A CASE STUDY AND CHALLENGES IN REPORTING OF ANO-RECTAL DISORDERS

Ano-rectal disorders namely Haemorrhoids, Fissure-in-ano and Fistula-in-ano here includes a variety of pathological disorders having different and various types of clinical presentation. These ano- rectal disorders generates relevant discomfort and disability to the patient. In this work our primary focus is only on these three anorectal disorders. The prevalence of Ano- rectal disorders are much higher than what we see in the hospital or clinics because most of the patient having such disorders do not seek for medical attention at an early stage. The present paper discusses about the hurdles or challenges faced while trying to enroll, update and increase the cases of Haemorrhoids, Fissure-in-ano and Fistula-in-ano reporting to Shalya Tantra OPD and IPD of Government Ayurvedic College and Hospital, Varanasi between year 2009-2019. The study had been also carried out to know the prevalence of diagnosed cases of Haemorrhoids, Fissure-in-ano and Fistula-in-ano and the interpretation of the data on the gender basis for better understanding of the disease. It is an institutional data study of total 5158 patients with an aim to estimate and evaluate the epidemiology of these ano–rectal disorders in eastern UP. This work is exploring scientifically the cause behind the prevalence of these three ano-rectal diseases reporting in our hospital

Conversational AI for Natural Language Processing: An Review of ChatGPT

ChatGPT is a conversational artificial intelligence model developed by OpenAI, which was introduced in 2019. It employs a transformer-based neural mesh to produce human being responses in real-time, allowing for natural language conversations with a machine. ChatGPT is instructed on huge quantities of data captured using the internet, making it knowledgeable in an extensive span of topics, from news & entertainment to politics and sports. This allows it to generate contextually relevant responses to questions and statements, making the conversation seem more lifelike. The model can be used in various applications, including customer service, personal assistants, and virtual assistants. ChatGPT has also shown promising results in generating creative content, such as jokes and poetry, showcasing its versatility and potential for future applications.This paper provides a comprehensive review of the existing literature on ChatGPT, highlighting its key advantages, such as improved accuracy and flexibility compared to traditional NLP tools, as well as its limitations and the need for further research to address potential ethical concerns. The review also highlights the potential for ChatGPT to be used in NLP applications, including question-answering and dialogue generation, and highlights the need for further research and development in these areas

DEVELOPMENT OF TAMOXIFEN CITRATE PELLETS BY HOT-MELT EXTRUSION FOR IMMEDIATE RELEASE: STUDY OF EFFECT OF VARIABLES

Objective: Objective of the study was to develop tamoxifen citrate immediate release pellets by hot-melt extrusion (HME) and to study the effect of various formulation and process variables. Methods: Pellets were prepared by HME technique. Effect of various parameters such as the concentration of ethylcellulose, PEG 6000, croscarmellose sodium, and spheronization speed were studied by using Central Composite Design. Pellets were evaluated for theoretical yield (%), mean pellet size (mm), sphericity (pellips), friability (%), porosity (%), mechanical crushing force (n), and dissolution efficiency. Optimized formulation was studied for compatibility study using IR, DSC, and XRD, SEM, In vitro drug release. In vitro Cell Cytotoxicity and Viability Assay were carried out using MCF-7 (human breast cancer cells) by MTT assay. Results: Results showed that a variable such as the amount of Methyl Cellulose, PEG 6000 and Spheronization speed showed positive correlation and amount of Croscarmellose sodium showed a negative correlation with dependent variables. Optimized formulation showed Korsmeyer Peppas model as a mechanism of drug release. Value of n was found to be in between 0.77+0.04, which reveals that, release mechanism of the drug as non-Fickian transport (0.45<n<0.89). MTT results of MCF-7 cells showed that optimized immediate release pellets have maximum cytotoxicity at 80 µg/ml. Conclusion: Study concluded that HME method and materials i.e. PEG 6000 and methylcellulose can effectively use to get immediate release of tamoxifen citrate so as to increase dissolution rate and cytotoxic effect

Business Decision Making by Big Data Analytics

Information is the key component towards success when it comes to controlling the decision-makers performance with the quality of a decision. In the modern era, an absolute amount of data is available to organizations for analysis usage. Data is the most important component of the business in the 21st century and a significant number of devices are already equipped with the internet. Based on this the solutions should be studied in order to control and capture the knowledge value pair out of the datasets. Following this, the decision-makers should have access to insightful and valuable data based on the dynamic high volume & velocity using big data analytics. Our research focuses on how to integrate big data analytics into the decision-making process. The B-DAD (big data analytics and decision) framework was created to map the big data tools, its architecture, and analytics for the several decision-making steps by the adoption of methodology based on design science. The ideal goal and offerings of the framework are adopting big data analytics in order to intensify & aid decision making for the organization using an integration of big data analytics into the corresponding decision-making process. Thus, the experiment was carried out in the retail domain to test the framework. As an end result, the results showcased the value-added if big data analytics is integrated with corresponding decision-making activity

Study of factors affecting maternal and fetal outcome in HIV positive women

Background: HIV virus infection was detected first time in India in Tamil Nadu in April 1986; India has the third largest HIV epidemic in the world. In 2013, HIV prevalence in India was an estimated 0.3 percent. The pregnant women and her unborn child who are HIV reactive are mostly innocent bearers of the brunt of the infection. Mother-to-child transmission of HIV is a major route of new infections in children. Without any intervention, the risk of transmission of HIV from infected pregnant women to her child is estimated to be around 20- 45%.Early diagnosis of children born to HIV positive mother using HIV DNA PCR and treating children who are diagnosed HIV-positive with antiretroviral drugs within their first 12 weeks of life reduces mortality by 75%.Methods: This retrospective data analytic study of HIV positive pregnant women who attended antenatal clinic and delivered at M.Y. Hospital, Indore from January 2011 to December 2013 .For screening of ANC patients ELISA method was used. For the children, HIV DNA was done by sending the dried blood smear on blot paper and was sent to the reference laboratory Kasturba Hospital, Mumbai and used for diagnosis at 6 week and 6 month.Results: Only 50% of HIV positive children were started on ART, 20% died, 20% loss to follow up and 10% were not willing for follow up. Also 30% mothers practiced mixed feeding. Neonatal mortality rate was 54.87 per thousand live births which is more than the seronegative mothers.Conclusions: First HIV DNA testing can be done at 72 hours to detect antenatal HIV transmission. Early testing can pick up these cases early and ensure treatment. Mixed feeding should be strongly discouraged by counseling and modern methods of communication

A Review on Different Methods Used for Performance Enhancement of Solar Air Heater

With the increased attention the efficiency of solar heating facilities and the performance of additional equipment are becoming increasingly important. In the present study, thinking is giving on the heat transfer characteristics of solar air heater with some modifications in design to increase air travel length. Performance of solar air dryer would be checked with and without air heater. Effect of climate conditions would also be studied on its performance. Keywords: Solar Air Heater, Air Heater, Heat transfer, Solar Collector, Solar Energy

Performance Enhancement of Solar Air Heater by Increase Air Travel Distance in Solar Air Heater

With the increased attention the efficiency of solar heating facilities and the performance of additional equipment are becoming increasingly important. In the present study, thinking is giving on the heat transfer characteristics of solar air heater with some modifications in design to increase air travel length. Performance of solar air dryer would be checked with and without air heater. Effect of climate conditions would also be studied on its performance. Keywords:Solar Air Heater, Air Heater, Heat transfer, Solar Collector, Solar Energy

Medical Knowledge-enriched Textual Entailment Framework

One of the cardinal tasks in achieving robust medical question answering systems is textual entailment. The existing approaches make use of an ensemble of pre-trained language models or data augmentation, often to clock higher numbers on the validation metrics. However, two major shortcomings impede higher success in identifying entailment: (1) understanding the focus/intent of the question and (2) ability to utilize the real-world background knowledge to capture the context beyond the sentence. In this paper, we present a novel Medical Knowledge-Enriched Textual Entailment framework that allows the model to acquire a semantic and global representation of the input medical text with the help of a relevant domain-specific knowledge graph. We evaluate our framework on the benchmark MEDIQA-RQE dataset and manifest that the use of knowledge enriched dual-encoding mechanism help in achieving an absolute improvement of 8.27% over SOTA language models. We have made the source code available here

Atlanto-axial subluxation with cervical myelopathy operated with occipital C2 fusion: A case report

ABSTRACT Atlanto-axial subluxation with cervical myelopathy is a rare condition that can occur mainly by trauma followed by Rheumatoid arthritis, Grisel syndrome, Down’s syndrome and various other metabolic disorders. It is characterized by excessive movement of atlas (C1) over axis (C2) either by bony or ligamentous abnormality. Due to its laxity the spinal cord may get damaged and cause neurologic symptoms. Reduction and fixation is needed for such instability. KEYWORDS: C1-C2 subluxation, Cervical myelopathy, Occipital C2 fusion. INTRODUCTION Atlantoaxial subluxation (AASL) is rare and mostly follows trauma but in our case the etiology was a degenerative cause to the cranio-vertebral junction (CVJ) [1]. Biomechanics include a repeated force of translation of C1 over C2 which leads to cord edema which gradually leads to cervical myelopathy. Most of the patients are neurologically intact [1,2]. Closed reduction and collar immobilization has been reported to be successful in a few cases though intact transverse axial ligament (TAL) is a prerequisite for conservative management [1,3]. Most of the previously reported cases have been managed with C1-C2 fusion [1]. We describe a patient with isolated ligamentous injury, without any fractures at CVJ and with neuro deficit managed with occipital cervical fusion. It is a rare case as most of the subluxation are a cause of trauma, Grisel syndrome or RA but this is a case of chronic degeneration of the transverse ligament leading to subluxation eventually leading to myelopathy of cervical spine. TYPES OF SUBLUXATION Table 1. Fielding Classification of AASL [4] Type I: Unilateral facet subluxation with intact transverse ligament. Odontoid acts as a pivot point and there is no anterior subluxation. Most common and benign type. Type II: Unilateral facet subluxation with 3 to 5 mm of anterior displacement. Injured Transverse ligament One facet acts as pivot point and one lateral mass is displaced Type III: Bilateral anterior facet displacement of > 5 mm. Rare with higher risk of neurologic involvement or instantaneous death. Both lateral masses are displaced Type IV: Posterior displacement of atlas (C1) Rare with higher risk of neurologic involvement or instantaneous death. The present report describes a case of type II subluxation with neurological involvement. Table 2. Nurick Classification: Cervical spondylotic myelopathy [5] Grade 0: Signs or symptoms of root involvement without spinal cord disease Grade I: Signs of spinal cord disease without difficulty in walking Grade II: Difficulty in walking without effect on employment Grade III: Difficulty in walking with effect on full-time employment Grade IV: Can walk only with aid or walker Grade V: Chair-bound or bed-ridden CASE REPORT This 55-year-old gentleman was apparently all right 4 years back when he gradually developed difficulty in walking and imbalance. There was no history of trauma. No history of Koch’s, joint pain or any other metabolic disorders. His neurological examination was suggestive of he having decreased power in the upper limb with right shoulder grade 4, right elbow grade 3, right wrist grade 2 while the right lower limb power was 4 compare to the power of left upper and lower side which was grade 5. Grip was poor in the right hand. Hoffmann’s sign was positive in bilateral upper limbs. Bilateral Babinski sign was positive, All deep tendon reflexes were brisk; muscle tone was increased with clasp-knife spasticity present in all four limbs. Ankle and patellar clonus was present bilaterally. His X-ray cervical spine showed C1-C2 subluxation in flexion and extension views. Magnetic resonance imaging (MRI) of CVJ. Showed Mild subluxation of atlantoaxial joint (3.1 mm) with posterior displacement of dens causing narrowing of bony cervical spinal canal with reduced distance between posterior aspect of dens of C2 and anterior aspect of posterior arch of C1 vertebrae. Posterior displacement of dens is seen causing compression of cervical spinal cord at the level of C1 – C2 with significant cord focal edema (figure 1). Atlas is slightly displaced anteriorly in relation to baso-occiput. RA factor was negative. ESR was 18 mm at end of one hour and C reactive protein was negative. We managed this patient with occipital cervical fusion after reduction from a posterior approach using screws and rods construct and fusion with bone graft from iliac crest. Postoperative immobilization consisted of using a hard cervical collar for 6 weeks. Post operatively the patient was able to walk without any support and tone of the muscles in lower limb decreased, no tingling or numbness are present, no signs of local infection or inflammation. Nurick grade of the patient improved from grade IV to grade I {Figure 2). DISCUSSION Usually the cause of subluxation of C1 – C2 is traumatic if not then RA but our case was of idiopathic etiology. Most of the cases with neurological deficit is associated with odontoid fracture while our case was rare with no association of any fracture. Most would agree that non-operative treatment has little, if any, role in the definitive treatment of occipital cervical dislocations or dissociations [6]. Halo vest immobilization is most often used as a temporary means of stabilizing or reducing injuries until surgery can be safely performed. Longitudinal traction is contraindicated [6]. In an anecdotal case review, one group reported successful treatment of a patient with a distractive atlantoaxial injury in a halo vest [6]. The patient was reportedly without complication at 5-year follow-up. Others have reserved non-operative treatment for select patients who are neurologically intact [7]. However, the authors did not offer a reliable method for selecting appropriate candidates. The goals of OCF are to regain normal alignment, to ensure adequate neural tissue decompression and to achieve structural stability [8]. OC-C1-C2 joint is an Osseo ligamentous complex and extremely mobile; a component of the cervical spine. It is largely believed that flexion at OC-C1 is limited by impingement of odontoid tip and extension by the tectorial membrane. There occurs a small flexion-extension movement at C1-C2 joint (of 10.1-22.4 degrees) with transverse ligament limiting flexion and tectorial membrane along with C1-C2 articular joint limiting extension [8]. In our case we did not do decompression of the patient as the reduction was enough to release the pressure of the cord and fusion was done at occiput to C2 level, as the reduction achieved at c1- c2 level was unstable. The use of posterior screw/rod instrumentation constructs were associated with a lower rate of postoperative adverse events (33.33%) (p < 0.0001), lower rates of instrumentation failure (7.89%) (p < 0.0001), and improved neurological outcomes (81.58%) (p < 0.0001) when compared with posterior wiring/rod, screw/plate, and on lay in situ bone grafting techniques [9]. The surgical technique associated with the highest fusion rate was posterior wiring and rods (95.9%) (p = 0.0484), which also demonstrated the shortest fusion time (p < 0.0064) [9]. Screw/rod techniques also had a high fusion rate, fusing in 93.02% of cases [9]. When comparing outcomes of surgical techniques depending on the disease status, inflammatory diseases had the lowest rate of instrumentation failure (0%) and the highest rate of neurological improvement (90.91%) following the use of screw/rod techniques [9]. Occipital cervical fusion performed for the treatment of tumors by using screw/rod techniques had the lowest fusion rate (57.14%) (p = 0.0089)[9]. Traumatic causes of occipital cervical instability had the highest percentage of pain improvement with the use of screw/plates (100% improvement) (p < 0.0001) [9]. CONCLUSION: We suggest to operate atlanto-axial subluxation and cervical myelopathy with occipital C2 fusion. REFERENCES Jiang LS, Shen L, Wang W, Wu H, Dai LY. Posterior atlantoaxial dislocation without fracture and neurologic deficit: A case report and review of literature. Eur Spine J 2010:19:s118-23. Zhen P, Lan X, Yang LW. Traumatic posterior atlantoaxial dislocation without fracture and neurological deficit. Arch Orthop Trauma Surg2011;131:681-5. Chaudary R, Chaudary K, Metkar U, Rathod A, Raut A, Shangvi D. Posterior atlantoaxial dislocation without odontoid fracture. Skeletal Radiol 2008;37:361-6. The Neurosurgeon's Handbook. Ed. G Samandouras. Oxford University Press, 2010 Williams KE, Paul R, Dewan Y. Functional outcome of corpectomy in cervical spondylotic myelopathy. Indian J Orthop. 2009 Apr.;43(2):205-209. Carroll EA, Gordon B, Sweeney CA, et al. Traumatic atlantoaxial distraction injury: a case report. Spine 2001;26:454-457. Huang CI, Chen IH, Lee LS. Traumatic atlantoaxial distractive instability: case report. J Trauma 1994;36:599-600. Steinmetz MP, Mroz TE, Benzel EC. Craniovertebral junction: biomechanical consideration. Neurosurgery 2010;66:7-12 Winegar CD, Lawrence JP, Friel BC, Fernandez C, Hong J, Maltenfort M, Anderson PA, Vaccaro AR. A systematic review of occipital cervical fusion: techniques and outcomes. J Neurosurg Spine. 2010 Jul;13(1):5-16. doi: 10.3171/2010.3.SPINE0814