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Compound fresh air requirement and also nitrogen transformation in a significant pilot-scale seed with a mixed enveloped anaerobic tissue layer bioreactor and also one-stage partially nitritation-anammox for treating well known wastewater from Twenty-five °C.
7%), the mean time of surgery was 2 hours and 27 minutes, the skull flap was preserved in the subcutaneous layer in 29 cases (87.8%), the mean of blood loss was 636.36 mL,and in-hospital mortality was 12%. Univariate analysis found differences between the APD diameter (120.3 mm vs. 85.3 mm; p = 0.003) and the presence of midline shift > 5 mm ( p = 0.033). Conclusion  The size of the skull flap and the presence of midline shift > 5 mm were predictors of mortality. In the absence of intercranial pressure (ICP) monitoring, clinical and radiological criteria are mandatory to perform a decompressive craniectomy.Objective  To estimate the serum zinc levels in children under the age of 5 years with febrile seizures and febrile children without seizures Materials and Methods  In this cross-sectional study from 2017 to 2018, 40 children with febrile seizures (simple and complex) were taken as cases. Forty age- and sex-matched febrile children without convulsions were recruited as controls. Serum zinc estimates were analyzed using a spectrophotometer (Biolis 50i-Autoanalyzer). Statistical Analysis  The demographic variables and serum zinc estimates were analyzed using the Mann-Whitney test. The odds ratio was used to calculate the association of zinc deficiency in febrile seizures; 5% level of significance was considered. Results  The mean serum concentrations of zinc in the cases and controls were 83.8 ± 33.1 μg/dL and 116.3 ± 30.3 μg/dL, respectively ( p = 0.002). Hypozincemia defined by "a serum zinc level of less than 63 μg/dL" was found in 12 (30%) cases and 2(5%) controls with an odds ratio of 81. Conclusion  Children with febrile seizures had significantly reduced concentrations of zinc in the serum.Objectives  Can undergraduate medical students (UGs) adopt a village model to identify mentally ill persons in an adopted village successfully? Materials and Methods  UGs during their first year adopt a village, and each student adopts seven families in the villages. During the visit, they look after immunization, tobacco and alcohol abuse, nutrition, hygiene, and sanitation. They help in identifying the health needs (including mental health) of the adopted family. The Indian Psychiatric Survey Schedule containing 15 questions covering most of the psychiatric illnesses were used by UGs to identify mental illness in the community. Persons identified as suffering from mental illness were referred to a consultant psychiatrist for confirmation of diagnosis and further management. Statistical Analysis   Calculated by percentage of expected mentally ill persons based on prevalence of mental illness in the rural community and is compared with actual number of patients with mental illness identified by the UGs. True-positive, false-positive, and true predictive values were derived. Results  In Umri village, UGs were able to identify 269 persons as true positives and 25 as false positives, whereas in Kurzadi village, UGs were able to identify 221 persons as true positives and 35 as false positives. It suggests UGs were able to identify mental illnesses with a good positive predictive value. In Umri village, out of 294 mentally ill patients, it gave a true positive value of 91.49% and a false positive value of 8.5%, whereas in Kurzadi village, out of the 256 mentally ill patients, it gave a true positive value of 86.3% and a false positive value of 13.67%. Conclusion  The ratio of psychiatrists in India is approximately 0.30 per 100,000 population due to which psychiatrists alone cannot cover the mental health problems of India. Therefore, we need a different model to cover mental illness in India, which is discussed in this article.Objective  This study aimed to assess the prevalence of cognitive impairment and psychiatric morbidity among the patients attending the rural noncommunicable disease clinic after controlling for various confounders (i.e., psychological morbidity, obesity, gender, level of education, duration of the illness and age). Materials and Methods  One-hundred twenty-four patients were evaluated on the Hindi Mental State Examination for the cognitive function, Physical Health Questionnaire-9 for depression, and Generalized Anxiety Disorder-7 for anxiety disorders. Results  About one-fourth (26.6%) of the participants had cognitive impairment. The prevalence of cognitive impairment was more among patients with hypertension (35.5%) as compared with the diabetes mellitus (13.6%) and those with comorbid hypertension and diabetes mellitus (26.6%). About one of the participants had depression (35.5%) and 29% of the patients had anxiety disorder. No significant difference was found in the level of cognitive deficits between those with hypertension and diabetes mellitus, when the confounding factors were not taken into account in the analysis. However, after controlling for psychiatric morbidity, obesity, gender, level of education, duration of the illness and age, those with hypertension were found to have significantly higher level of cognitive impairment compared with those with diabetes mellitus. A higher level of dysfunction was seen in the domains of orientation, registration, attention, recall, language, and visuospatial domains. Conclusion  Present study suggests that patients of hypertension have higher level of cognitive impairment, when compared with those with diabetes mellitus, even after controlling for various confounders. Lack of difference between the two groups can be accounted by the confounding variables.Objective  Gliomas, the most frequent primary brain tumors, have various grades, among which grade II, III, and IV are diffusely infiltrating astrocytomas. As therapeutic approaches and outcome differ considerably, depending on the grade of these tumors, prediction is important regarding outcome. Magnetic resonance spectroscopy (MRS) can be of help in understanding of the biochemical changes of pathological state to study, monitor, predict grading and outcome of gliomas. Materials and Methods  All the 30 patients in the study with intracranial diffusely infiltrating astrocytoma had MRS study using 1.5 Tesla MR scanner. The study population was divided into three groups on the basis of the grades of the tumor according to histopathology. Mean height of choline (Ch), N-acetyl aspartate (NAA), creatine (Cr) peak, and choline/creatine (Ch/Cr) ratio was documented. Mean value of each variable among three grades was analyzed and compared with analysis of variance (ANOVA) test (F-test). Results  There was positive relationship regarding Ch/Cr ratio among astrocytomas grade II to IV and the result was significant ( p = 0.047). A positive relationship of Ch peak was also observed for grade II to IV astrocytoma, though the result was not significant ( p = 0.578). The result was nonsignificant for NAA ( p = 0.696) and Cr ( p = 0.740) peak also. Conclusion  We recommend Ch/Cr ratio to be considered as a dependable MRS data to comment on low- or high-grade astrocytomas. MRS can be done as a routine investigation in the developing countries for astrocytomas where other facilities are less accessible for reliable prediction and counseling.Background  Amyotrophic lateral sclerosis (ALS) is a rare motor neuron disease with progressive degeneration of motor neurons. Various molecules have been explored to provide the early diagnostic/prognostic tool for ALS without getting much success in the field and miscellaneous reports studied in various population. Objective  The study was aimed to see the differential expression of proteins involved in angiogenesis (angiogenin [ANG], vascular endothelial growth factor [VEGF], vascular endothelial growth factor receptor 2 [VEGFR2], etc), proteinopathy (transactive response DNA binding protein-43 [TDP-43] and optineurin [OPTN]), and neuroinflammation (monocyte chemoattractant protein-1[MCP-1]) based on the characteristics of ALS pathology. Though, suitable panel based on protein expression profile can be designed to robust the ALS identification by enhancing the prognostic and diagnostic efficacy for ALS. Methods  A total of 89 ALS patients and 98 nonneurological controls were analyzed for the protein expression. Expression of angiogenic (VEGF, VEGFR2, and ANG), neuroinflammation (MCP-1), and proteinopathy (TDP-43 and OPTN) markers were estimated in plasma of the participants. Proteins were normalized with respective value of total protein before employing statistical analysis. Results  Analysis has exhibited significantly reduced expression of angiogenic, proteinopathy, and neuroinflammation biomarkers in ALS patients in comparison to controls. Spearman's correlation analysis has showed the positive correlation to each protein. Conclusion  Altered expression of these proteins is indicating the prominent function in ALS pathology which may be interdependent and may have a synergistic role. Hence, a panel of expression can be proposed to diagnose ALS patient which may also suggest the modulation of therapeutic strategy according to expression profile of patient.Objective  Despite the technological advancement in imaging, digital subtraction angiography (DSA) remains gold standard imaging modality for spontaneous subarachnoid hemorrhage (SAH). But even after DSA, around 15% of SAH remains elusive for the cause of the bleed. This is an institutional review to solve the mystery, "when is second DSA really indicated?" Methods  In a retrospective review from January 2015 to December 2017, we evaluated cases of spontaneous SAH with initial negative DSA with repeat DSA after 6 weeks to rule out vascular abnormality. The spontaneous SAH was confirmed on noncontrast computed tomography (NCCT) and divided into two groups of perimesencephalic SAH (PM-SAH) or nonperimesencephalic SAH (nPM-SAH). The outcome was assessed by a modified Rankin's score (mRS) at 6 months postictus. Results  During the study period, we had 119 cases of initial negative DSA and 98 cases (82.3%) underwent repeat DSA after 6 weeks interval. A total of 53 cases (54.1%) had PM-SAH and 45 cases (45.9%) had nPM-SAH. Repeat DSA after 6 weeks showed no vascular abnormality in 53 cases of PM-SAH and in 2 (4.4%) out of 45 cases of nPM-SAH. Honokiol At 6 months postictus, all cases of PM-SAH and 93% of nPM-SAH had mRS of 0. Conclusion  We recommend, a repeat DSA is definitely not required in PM-SAH, but it should be done for all cases of nPM-SAH, before labeling them as nonaneurysmal SAH. Although the overall outcome for nonaneurysmal spontaneous SAH is better than aneurysmal SAH, nPM-SAH has poorer eventual outcome compared to PM-SAH.Objective  There is a direct fistulous connection between the cavernous segment of the internal carotid artery and cavernous sinus in cases of direct carotid-cavernous fistula (CCF). Endovascular embolization is the mainstay of management in this condition. This study is about the evolution of endovascular treatment methods and the development of a cost-effective technique for embolization of direct CCF at a tertiary care center. Materials and Methods  A retrospective analysis was performed of all the cases of direct type CCF embolized by endovascular techniques in our department from 2008 to 2018.Clinical follow-up of these patients was done at 1 week, 3 months, and 6 months. Results  A total of 45 patients with 40 having a prior history of head trauma were included in this study. All cases were treated with a transarterial route except one which was treated with the transvenous approach. Detachable balloon s were used in 12 (26.67%) patients, only detachable coils in 14 cases (31.11%), both detachable balloons and coils in 9 cases (20%), and both detachable and push coils, that is, sandwich technique in 8 cases (17.
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