Background: A consensus on the diagnostic utility of cerebrospinal fluid adenosine deaminase (ADA) for tuberculous meningitis (TBM) is lacking. Methods: Patients aged ≥12 years admitted with CNS infections were enrolled prospectively. ADA was measured with spectrophotometry. Results: We enrolled 251 TBM and 131 other CNS infections. The optimal cutoff of ADA was calculated at 5.5 U/l against microbiological reference standard with area under curve 0.743, sensitivity 80.7%, specificity 60.3%, positive likelihood ratio 2.03 and negative likelihood ratio 3.12. The widely used cutoff value 10 U/l had specificity 82% and sensitivity 50%. The discriminating power was higher for TBM versus viral meningoencephalitis than bacterial or cryptococcal meningitis. Conclusion: Cerebrospinal fluid ADA has a low-to-modest diagnostic utility.

Background: Maternal diaphragmatic hernias (DH) identified during pregnancy are rare and pose significant management challenges with respect to the timing of delivery, mode of delivery, and hernia repair. Case presentation: We describe a case of traumatic maternal DH, diagnosed at 31 weeks of gestation presenting with multiple episodes of vomiting. Owing to no evidence of visceral compromise and a stable maternal and fetal condition, the patient was conservatively managed allowing further fetal maturation and was delivered by cesarean section at 34 weeks. This was followed by laparoscopic intraperitoneal mesh hernial repair at 6 weeks postpartum. The patient had an uncomplicated recovery. Conclusion: Maternal DH in pregnancy require multidisciplinary care and individualized management for the optimal outcome for mother and fetus.

Power System can be broadly divided into three key sectors viz. Generation, Transmission & Distribution. In all three sectors, automation systems are used for the day-to-day operation of the concerned segment of the Power System. These systems use different applications for effective visualization of Power System devices. However, a common feature of all these systems is the need of having accurate time and synchronization of their clocks for desired level of precision in operation, control, coordination and studies. For this purpose, standard time signal receivers are used which are based on the Navigational Satellite Systems. Presently, Global Positioning System (GPS) is being used as a de-facto standard in various equipment in the Indian Power System to effect time synchronization of various devices & control systems. However, the GPS carries certain inherent technical & strategic vulnerabilities with it. In this context, NavIC (Navigation through Indian Constellation) based standard time signal receivers may prove to be a much better substitute for critical Power System applications. NavIC (an acronym for Navigation with Indian Constellation; also, navik ‘sailor’ or ‘navigator’ in Sanskrit, and many other Indian languages) is the operational name of the indigenously developed Indian Regional Navigation Satellite System, by the Indian Space Research Organisation (ISRO). This paper attempts to explain the operational experience of Power System Operation Corporation (POSOCO), with NavIC standard time signal receivers in place of GPS.

In this paper, we consider a pseudo-parabolic equation with the Atangana-Baleanu Caputo fractional derivative. Our main tool here is using fundamental tools, namely the Fractional Tikhonov method and the generalized Tikhonov method, the error estimate is shown. Finally, we provided numerical experiments to prove the correctness of our theory.

A 15-year-old woman was admitted to the emergency department with fever, headache, vomiting and altered mental status for 4 days. At presentation, she was unconscious with a Glasgow Coma Scale score of 6 out of 15. Her pulse rate was 112 beats per minute, and her blood pressure was 80/40 mm Hg.

With gradual expansion of the grid, the conventional Supervisory Control and Data Acquisition (SCADA) required additional visualization tools to operate the grid in more efficient manner. Due to low situational awareness, it became difficult for the operator to control the grid in safe and secure manner. This also resulted in isolated blackouts in the grid. In order to enhance the situational awareness, Phasor Measurement Units (PMUs) were installed initially at critical locations identified on the basis of system studies. Upon installation of PMUs, the resolution of data increased from 2 to 4 (SCADA) to 40–60 samples/cycle (PMU). India being geographically diverse and large, the number of PMUs requirement was very high. This large-scale integration of PMUs with existing SCADA posed many technological, geographical, financial and adaptability problems (electricity being concurrent subject of state and centre). This paper elaborates all such integration issues and challenges faced during integration of SCADA-PMU pan India.

Cesarean section is one of the oldest surgical procedure performed on cows for delivery of the fetus at parturition. Depending upon the health status of dam and fetus cesarean section has been classified as emergency, non emphysematous and emphysematous procedure. The common maternal indications for performing cesarean section include pelvic fractures, cervical dilation failure and uncorrectable uterine torsion whereas the fetal indication include oversized fetuses and maldisposed calves. Many anesthetic protocols are available for cow however, most cesarean section in cattle can be satisfactorily performed under mild sedation and local infiltration anesthesia using 2% lidocaine. Operative sites for cesarean section in cattle include right and left flank, midline, paramedian, parammary and oblique ventrolateral. The choice of operative sites depends upon facility and patient condition. Peri-operative (before, during and after the operation) care appears to be of utmost significance, post-operative complications of cesarean section include peritonitis, seroma formation, hernia and poor fertility. On the successful outcome of cesarean section in cows in terms of dam and calf survival and future fertility of cows underdoing cesarean section. Previous handling, delay in presentation to referral centers results in poor outcome and thus animal owners must be explained the benefits of prompt presentation of cow to cesarean section for optimal benefits.

Infections of the central nervous system (CNS) are a leading cause of mortality in low- and middle-income countries. We studied the spectrum, aetiology and outcome of CNS infections in 401 consecutive patients aged ≥12 years admitted at the medical emergency centre of PGIMER, Chandigarh, India. An aetiological diagnosis was made in 365 (91.0%) patients, with 149 (40.8%) microbiologically confirmed cases. CNS tuberculosis was the most prevalent cause (51.5%), followed by viral meningoencephalitis (13.9%), community-acquired bacterial meningitis (9.7%), cryptococcal meningitis (6.2%), scrub typhus meningoencephalitis (1.7%), neurocysticercosis (1.7%) and fungal brain abscess (1.7%). Human immunodeficiency virus (11.0%) and diabetes mellitus (6.2%) remained the usual predisposing conditions. We found a mortality rate of 27.9%, highest in cases without an aetiology (64.5%). Tuberculosis remained the most common cause; however, an increasing number of scrub typhus, dengue, fungal infections and non-classical bacterial pathogens may indicate a change in the epidemiology of community-acquired CNS infections in India.

Context: There is limited experience of use of dinoprostone controlled release vaginal pessary in Indian scenario. Hence, we aim to find its efficacy for induction of labor (IOL). Aims: To compare two formulations of dinoprostone: intracervical gel and controlled release vaginal pessary for IOL. Settings and Design: Randomized controlled study in a tertiary care center. Methods: A double-blinded randomized controlled study was done on 106 women with singleton pregnancy, 37 to 41 weeks with vertex presentation, no obvious fetal compromise, and planned for IOL. They were randomly divided into equal groups to receive either dinoprostone intracervical gel (Group A) or dinoprostone controlled release vaginal pessary (Group B). The main outcome measures: change in Bishop score (using simplified Bishop score) at 0 to 6 hours and 6 to 12 hours after application and success to initiate active labor. The secondary outcome measures: maternal adverse effect, induction to delivery time, requirement of oxytocin infusion, cesarean section rate, APGAR score, and neonatal intensive care unit admission. Statistical Analysis: Statistical Package for Social Sciences (SPSS) version 17.0. Results: Increase in Bishop score and women achieving active labor were more in Group B (90.6% vs. 41.5%; P < 0.01). Mean time from induction to delivery was higher in Group A (19.72 hours vs. 12.53 hours; P < 0.01). Requirement of oxytocin was lesser in Group B (35.8% vs. 75.5%; P < 0.001). No adverse maternal or fetal outcome was noted in either of the groups. Conclusions: Dinoprostone controlled release vaginal pessary has significantly better outcomes than intracervical gel for IOL.

Introduction: The most recent vaccine incorporated in the Universal Immunization Program of India is measles-rubella vaccine, introduced as a catch-up campaign to eliminate measles and control rubella by the year 2020. The success of any immunization campaign lies on its meticulous planning for areas such as trainings, cold chain management, advocacy, and social mobilizations. Rapid convenience monitoring (RCM) was done in nine health blocks of a hilly district of Himachal Pradesh, pertaining to various campaign activities, for determining vaccine coverage and side effects.Material and Methods: Standardized formats developed by the World Health Organization for RCM of the quality of activity at session sites which included information regarding vaccinating teams, immunization sites, logistics used, cold chain and aseptic condition management, waste disposal, and record maintenance were used. School and house-to-house visits were conducted randomly to check the indelible ink mark/vaccination cards to find out any missed child.Results: A total of 107 immunization sessions were observed for compliance. We assessed 1182 children between the age group of 9 months and 15 years for determining vaccine coverage during the measles–rubella campaign in September–October 2017. Compliance to various aspects of the campaign was found very good, exceeding 90% in almost all the domains. The total vaccination coverage was 98.1%. Schools and health-care providers were the major source of information for this campaign. No severe adverse events following immunization were reported during the survey.Conclusion: Activity compliance and vaccination coverage were found high. Adequate supply of indelible ink pens and functional hub cutters needs to be ensured. There should be revision of incentives to team members with increased involvement of accredited social health activist workers in such campaigns.

Renal hemangioblastoma (RH) is a very rare benign tumour. Hemangioblastoma most commonly occurs in the central nervous system (CNS), and only few cases of RH have been reported as they occur most commonly as asymptomatic masses found incidentally. Mixed Mullerian tumour (MMT) of the uterus is a rarer and aggressive form of uterine malignancy. The detection of two primary rare tumours incidentally is a rare entity. A 50-year-old female presented with abnormal uterine bleeding which on endometrial sampling was diagnosed as a rare variety of endometrial cancer, i.e. MMT or uterine carcinosarcoma. On preoperative imaging, a renal mass was also detected which was highly vascular and was mimicking renal cell carcinoma (RCC). Fine needle aspiration cytology (FNAC) was done from the renal mass to differentiate between RCC and metastasis, but it showed only blood cells. Patient underwent staging laparotomy for endometrial cancer and frozen section examination of the renal mass which was inconclusive with few atypical cells, and thus, patient underwent radical nephrectomy too. Histopathological examination revealed it to be a RH which is a very rare benign tumour. RH is a rare benign tumour which does not require any treatment in majority of the patients. Only 26 cases of RH outside the CNS have been reported till date. MMT is a rare aggressive uterine tumour with an incidence of 1–2 % of all uterine neoplasms, which metastasizes early, and thus, early identification and treatment is the key. RH needs to be differentiated from RCC to avoid over treatment. Morphological findings are similar in RCC and RH; preoperative FNAC, PET scan, and intraoperative frozen section can be utilized to differentiate the two, in well-circumcised tumours and high index of suspicion. Occurrence of renal mass as an incidental finding in the preoperative work up of uterine malignancy directed us to the differentials of metastasis or another histologically distinct primary tumour. The presence of two rare primary tumours, i.e. RH and MMT in the same patient which are unrelated, is a rare entity.

Decidual cast is the entire sloughed endometrium that takes the form of the endometrial cavity. It causes membranous dysmenorrhea because the intact cast passes through an undiluted cervix. It may be associated with ectopic pregnancy, incomplete abortion, non-pregnant state with use of progesterone, Depot medroxyprogesterone acetate (DMPA), rarely with oral contraceptive pills. Authors are reporting a case of recurrent decidual caste formation with membranous dysmenorrhoea in 33 years old women P3L3 who was on norethisterone acetate treatment for a typical uterine bleed (AUB). She presented with heavy menstrual bleeding with severe dysmenorrhea in Gynae causality of ESI Basaidarapur medical college, Delhi. She expelled decidual caste and required therapeutic Dilation and Curettage (D and C) to control bleeding per vaginum. Her histopathology report showed marked decidua like change of the stroma but no villi suggestive of endometrial caste.

In the last some years, veterinarians are now frequently requested to solve fertility problems in the dogs, mainly due to the increased popularity of purebred dogs as well as for sentimental or financial reasons. Endometritis is one of the very common post-partum/post estrus complication that usually remains unnoticed until the appearance of notifiable clinical sings. Primary sins observed by the clinician is purulent vaginal discharge, may be associated with fever, dehydration, anorexia. Reports have shown that E. coli is the main bacterium associated with it but some case also shows mixed infection of several bacterium. In the case of nursing mother care of puppies also challenging due to dam unable to nurse them or puppies have been isolated due to the antibiotic residue found in dam’s milk. History and clinical signs are the first approaches for diagnosis, it is more adventitious to diagnose by the use of modern technique like ultrasonography, ABST and blood picture profile. Antibiotics and ecbolic drugs with supportive therapy give results in most of the case if the patient in stable condition.

Background: Jaundice in pregnancy is responsible for 10% of maternal deaths but more importantly it carries a grave prognosis for both the fetus and the mother. Though it only affects a small proportion of pregnant women population, yet it takes a major toll on health of both mother and fetus especially in developing countries like India. The aim of the study was to assess maternal and fetal outcome of jaundice during pregnancy. Methods: 126 pregnant women with jaundice attending the Institute of obstetrics and gynaecology, IGMC, Shimla in year 2016-2017 have been studied for etiology, clinical profile and pregnancy outcome. Results: Age group of 25-29 years was most affected (35.72%). Majority (62.7%) belongs to rural locality, were multi gravidae (60.3%) and have period of gestation more than 28 weeks (89.7%). Viral hepatits and intra hepatic cholestasis were (33.3%) the most common etiologies for jaundice. Neonatal mortality was found to be 8.25% Prematurity (n-4) birth asphyxia (n-2) and sepsis (n-1) was the causes of mortality. 13 study patients died in current study i.e. four with viral hepatitis, two with PIH and one with Srcub infection resulting in maternal mortality of 7.14% Conclusions: Feto-maternal outcome in current study was relatively poor. Jaundice and pregnancy in combination, result in high morbidity and mortality, and warrant an early diagnosis and careful management.

Ocimum species commonly referred to as “Tulsi” are well-known for their distinct medicinal and aromatic properties. The characteristic aroma of Ocimum species and cultivars is attributed to their specific combination of volatile phytochemicals mainly belonging to terpenoid and/or phenylpropanoid classes in their essential oils. The essential oil constituents are synthesized and sequestered in specialized epidermal secretory structures called as glandular trichomes. In this comparative study, inter- and intra-species diversity in structural attributes and profiles of expression of selected genes related to terpenoid and phenylpropanoid biosynthetic pathways have been investigated. This is performed to seek relationship of variations in the yield and phytochemical composition of the essential oils. Microscopic analysis of trichomes of O. basilicum , O. gratissimum , O. kilimandscharicum , and O. tenuiflorum (green and purple cultivars) revealed substantial variations in density, size, and relative proportions of peltate and capitate trichomes among them. The essential oil yield has been observed to be controlled by the population, dominance, and size of peltate and capitate glandular trichomes. The essential oil sequestration in leaf is controlled by the dominance of peltate glandular trichome size over its number and is also affected by the capitate glandular trichome size/number with variations in leaf area albeit at lower proportions. Comprehension and comparison of results of GC-MS analysis of essential oils showed that most of the Ocimum ( O. basilicum , O. tenuiflorum , and O. gratissimum ) species produce phenylpropanoids (eugenol, methyl chavicol) as major volatiles except O. kilimandscharicum , which is discrete in being monoterpenoid-rich species. Among the phenylpropanoid-enriched Ocimum ( O. basilicum , O. gratissimum , O. tenuiflorum purple, O. tenuiflorum green) as well, terpenoids were important constituents in imparting characteristic aroma. Further, comparative abundance of transcripts of key genes of phenylpropanoid (PAL, C4H, 4CL, CAD, COMT, and ES) and terpenoid (DXS and HMGR) biosynthetic pathways was evaluated vis-à-vis volatile oil constituents. Transcript abundance demonstrated that richness of their essential oils with specific constituent(s) of a chemical group/subgroup was manifested by the predominant upregulation of phenylpropanoid/terpenoid pathway genes. The study provides trichomes as well as biosynthetic pathway-based knowledge for genetic improvement in Ocimum species for essential oil yield and quality.

Preeclampsia and placenta praevia are two known complications of pregnancy which have opposite pathophysiology. The protective role of placenta praevia in preventing preeclampsia has been observed ...

The study was aimed to superovulate donor Indian mares using eFSH. eFSH administration was initiated on 7th day of estrus cycle with dose of 25 mg @ 12.5 mg x 12 hourly or 6.25 mg x 6 hourly in total six mares. Another six mares served as control. Treatment was continued till development of two or more follicles of 35 mm size. The superovulatory response was assessed by serial ultrasonography of ovaries twice daily. Artificial insemination was undertaken in all mares with detected ovulations were detected. Similar super-ovulatory response was seen in all six mares with average days (n) of eFSH treatment of 8.6 days. Average number of follicles (>35 mm) in super-ovulated mares were 5.5. Although ovulations per mare were 4.16, yet embryo collection per mare was only 1.16 (seven embryos from six treated mares) where as in control group, it was 0.83 (five from six control mares).