In this work, we present an improved compact model for electrostatic discharge field-effect transistors (ESDFETs) that accurately captures key snapback characteristics including triggering voltage ( ${V}_{{t}{1}}$ ), current ( ${I}_{{t}{1}}$ ), hold voltage ( ${V}_{{h}{1}}$ ), and hold current ( ${I}_{{h}{1}}$ ). The model incorporates the effects of gate and body bias, temperature, and input rise time on these critical parameters. The model is simple, provides explicit parameters for ${V}_{{t}{1}}$ and ${I}_{{t}{1}}$ control, and can be readily implemented with any standard process design kit (PDK) model. The transition to the negative differential region during snapback is smooth and continuous. The model is extensively tested with numerical simulations as well as experimental data, showing excellent ability to capture device behavior over a wide range of operating conditions.

Pelvic fractures are associated with significant long-term complications, including pain, infertility, gait disturbances, and sexual dysfunction, which adversely affect quality of life (QoL). Existing literature, mostly from Western populations, often addresses a single outcome without a comprehensive evaluation, and data from the Indian population remains scarce. Hence, we conducted this study to evaluate the long-term impact of pelvic fractures on quality of life, sexual function, infertility, gait, gluteal claudication, and associated factors in an Indian population using validated tools. An ambispective observational study was conducted at a Level 1 trauma center in North India, with retrospective data from 2014–2017 and prospective data from 2017-2018. Patients aged ≥18 years with pelvic fractures were included. Data collection involved hospital records, outpatient follow-ups, and telephone interviews. Tools used included the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) for Quality of Life (QOL, the Brief Male Sexual Function Inventory (BSFI) for male sexual function, the Female Sexual Function Index (FSFI) for female sexual function, and specific assessments for gait, pain, infertility, and gluteal claudication. Statistical analysis was performed using SPSS v23.0. Out of 501 eligible patients, 133 (31.8%) were followed up. Limping was reported in 31.6% initially, reducing to 13% at 6 months. Pain was present in 27.8%. Among males, 36.6% reported premature/retrograde ejaculation; 16.1% had urogenital injuries. Infertility was noted in 28.6% of retrospective females, with one case associated with angioembolization. Mean WHOQOL-BREF scores showed significant improvement across all domains at 6 months, though psychological and environmental domains remained lower. Gluteal claudication was reported in 22.2% retrospectively and 11.6% prospectively at 6 months. BSFI and FSFI scores were lower post-injury but showed gradual improvement with time. Pelvic fractures have a profound impact on quality of life, sexual function, and mobility, with a subset of patients experiencing persistent issues. However, improvements are seen over time with appropriate follow-up and rehabilitation. This study underscores the need for comprehensive, multidisciplinary long-term care in pelvic trauma and highlights the utility of validated questionnaires for outcome assessment in the Indian context.

Urinary stone disease is a significant risk factor for chronic kidney disease. Percutaneous nephrolithotomy is the standard treatment for complex renal stones, yet its long-term effects on renal function in such patients remain underexplored. This study evaluates the outcomes, complications, and factors influencing percutaneous nephrolithotomy success in chronic kidney disease patients. This single-center study included 502 chronic kidney disease patients undergoing percutaneous nephrolithotomy between March 2019 and April 2024. Outcomes assessed were changes in effective glomerular filtration rate, stone-free rates, complications (Clavien-Dindo classification), and mortality. Preoperative, intraoperative, and postoperative parameters were analyzed, and follow-up outcomes were recorded and analyzed. The cohort’s mean age was 47.25 ± 13.48 years, with 65.9

Background:Well-designed and functioning emergency medical service(EMS)can provide equitable access to emergency care to im-prove health issues,especially in low-and middle-income countries where the majority of deaths are due to conditions that could be treated with emergency care.To address this gap,this study explored the contextually appropriate development process in addition to the system architecture,which is lacking in Global South EMS research. Method:This study was a thematic analysis of the development of EMS systems in six Asian countries.Experts in emergency care were selected through convenience sampling.Each country described and evaluated its EMS system using a standardized form with 102 EMS items that cover the emergency care system in terms of leadership,governance,financing,community-based activities,prehospital care,and quality assessment.From the descriptions,various themes were extracted focusing on the developmental perspective of EMS in Asia. Result:The study identified the domain of the developmental focus,best practices,and future strategies for EMS in the Asian region.The identified areas for developmental focus are governance,multidisciplinary collaboration,communication/coordination,community partic-ipation,decentralization,equitable access,supply-demand balance,and quality assurance activities. Conclusion:Countries under investigation achieved progress in planning,implementing,and sustaining EMS through varied strategies in the mentioned focal areas that can be emulated by other countries in this region.Further,their development levels varied according to the extent to which each country realized the development principles identified in this study.

As we approach the 3nm technology node, achieving both high I ON /I OFF ratio and optimal RF performance in gate-all-around (GAA) nanosheet FET becomes increasingly challenging. As per IEEE International Roadmap for Devices and Systems (IRDS), scaling spacer thickness down to 5nm reduces series resistance. It also leads to an increase in parasitic capacitance (C par ) negatively impacting RF figures of merit. This work proposes a novel Front-End-Of-Line (FEOL) design approach to mitigate this trade-off. Utilizing 3D TCAD simulations, we demonstrate that adjusting the source/drain-epi height (H s / d − epi ) can significantly improve RF performance without compromising the I ON /I OFF ratio. Compared to conventional designs, our optimized GAA nanosheet structure exhibits a 24.88%reduction in C par , 3.22% improvement in transconductance (g m ), and 13.66% increase in cut-off frequency (F t ), making it a promising candidate for high-performance RF applications at the 3nm node.

The initial six months following HIV infection have a high viral load. Nonspecific presentations might lead to the missing primary HIV diagnosis. Multiorgan and multisystem diagnosis is a rare presentation of primary HIV. A 40-year-old male patient with no documented comorbidities presented with bilateral flank pain. The onset of the pain was gradual, characterized as dull and aching, with radiation toward the groin. The patient also had severe pain in the left shoulder and left ankle region. Per-abdominal examination revealed bilateral flank tenderness, with the right side being more tender than the left. Swelling of the left shoulder and ankle was observed, accompanied by tenderness and a restricted range of motion. Contrast-enhanced computed tomography of the chest and abdomen revealed bilateral pyelonephritis multiple renal abscesses and liver abscesses. Left shoulder septic arthritis was also present. Pus culture and blood culture were positive for methicillin-sensitive Staphylococcus aureus. Antibiotics, according to the culture sensitivity, were given, and retroviral therapy was started from the antiretroviral clinic. Primary HIV infection can present with a variety of signs and symptoms. This case demonstrates that AIDS can affect any organ and mimic other disease processes. The initial clinical picture might be confused with individually occurring diseases; therefore, we should consider AIDS in patients presenting with multiorgan failure. Early initiation of empiric and then culture-specific antibiotics along with antiretroviral therapy helps in the rapid improvement of the patient and controls the high viremia. The infected patient also needs appropriate counseling on ways to avoid high-risk behavior, which may prevent transmission of HIV.

Objective: Emphysematous pyelonephritis (EPN) is a life-threatening condition that requires prompt diagnosis and treatment. The prognosis of EPN is variable, and there is no single treatment that is universally effective. Materials and Methods: In this study, we developed a scoring system to predict the prognosis of EPN and to guide management. The scoring system was developed based on a retrospective analysis of 91 patients with EPN. Nineteen risk factors for emphysematous pyelonephritis were assessed with univariate and multivariate analysis. Results: Seven factors were found significant on analysis. The scoring system was developed by including these 7 risk factors: renal stone disease, leukocytosis, raised creatinine, EPN grade, and septic shock. The score ranged from 1 to 18, with a higher score indicating a worse prognosis. The scoring system was able to stratify patients into three risk groups: good risk, intermediate risk, and poor risk. The scoring system can be used to personalize the management of EPN. Patients in the good-risk group may be managed with conservative treatment, while patients in the intermediate-risk and poor-risk groups may require intervention, such as DJ stenting, percutaneous nephrolithotomy or nephrectomy. The scoring system is a valuable tool for predicting the prognosis of EPN and guiding management. It can help clinicians to tailor treatment to the individual patient and to improve outcomes. Conclusion: The prognostic score helps identify patients who are at high risk. This score helps in the selection of appropriate management options.

Abdominal vascular injuries are rare injuries with an incidence of 1% to 10% depending upon the mechanism of injury. Arterial injuries are more commonly seen than venous injuries. Abdominal aorta, renal artery and superior mesenteric artery are commonly injured arteries and among veins, inferior vena cava and portal vein are commonly injured. Visceral venous injuries are rare. Hence, the natural history of such injuries is still largely unknown, and there is no consensus on the management principles. Various options for the management of visceral venous injuries such as primary repair, interposition graft placement or ligation have been reported. We report herein a case of traumatic Superior Mesenteric Vein (SMV) pseudoaneurysm which was managed successfully by endovascular and surgical procedures. A 16-year-old boy while riding a bicycle had a head-on collision with a bullock cart. He was referred to our hospital about 16 hours after the injury with a contrast enhanced Computed Tomography (CT) scan of the abdomen. Upon arrival, his primary survey was unremarkable. But Focussed Assessment by Sonography in Trauma was positive. On the secondary survey, there was no rigidity or rebound tenderness in the abdomen. However, there was mild tenderness in the umbilical region with guarding in the right iliac fossa. His contrast enhanced CT scan of the abdomen revealed a pseudoaneurysm of 5 × 4 cm size arising from the SMVand grade 5 injury of the right kidney with mild hemoperitoneum (Figure 1). There was no pneumoperitoneum, no pneumoretroperitoneum or bowel thickening or bowel discontinuity on CT scan. A decision was made to intervene for pseudoaneurysm because of its size and the abdominal pain. Since there was no frank peritonitis, nor any bowel thickening or pneumoperitoneum on the CT scan of the abdomen, a decision was made to approach the pseudoaneurysm of the SMV through endovascular route. It was also expected that the patient may require laparotomy in next 48-72 hours and control of SMV intraoperatively might be difficult. Under ultrasound and fluoroscopic guidance, the SMV was approached through transhepatic route via the portal vein. On venography, a pseudoaneurysm of 3 × 5 cm size was noted in the SMV (Figure 2). There was no contrast leak from the pseudoaneurysm. An endovascular stent made up of expanded polytetrafluoroethylene (8 mm diameter, 8 cm length) was placed across the pseudoaneurysm. Post-procedure venogram showed no contrast leak from the stented area. The transhepatic route was embolised with gel foam at the end of the procedure to prevent any intraperitoneal bleeding from the liver. Post-stenting anticoagulation was started using unfractionated heparin. On post-stenting day 2, the patient developed signs of peritonitis and a repeat CT scan of the abdomen showed stent in the SMV with pneumoperitoneum. On exploratory laparotomy, haematoma of the ascending mesocolon with caecal perforation and a perforation in the 3rd part of the duodenum were noted. Right hemicolectomy with end ileostomy for devitalised ascending colon and caecal perforation and right-sided nephrectomy for devascularised grade 5 renal injury were planned. During surgery, the stent got accidentally dislodged leading to massive

Objectives:Complications during trauma management are the main factor responsible for the overall increase in treatment cost. There are very few grading systems to measure the burden of complications in trauma patients. A prospective study was conducted using the Adapted Clavien Dindo in Trauma (ACDiT) scale, with the primary aim of validating it at our center. As a secondary aim, it was also wanted to measure the mortality burden among our admitted patients. Material and Methods:The study was conducted at a dedicated trauma center. All patients with acute injuries, who were admitted, were included. An initial treatment plan was made within 24 hours of admission. Any deviation from this was recorded and graded according to the ACDiT. The grading was correlated with hospital-free days and ICU-free days within 30 days. Results:A total of 505 patients were included in this study, with a mean age of 31 years. The most common mechanism of injury was road traffic injury, with a median ISS and NISS of 13 and 14, respectively. Two hundred and forty-eight out of 505 patients had some grade of complication as determined by the ACDiT scale. Hospital-free days (13.5 vs. 25; p <0.001) were significantly lower in patients with complications than those without complications, and so were ICU-free days (29 vs. 30; p <0.001). Significant differences were also observed when comparing mean hospital free and ICU free days across various ACDiT grades. Overall mortality of the population was 8.3 %, the majority of whom were hypotensive on arrival and required ICU care. Conclusion:We successfully validated the ACDiT scale at our center. We recommend using this scale to objectively measure in-hospital complications and improve trauma management quality. ACDiT scale should be one of the data points in any trauma database/registry.

For the first time, we reported the reconfigurable ferroelectric electrostatic doped (Fe-ED) negative capacitance (NC) nanosheet field-effect transistors. With the introduction of NC effect, Fe-ED NCFETs acquire the voltage amplification effect, achieving the enhanced gate control superior to reference devices. As a result, Fe-ED NCFETs demonstrate steeper subthreshold swing below 60 mV/decade, ~ 40% enhancement in transconductance, and 1 ~ 2 orders reduction in OFF-state current over reference devices. This thus contributes to a drastic increase in the ratio of ON/OFF state current from ~ 1×10 6 to ~1×10 8 at |V DD | = 0.7 V and facilitates the supply voltage scaling below 0.45 V. Such fantastic device holds great promise to be one of the key enablers for future ultra-low power and ultra-high function density electronic devices in hyper-scaling era.

It is advised that we should never hesitate in leaving the abdomen open when required. However, once the patient is stabilised, we should close it as soon as possible. But the factors which would hamper delayed primary fascial closure (DPFC) are not well studied. A retrospective 5-year analysis of patients with open abdomen (OA) after trauma laparotomy who survived was conducted. Patients were divided into 2 groups: those in which DPFC was possible and those in whom it was not. Out of the 58 patients that were recruited, DPFC could not be performed in 48 patients. Quantum of fluid resuscitation at 48 h was not associated with an inability to perform DPFC. Early definitive control of bleeding and damage control resuscitation are associated with the ability to perform DPFC in OA patients. Presence of blood stream infections (BSIs), ventilator-associated pneumonia (VAP), and intra-abdominal sepsis (IAS) precluded DPFC.

INTRODUCTION:Recent literature on managing traumatic duodenal injuries suggests the superiority of primary repair. We hypothesized that duodenal trauma repair by primary closure might not be a safe strategy in an environment dealing predominantly blunt injuries with limited resources. METHODS:Data analysis was done from the prospectively maintained trauma registry. The study period chosen was from January 1, 2014 to December 31, 2018. Data of 63 patients were analyzed for demographics, injuries, management, and outcome. Logistic regression was used to identify mortality predictors. RESULTS:The most common mechanism of injury was blunt (56/63, 88.9%). Forty (63.5%) patients had associated intraabdominal injuries. The most common American Association for the Surgery of Trauma grade of injury to the duodenum was three in 21 patients. Univariate analysis showed that mortality was associated with hypotension on presentation, higher duodenal grade, associated abdominal vascular injuries, primary closure, and duodenal leak. Logistic regression showed associated associated abdominal vascular injuries, primary closure, and leak remained significant predictors of mortality. CONCLUSIONS:Primary repair was found to be an independent predictor of mortality. A patient's physiology is a critical determinant of the outcome. Liberal use of tube duodenostomy over primary repair seems reasonable for blunt duodenal injury management.

With the evolution of COVID-19, more and more associated complications are unfolding. In addition to the disease process, associated comorbidity (viz. diabetes mellitus, chronic obstructive pulmonary disease) and immunosuppressive conditions (viz. corticosteroid therapy, ventilation, intensive care unit stay) make patients prone to severe opportunistic infections. These may lead to oropharyngeal candidiasis, Pneumocystis jiroveci pneumonia and pulmonary aspergillosis. However, recently in India, the incidence of mucormycosis is rising at an alarming rate, both as a co-infection and as a sequela of COVID-19. Many states in India declared it an epidemic and >28,000 cases have been reported by 7 June 2021, of whom 86% had a history of COVID-19 co-infection. The states of Maharashtra and Gujarat are the worst affected, contributing to 42% of the cases. Sensitisation of all COVID care personnel regarding mucormycosis is now mandatory. Mucormycosis is a fungal emergency that has a propensity for aggressive spread and is associated with a poor prognosis. Its risk factors in a COVID patient imply an immunocompromised state, typically uncontrolled diabetes, post-renal transplantation, or just a history of steroid administration for severe COVID19 infection. The use of immunomodulatory drugs such as tocilizumab also increases the risk of infection. Mucormycosis can affect the lungs, intestines, open wounds in the extremities, the face or the brain. The surge in India is, however, predominantly of rhinoorbito-cerebral mucormycosis (ROCM), whose spectrum ranges from small lesions to destruction of the eyeball and cavernous sinus thrombosis. It has been suggested that this increased incidence of ROCM may be due to increased requirements of oxygen supplementation in patients with COVID-19, thus leading to a drying out of the nasopharyngeal mucosa. Diabetes mellitus is found in 62.3% of ROCM cases in India. Corticosteroids, of course, act as immunosuppressants but also lead to deranged glucose tolerance, thus doubly contributing to mucormycosis. Furthermore, recent evidence is that COVID-19 can itself destroy b-cells of the pancreas, leading to new-onset hyperglycaemia. The successful management of ROCM depends upon its early identification in patients with risk factors, and initiation of prompt effective treatment which may mean a multidisciplinary team approach. Simple tests for vision, pupil and ocular motility and examination for sinus tenderness, proptosis, palpebral oedema and palatal eschars, should become part of routine physical evaluation of all COVID-19 patients hospitalised with moderate to severe infection (especially those taking systemic corticosteroids, diabetics and those on prolonged oxygen support). In the initial stages, there may be features of cellulitis or oedema with blackening of tissues, later owing to cell death. Features such as diplopia, visual loss, headache, convulsions, altered mental status, cranial nerve palsy or gait disturbances suggest cerebral involvement. A nasal swab for potassium hydroxide mount and culture is necessary. Treatment involves the use of liposomal amphotericin B and/or posaconazole together with endoscopic or open sinus debridement. The mortality rate of ROCM remains high (50% even in hospitalised patients), particularly in the elderly, where there is cerebral involvement, and in patients already admitted to intensive care units. Since fungal infections develop during the middle and later stages of COVID-19 infection, follow-up of high-risk patients recovering from this infection is also

The natural history of traumatic visceral venous pseudoaneurysm (VVP) is largely unknown, and hence, there is a lack of consensus for their management. This review aims to determine the management and outcomes of these injuries. A review of the reported cases over the last 25 years was performed. Only 32 cases were found, 24 abdominal, and 8 thoracic. Traumatic abdominal VVPs were largely managed nonoperatively, while majority of traumatic thoracic VVPs underwent intervention. Hemodynamic instability was the most common cause for intervention. No uniformity was noted for follow-up imaging of these injuries.

The incidence of sternal fracture ranges from 3 to 8%. In more than half, they are associated with other organ trauma such as blunt cardiac injuries, rib, scapular or vertebral fractures. Hence, the presence of sternal fracture is considered a marker for significant transmission of energy. The management of isolated sternal fractures is usually non-operative with surgery reserved for displaced fractures or in cases of respiratory insufficiency. However, management may become challenging when they are associated with other significant trauma. We discuss a case of sternal fracture complicated by the presence of blunt cardiac injury, open pneumothorax, rib fractures, anterior flail chest and empyema.

Introduction: Three-dimensional (3D), high-definition (HD), and ultra-high-definition (4K HD) are recent additions over regular HD technology for laparoscopic surgery. The aim of this study was to evaluate the learning pattern of these systems on standardized phantom tasks. Methodology: Forty-five stereo-enabled resident doctors were randomly assigned into three groups. They performed three validated tasks, precision touch on flat surface, precision touch on uneven surface, surgical knot on rubber tube using either two-dimensional (2D) HD, 3D HD, or 4K HD Endovision systems. Each task was repeated 20 times. Data from four consecutive repetitions were pooled to make five blocks. Split group analysis by comparing the consecutive blocks in execution time and errors were made to see the learning pattern. A significant difference was accepted as continuous learning while no significant difference was accepted as learning stabilization. Result: Operating time was stabilized in two tasks after third block in 2D HD, one task after fourth block in 4K HD. There was continuous learning in all tasks with 3D HD. The 3D HD group was significantly faster than 2D HD and 4K HD in most of the tasks on fifth block. The error scores were similar between the consecutive blocks in 4K HD. It was stabilized after second block in 2D HD group and third block on 3D HD. Conclusion: The 3D HD Endovision system has more potential of faster execution of a task, but need more practice to reach similar safety profile. The 4K HD reached the safety plateau with minimal repetitions.

Complex perineal injuries pose a major diagnostic and therapeutic challenge to trauma surgeons. A retrospective review of the hospital records of 29 patients with complex perineal injury following blunt trauma was done. Demographic profile, management and outcomes were collected. Quality of life analysis was conducted for patients with complex perineal injuries who were discharged. The most predominant mode of injury was a road crash: being a pedestrian run over by a heavy motor vehicle. Pelvic fracture was seen in 20, anorectal involvement in 22 and urogenital injuries in 14. Urgent surgical debridement was done in all patients, faecal diversion in 27 and urinary diversion in 14. There were nine deaths, three from haemorrhage, and the remainder from sepsis and multi-organ dysfunction. Complex perineal injury remains a major cause of morbidity and mortality in trauma patients. There is a need to ensure adequate rehabilitation services for such patients.

Abdominal trauma management has seen a paradigm shift over the last few decades. There is wide variation in the treatment depending on the level of healthcare facilities available. With an aim to standardise the treatment of solid organ injuries in blunt abdominal trauma, Indian Society for Trauma and Acute Care (ISTAC®) formulated consensus guidelines to benefit doctors engaged in trauma care in the country.