341 research outputs found

    Spontaneous third-degree Atrioventricular block in a diabetic patient – presenting as recurrent syncope.

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    Chronic uncontrolled hyperglycemia is associated with an increased incidence of coronary artery disease (CAD), cardiac failure, diabetic nephropathy, diabetic retinopathy, and associated mortality. A 72-year-old female presented to the OPD with multiple episodes of loss of consciousness for the past one month. The patient also had other comorbidities like hypertension, diabetes mellitus, and hypothyroidism. On systemic examination, her BP was 124/77 mmHg (supine) and 116/72 mmHg (standing), pulse rate was 56 beats per minute. She had a loss of vibration sense in both lower limbs up to the ankle. Fundus examination showed Non-proliferative diabetic retinopathy (NPDR). The rest of the systemic examination was clinically normal. Her HbA1C was 8.1%, and other routine investigations were within normal limits. Electrocardiography (ECG) showed sinus bradycardia. Echocardiography showed normal ventricular function with no evidence of ischemic heart disease. 24-hour Holter ECG revealed Sinus bradycardia with Intraventricular conduction defect (IVCD), third-degree AV block with junctional beats, and rare supra-ventricular ectopics. This is a case of Type 2 Diabetes mellitus with complete heart block (CHB) of spontaneous onset. Other causes of AV block have been ruled out, and it seems this case of CHB is possibly due to cardiac autonomic neuropathy (CAN). Multiple factors like the duration of diabetes, poor glycemic control, metabolic derangements, and genetic factors determine CAN. This case emphasizes that patients with type 2 diabetes without ischemic heart disease (IHD) can develop CHB spontaneously

    Universally Composable End-to-End Secure Messaging

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    We model and analyze the Signal end-to-end secure messaging protocol within the Universal Composability (UC) framework. Specifically: (1) We formulate an ideal functionality that captures end-to-end secure messaging in a setting with Public Key Infrastructure (PKI) and an untrusted server, against an adversary that has full control over the network and can adaptively and momentarily compromise parties at any time, obtaining their entire internal states. Our analysis captures the forward secrecy and recovery-of-security properties of Signal and the conditions under which they break. (2) We model the main components of the Signal architecture (PKI and long-term keys, the backbone continuous-key-exchange or asymmetric ratchet , epoch-level symmetric ratchets, authenticated encryption) as individual ideal functionalities. These components are realized and analyzed separately, and then composed using the UC and Global-State UC theorems. (3) We show how the ideal functionalities representing these components can be realized using standard cryptographic primitives with minimal hardness assumptions. Our modeling introduces additional innovations that enable arguing about the security of Signal, irrespective of the underlying communication medium, and facilitate the secure composition of dynamically generated modules that share state. These features, in conjunction with the basic modularity of the UC framework, will hopefully facilitate the use of both Signal-as-a-whole and its individual components within cryptographic applications

    Post COVID sequelae among COVID-19 survivors: insights from the Indian National Clinical Registry for COVID-19

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    Introduction The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities.Methods Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020–October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting.Results Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30–60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6–7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03).Conclusion Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality

    Investor Perception, Green Innovation, and Financial Performance: Insights from Indian Manufacturing Firms

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    In this study the complex relationships between sustainability practices and green innovation in Indian manufacturing firms, focusing on quality management, green process innovation, and green product innovation are examined. The aim of the study was to investigate the impact of green technological advancements and quality management on the financial performance and investor-perceived value of manufacturing firms. The green process and green product innovations implication on financial performance and investor perception was also explored. With the help of Pearson correlation and regression analyses, the study assessed the impact of quality management and green innovations on financial performance and investor perception. The findings revealed a significant positive correlation between green product innovation and investor perception, endorsing environmentally responsible companies to attract higher investments and improve financial prospects. However, no significant positive correlation was found between green process innovation and financial performance, which may be influenced by upfront costs and delayed benefits. Green process innovation moderates the relationship between quality management and investor perception, while green product innovation mediates the relationship between green process innovation and investor perception. These insights highlight the importance of prioritising green product innovation to enhance investor perception and integrate environmental considerations into quality management. The study's results align with Sustainable Development Goal 9, promoting sustainable industrialisation, innovation, and infrastructure in the Indian manufacturing industry, fostering a more resilient and environmentally responsible sector


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    Background: Over the world, tobacco kills more than 8 million people every year. A WHO report on tobacco consumption mention that tobacco consumption in India will continue to increase at 2.4% per annum and most of the new users will be school children. Objectives: The objective of the study was to estimate prevalence and pattern of tobacco use among school-going adolescents and to assess their knowledge of harmful effects of tobacco. Methods: A cross-sectional study was carried out at government schools in urban and rural field practices areas of Jhalawar Medical College, Jhalawar. A semi-structured questionnaire pertaining information regarding age, sex, use of tobacco, knowledge of hazards, etc., was used for data collection. Results: Out of the 337 students, 15.1% reported an experience of any type of tobacco use. 8.61% students use smoking form of tobacco, 6.52% student use smokeless tobacco, and 1.48% of students use both form of tobacco. The difference of tobacco use among boys and girls student was statistically significant. Most common influential factor for tobacco use was peer pressure among the tobacco user. Out of the 51 tobacco users, adolescent students 31.37% have desire to quit tobacco. Conclusion: High prevalence of tobacco use among school-going students was alarming situation. The desire to quit tobacco among adolescent was very low

    Passive atomic-scale optical sensors for mapping light flux in ultra-small cavities

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    Abstract Understanding light propagation and attenuation in cavities is limited by lack of applicable light sensing technologies. Here we demonstrate the use of light-sensitive metastable states in wide bandgap aluminosilicates (feldspar) as passive optical sensors for high-resolution mapping of light flux. We develop non-destructive, infrared photoluminescence (IRPL) imaging of trapped electrons in cracks as thin as 50 µm width to determine the spatio-temporal evolution of light sensitive metastable states in response to light exposure. Modelling of these data yields estimates of relative light flux at different depths along the crack surfaces. Contrary to expectation, the measured light flux does not scale with the crack width, and it is independent of crack orientation suggesting the dominance of diffused light propagation within the cracks. This work paves way for understanding of how light attenuates in the minutest of cavities for applications in areas as diverse as geomorphology, biology/ecology and civil engineering
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