A Rare Case of Situs Inversus with Mesocardia

A ten year old male child having congenital heart disease admitted with recurrent history of respiratory infection. ECHO cardioraphy showed Mesocardia, congenitally corrected TGA, bidirectional VSD and severe pulmonary valve stenosis.On sonographic evaluation showed intra-abdominal mirror imaging of all the solid organs and vessels which was suggestive of a rare presentation of Sinus inverses with Mesocardia. Corrective surgery as pulmonary valve balloon dilation or valvuloplasty and vestricular septal repair has to be done to the child for better morbidity and reducing the mortality risk. This anomaly complicates the diagnosis and management of acute abdominal conditions like appendicitis, diverticulitis and biliary coli

Implementation of Peltier Cooling in Hermetically Sealed Electronic Packaging Unit for Sub-sea Vessel

This paper presents the methodology adopted for implementation of Peltier cooling in hermetically sealed electronic packaging units used in sub-sea vessels. In sub-sea vessels, sonar front-end electronics is packaged in hermetically sealed electronic packaging units. The thermal design of the unit is a highly challenging task considering the heat dissipation of 300W from the electronics, non-availability of chilled air for cooling and IP68 sealing requirements. Cooling fans cannot be integrated, since these units are to be placed in acoustically sensitive pressure capsule area of the subsea vessel. The electronic cooling in this unit is achieved using conduction cooling with external fins. To enhance the cooling, suitable Peltier cooling (Thermo-electric cooling or TEC) module is selected and implemented with the system. Computational fluid dynamic analysis of the unit is carried-out to study the air-flow and thermal performances with Peltier cooler. The unit is realised and the estimated temperatures validated by experimental temperature measurements on the realised unit. The measured temperatures are within the safe operating limits of the electronic components and hence the cooling design of the unit is satisfactory. It is also observed that maximum temperature reduction has occurred at 1.5A current and card edge temperature of Printed circuit board lowered by 9.28 °C by implementing Peltier cooling

Acceptability of different oral dosage forms in paediatric patients in hospital setting

Objective The understanding of acceptability of existing dosage forms is limited in most of the world and hinders the development of acceptable, age‐appropriate medicines. The attributes of paediatric medicine acceptability may differ from country to country based on culture, healthcare infrastructure and health policies. This study was designed to map the acceptability of oral medicines in paediatric patients treated in hospital in India. Methods An observational, cross-sectional study was conducted in patients aged below 18 years and taking any form of oral medication. Acceptability scores were obtained using CAST–ClinSearch Acceptability Score Test tool. Findings 490 patients were recruited and 193 evaluations of different pharmaceutical products available in 20 dosage forms and 7 routes of administration were studied. Oral liquids (50%) and tablets (35%) were the most commonly prescribed and administered forms. Regardless of the therapeutic class and age, the oral liquids were ‘positively accepted’ in infants and toddlers. Acceptability of tablets improved with age and appeared to be generally good from the age of 6. Conclusion This study indicates the limited progress towards adoption of age-appropriate dosage forms in India and thus impact on the acceptability of existing oral dosage forms. The key challenges posed by the adoption of age-appropriate formulations in India are (1) awareness of importance of appropriate administration and acceptability of medicines to children in India, (2) availability of age-appropriate dosage forms and (3) lack of child-appropriate medicine policies

DIALYSIS PRACTICE PATTERN IN PATIENTS UNDERGOING HEMODIALYSIS IN A TERTIARY AND A PRIVATE HOSPITAL

Objective: To evaluate the dialysis practice pattern in chronic kidney disease patients undergoing hemodialysis in a tertiary and a private hospital Methods: A prospective observational study of six months duration was carried out in 158 CKD patients on hemodialysis for a minimum period of one month. Data such as socio-demographic, clinical characteristics and dialysis practice details were captured from the patient’s medical records into the pre-designed Patient Proforma. The collected data were analysed. Results: Majority of respondents were male (67.09%), more than 60 y of age (32.28 %), married (89.24%). Hypertension (26.51%, 17.33%) was found to be the leading cause of CKD in a tertiary and private hospital. In the tertiary hospital, 78.31% of patients were undergoing twice-weekly hemodialysis, whereas in the private hospital thrice weekly (50.67%) hemodialysis was common. About 51.81% of patients in the tertiary and 58.67% in the private hospital was undergoing hemodialysis for 1-5 y with Arterio-Venous Fistula (59.04%, 94.67%) as the permanent vascular access (P<0.001). Conclusion: This study shows that hypertension was the leading cause of CKD in both hospitals. In the tertiary hospital twice weekly hemodialysis with arteriovenous fistula (AVF) and Permanent Catheter (IJV), were both preferred as the permanent vascular access. Whereas in the private hospital majority were undergoing thrice weekly hemodialysis and AVF was highly preferred

An ontological clinical decision support system based on clinical guidelines for diabetes patients in Sri Lanka

Health professionals should follow the clinical guidelines to decrease healthcare costs to avoid unnecessary testing and to minimize the variations among healthcare providers. In addition, this will minimize the mistakes in diagnosis and treatment processes. To this end, it is possible to use Clinical Decision Support Systems that implement the clinical guidelines. Clinical guidelines published by international associations are not suitable for developing countries such as Sri Lanka, due to the economic background, lack of resources, and unavailability of some laboratory tests. Hence, a set of clinical guidelines has been formulated based on the various published international professional organizations from a Sri Lankan context. Furthermore, these guidelines are usually presented in non-computer-interpretable narrative text or non-executable flow chart formats. In order to fill this gap, this research study finds a suitable approach to represent/organize the clinical guidelines in a Sri Lankan context that is suitable to be used in a clinical decision support system. To this end, we introduced a novel approach which is an ontological model based on the clinical guidelines. As it is revealed that there are 4 million diabetes patients in Sri Lanka, which is approximately twenty percent of the total population, we used diabetes-related guidelines in this research. Firstly, conceptual models were designed to map the acquired diabetes-related clinical guidelines using Business Process Model and Notation 2.0. Two models were designed in mapping the diagnosis process of Type 1 and Type 2 Diabetes, and Gestational diabetes. Furthermore, several conceptual models were designed to map the treatment plans in guidelines by using flowcharting. These designs were validated by domain experts by using questionnaires. Grüninger and Fox’s method was used to design and evaluate the ontology based on the designed conceptual models. Domain experts’ feedback and several real-life diabetic scenarios were used to validate and evaluate the developed ontology. The evaluation results show that all suggested answers based on the proposed ontological model are accurate and well addressed with respect to the real-world scenarios. A clinical decision support system was implemented based on the ontological knowledge base using the Jena Framework, and this system can be used to access the diabetic information and knowledge in the Sri Lankan context. However, this contribution is not limited to diabetes or a local context, and can be applied to any disease or any context

Suzuki-Miyaura coupling under microwave enhanced conditions: Synthesis of 2-(hetero)aryl benzimidazoles

An expedient, palladium-mediated cross-coupling approach to functionalize the benzimidazole-based core under microwave-assisted conditions has been developed and is described. This protocol, which incorporates appendage diversity on this potential scaffold, is found to be compatible with a wide range of electronicallyand sterically-divergent (hetero)aryl boronic acids. The use of the PdCl2/(SPhos) catalytic system allows the formation of a stable and highly active LPd(0) species which was found to be critical for the successful synthesis of these novel, pharmacologically-relevant molecules. © AUTHOR(S).Russian Foundation for Basic Research, RFBR: 170300641AThe authors are thankful to SAIF, Indian Institute of Technology, Madras, for providing all the analytical data and spectra. Vasiliy A. Bakulev is thankful to Russian Foundation for Basic Research (Grant # 170300641A)

Cost-effectiveness of janus kinase inhibitors for rheumatoid arthritis: A systematic review and meta-analysis of cost-utility studies

Introduction: Janus kinase inhibitors (JAK-i), a class of targeted synthetic disease-modifying antirheumatic drugs (tDMARDs), are suggested as second or third-line therapies in rheumatoid arthritis (RA). Synthesized cost-effective evidence would aid in informed decision-making given the similar clinical effectiveness of JAKi, but incongruent cost-effectiveness reports.Methods: Literature search was conducted in PubMed, Embase, Scopus, and Tufts Medical Centers’ cost-effective analysis registry. We pooled the incremental net benefit (INB) with 95% confidence interval (CI) using random-effects model and the heterogeneity was assessed using Cochrane-Q test and I2 statistic. Modified economic evaluation bias checklist was used to assess the quality of selected studies. Publication bias was assessed using a funnel plot and Egger’s test. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) assessment was performed to assess the certainty of outcomes presented.Results: We included seventeen relevant studies for systematic review, of which fifteen were eligible for meta-analysis. The meta-analysis results showed that JAK-i is cost-effective compared to csDMARDS/bDMARDs with a pooled INB (INBp) of $19,886 (95$23,144 (74.1–46,214) and high heterogeneity (I2 = 99.67). But on a separate analysis JAK-i as second-line treatment is not cost-effective than TNF-a-i (INBp = $25,813, -5,714 to 57,340). However, leave-one-out analysis found that omitting a single outlier makes JAK-i cost-effective. Further, JAK-i is not cost-effective as a third-line treatment for csDMARD-TNF-a-I failed RA, compared to csDMARDs/bDMARDs with INBp$26,157 (-7,284 to 59,598).Conclusion: Meta-analysis suggests that JAK-i is cost-effective when used after csDMARD failure but not cost-effective when used after csDMARD-TNF-a-i failure with low certainty of evidence.Clinical Trial Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021222541, identifier CRD4202122254

Data mining techniques applied to a manufacturing SME

This paper examines how data mining, an aspect of analytical science, can be applied to assist a Small to Medium Enterprise (SME) industry using unsupervised learning techniques, association rules and time-series analysis. Whilst recent developments have meant it is now possible for SME to compile large amounts of commercial data, this information is rarely utilised effectively. The study builds on a number of standard data mining techniques to produce a tailored set of analyses that provide maximum benefit to the company. Self-Organising Maps were utilised to visualise the core characteristics of the firm's customers. The study outlines a new technique to determine associations between customer variables using the arules package available within RStudios. Finally, time-series forecasting was conducted highlighting the seasonal variations and trends for potential growth in the coming year