incurable, and costly to treat conditions. The presence of a DFI renders machine learning (ML) systems extremely nonlinear, posing difficulties in CVD/stroke risk stratification. In addition, there is a limited number of well-explained ML paradigms due to comorbidity, sample size limits, and weak scientific and clinical validation methodologies. Deep neural networks (DNN) are potent machines for learning that generalize nonlinear situations. The objective of this article is to propose a novel investigation of deep learning (DL) solutions for predicting CVD/stroke risk in DFI patients. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) search strategy was used for the selection of 207 studies. We hypothesize that a DFI is responsible for increased morbidity and mortality due to the worsening of atherosclerotic disease and affecting coronary artery disease (CAD). Since surrogate biomarkers for CAD, such as carotid artery disease, can be used for monitoring CVD, we can thus use a DL-based model, namely, Long Short-Term Memory (LSTM) and Recurrent Neural Networks (RNN) for CVD/stroke risk prediction in DFI patients, which combines covariates such as office and laboratory-based biomarkers, carotid ultrasound image phenotype (CUSIP) lesions, along with the DFI severity. We confirmed the viability of CVD/stroke risk stratification in the DFI patients. Strong designs were found in the research of the DL architectures for CVD/stroke risk stratification. Finally, we analyzed the AI bias and proposed strategies for the early diagnosis of CVD/stroke in DFI patients. Since DFI patients have an aggressive atherosclerotic disease, leading to prominent CVD/stroke risk, we, therefore, conclude that the DL paradigm is very effective for predicting the risk of CVD/stroke in DFI patients