Implementation of high step-up power converter for fuel cell application with hybrid MPPT controller.

As of now, there are multiple types of renewable energy sources available in nature which are hydro, wind, tidal, and solar. Among all of that the solar energy source is used in many applications because of its features are low maitainence cost, less human power for handling, a clean source, more availability in nature, and reduced carbon emissions. However, the disadvantages of solar networks are continuously depending on the weather conditions, high complexity of the solar energy storage, and lots of installation place is required. So, in this work, the Proton Exchange Membrane Fuel Stack (PEMFS) is utilized for supplying the power to the local consumers. The merits of this fuel stack are high power density, ability to work at very less temperature values, efficient heat maintenance, and water management. Also, this fuel stack gives a quick startup response. The only demerit of PEMFS is excessive current production, plus very less output voltage. To optimize the current supply of the fuel stack, a Wide Input Operation Single Switch Boost Converter (WIOSSBC) circuit is placed across the fuel stack output to improve the load voltage profile. The advantages of the WIOSSBC are less current ripples, uniform voltage supply, plus good voltage conversion ratio. Another issue of the fuel stack is nonlinear power production. To linearize the issue of fuel stack, the Grey Wolf Algorithm Dependent Fuzzy Logic Methodology (GWADFLM) is introduced in this article for maintaining the operating point of the fuel cell near to Maximum Power Point (MPP) place. The entire system is investigated by utilizing the MATLAB software.

Role of Reflux Symptom Index and Reflux Finding Score in Diagnosing Laryngopharyngeal Reflux: A Prospective Study.

Laryngopharyngeal Reflux Disease (LPRD) is caused due to reflux of gastric content into the larynx and pharynx. The present study was done to assess the role of Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) in the treatment outcomes in symptomatic patients with LPRD. This is a prospective analytical study conducted on 200 patients for a period of 2 years, from January 2020 to February 2022. Patients suspected with LPR were evaluated using RSI and RFS, and both pre and post treatment scores were compared to assess the change in scores of RSI and RFS following 8 weeks of treatment with PPI (Proton pump inhibitor). The patients experienced a greater incidence of moderate symptoms in RSI. Wilcoxon signed-rank test showed significant difference between pre and post treatment scores with respect to reflux symptoms and reflux findings (p < 0.05). Implementation of RSI and RFS scoring system helped for early diagnosis of LPR, and a significant difference was seen between pre and post treatment scores in both RSI and RFS.

Impact of Exercise on Fatigue in Patients Undergoing Dialysis in a Tertiary Care Hospital.

Background Chronic kidney disease (CKD) is a current public health problem associated with progression to end-stage renal disease (ESRD), cardiovascular disease, and increased mortality rates. The disease is progressive. It is estimated that there are about 20-25 patients with milder kidney damage for every patient on renal replacement therapy. Physical activity is one of the critical elements for the prevention of chronic diseases and exercises in CKD help to improve muscular strength, cardiorespiratory endurance, overall function, and quality of life. Fatigue can cause an inability to perform exercises and can affect physiological and psychological function. There is a need to analyze the effects of exercises on fatigue in outpatients undergoing dialysis in the Indian rural population. Methods This study was a randomized, controlled, interventional, single-center trial. The participants diagnosed with ESRD and who were on hemodialysis were randomly assigned to group A, the exercise group (EG), which had exercise training during dialysis, and group B, the control group (CG), which had no added exercises during dialysis or at home and followed a standard routine method. The outcome measure of fatigue was evaluated through the total Fatigue Assessment Scale (FAS) score at 0, 12, 24, and 36 weeks. The exercise was pilot tested and planned based on the guidelines and carried out during hemodialysis two days a week. It was followed up with a five-day home exercise program when the patients did not undergo dialysis. Results A total of 48 participants were chosen for the study, of which 30 participants completed 36 weeks of training, with exercise adherence of more than 60%. There was a statistically significant difference in FAS between the two groups (F (3, 84) = 10.513, P < 0.001) at a 95% confidence interval (P < 0.05). Post hoc comparisons between groups at baseline and at 12 weeks indicated that there was no significant difference in FAS (P = 0.271 and P = 0.08), but recorded a significant difference (P = 0.001) at 24 and 36 weeks, respectively, between the EG and CG. Conclusions The results indicate that the intradialytic exercise intervention was effective in reducing the level of fatigue in outpatients undergoing dialysis on a long-term exercise program.

Learning how to deliver bad and challenging news: Exploring the experience of trainee sonographers - A qualitative study.

BACKGROUND: Previous studies suggest there is a need to improve the delivery of bad and challenging news in obstetric ultrasound settings. However, no research has explored the experiences of trainee sonographers when learning how to deliver challenging news. Understanding this could identify gaps in current provision and inform future training interventions. AIMS: To explore the experiences of trainee sonographers when learning how to deliver challenging news. METHODS: Semi-structured interviews were conducted with trainee sonographers (n = 7) from four training centres to explore their experiences and preferences for news delivery training. RESULTS: Learning how to deliver difficult news was a journey where trainees developed their confidence over time. Most learning occurred in clinical settings, but classroom teaching complemented this. Trainees appreciated the opportunity to observe clinical practice and to hear from patient representatives. However, quality of teaching varied between centres and trainees reported uncertainty regarding the specific language and behaviours they should use. They described building their own personal protocol for news delivery through the course of their training. DISCUSSION: An ultrasound-specific news delivery protocol which details the words and behaviours sonographers can employ could help reduce uncertainty in trainees. Trainees may also benefit from receiving structured feedback on their news delivery performance.

A Prospective Study to Compare the Efficacy of Powered Turbinectomy Versus Submucous Resection in the Surgical Management of Inferior Turbinate Hypertrophy.

Over the years many surgical techniques have been described in the literature for the treatment of inferior turbinate hypertrophy (ITH) but the debate for ideal procedure is still on. In our study we are comparing two surgical procedures namely submucosal resection (SMR) of inferior turbinate and Powered inferior turbinectomy (PT) for the management of ITH. Surgical procedures are to be analyzed in terms of results and complications by subjective and Objective assessment. A prospective study was conducted from 1st December 2011 to 1st June 2013. Subjective assessment of nasal obstruction was done by visual analogue scoring before surgery and graded into none, mild, moderate, and severe. Patients were also subjected to nasal endoscopy for objective assessment of inferior turbinate size and graded as I, II, III. A total of 60 patients were operated (30 patients in each group), patients in Group A underwent SMR and in Group B patients PT was performed. Patients were assessed for various parameters like age, gender, laterality, intra operative and postoperative complications. Overall improvement of 66.7% in Nasal Obstruction and 76.7% in size of inferior turbinate was seen in Group A, whereas improvement of 90% in nasal Obstruction and 83.3% in size of turbinate was seen in Group B. Both SMR and PT are efficient methods for relieving nasal obstruction related to ITH. However, the results in our study confirm that PT is a safe and effective procedure in relieving nasal obstruction and enabling optimal volume reduction with preservation of function of the inferior turbinate.

Comparative assessment of antibacterial efficacy of aqueous extract of commercially available black, green, and lemon tea: an in vitro study.

OBJECTIVES: The objective of this study is to determine and compare antibacterial efficacy of aqueous extracts of black, green, and lemon tea of a commercially available brand. MATERIALS AND METHODS: The well-diffusion method was used to evaluate the antibacterial efficacy of commercially available black tea, green tea, and lemon tea at three different concentrations (1.5 g, 5 g, and 7.5 g) against Streptococcus mutans and Lactobacillus acidophilus. After incubation in appropriate culture medium, diameter of zone of inhibition was measured to assess the antibacterial efficacy of tea. RESULTS: Maximum zone of inhibition was found with lemon tea (27 mm) followed by green tea (26 mm) and black tea (13 mm) against S. mutans and L. acidophilus. Zone of inhibition was highest at 7.5 g concentration (1 and half tea spoon) for lemon tea followed by green tea and black tea. Results were statistically analyzed with the analysis of variance (ANOVA). For pairwise intergroup multiple comparisons, bonferroni test was applied. The difference between black tea, green tea, and lemon tea were statistically significant (P < 0.001) at 5% of level of significance. CONCLUSION: Lemon tea at 7.5 g concentration was more effective followed by green tea and black tea against S. mutans and L. acidophilus.

Microbial contamination of removable dental prosthesis at different interval of usage: An in vitro study.

BACKGROUND: Loss of teeth affects the individual's health. Many factors determine the need to wear a removable dental prosthesis. Due to nature of design, age and lack of awareness, prosthesis often are neglected to maintain in an aseptic condition leading to microbial contamination. This provided an impetus for the present study with the aim of determining the microbial contamination of removable dental prosthesis. METHODOLOGY: Total, 45 patients wearing removable dental prosthesis were randomly selected. Patients were divided into three groups as per duration of usage since 1 month, 6 month and ≥1 year. Sterile cotton swab moistened with phosphate buffer saline (PBS) was used to collect swab from the fitting areas of prosthesis. Swab samples was inserted immediately into the sterile tube containing 1 ml of PBS solution, 10 µl PBS is inoculated on the blood agar and MacConkey agar plates using spread plate technique. Samples were cultured and incubated at 37°C for 48 h. Calibrated microbiologist isolated, identified and counted microorganisms using colony counter. Depending on the nature of data, statistical analysis was done applying Kruskal-Wallis test, Mann-Whitney U-test and Chi-square test. RESULT: Streptococcus species and Staphylococcus aureus were the common microorganisms isolated in all three groups and was statistically significant at P <0.05. Candida albicans, Diptheroid, Escherichia coli, Micrococcus species were isolated from Group II and Group III. CONCLUSION: There is a linear increase in microbial contamination of removable dental prosthesis as the duration of usage increases and might increase the susceptibility of individuals' to many diseases.

Metastatic Renal Cell Carcinoma Presenting as Nasal Mass: Case Report and Review of Literature.

Sinonasal neoplasms are rare and exceptional site for metastatic tumours and comprising <3 % of all malignant aerodigestive tumours and <1 % of all malignancies. Renal cell carcinoma is known to metastasise to the most unusual sites, the sinonasal region being one of them. We here by present a case of 60 year old male patient who presented with epistaxis and nasal obstruction. Clinical examination and CT scan revealed a tumour in the right nasal cavity and maxillary sinus. The presence of primary renal cell carcinoma was recognized only after surgical removal of metastatic tumour. Very few reports have been presented in literature of metastatic renal cell carcinoma in the sinonasal region. We present this case to document its occurrence; highlight the rarity, presentation and difficulties in diagnosis and treatment along with review of literature.

Structure and Catalytic Activity of Cr-Doped BaTiO3 Nanocatalysts Synthesized by Conventional Oxalate and Microwave Assisted Hydrothermal Methods.

In the present study synthesis of BaTi1-xCrxO3 nanocatalysts (x = 0.0 ≤ x ≤ 0.05) by conventional oxalate and microwave assisted hydrothermal synthesis methods was carried out to investigate the effect of synthesis methods on the physicochemical and catalytic properties of nanocatalysts. These catalysts were thoroughly characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), transmission electron microscopy (TEM), X-ray photoelectron spectroscopy (XPS), N2 physisortion, and total acidity by pyridine adsorption method. Their catalytic performance was evaluated for the reduction of nitrobenzene using hydrazine hydrate as the hydrogen source. Structural parameters refined by Rietveld analysis using XRD powder data indicate that BaTi1-xCrxO3 conventional catalysts were crystallized in the tetragonal BaTiO3 structure with space group P4mm, and microwave catalysts crystallized in pure cubic BaTiO3 structure with space group Pm3̅m. TEM analysis of the catalysts reveal spherical morphology of the particles, and these are uniformly dispersed in microwave catalysts whereas agglomeration of the particles was observed in conventional catalysts. Particle size of the microwave catalysts is found to be 20-35 nm compared to conventional catalysts (30-48 nm). XPS studies reveal that Cr is present in the 3+ and 6+ mixed valence state in all the catalysts. Microwave synthesized catalysts showed a 4-10-fold increase in surface area and pore volume compared to conventional catalysts. Acidity of the BaTiO3 catalysts improved with Cr dopant in the catalysts, and this could be due to an increase in the number of Lewis acid sites with an increase in Cr content of all the catalysts. Catalytic reduction of nitrobenzene to aniline studies reveals that BaTiO3 synthesized by microwave is very active and showed 99.3% nitrobenzene conversion with 98.2% aniline yield. The presence of Cr in the catalysts facilitates a faster reduction reaction in all the catalysts, and its effect is particularly notable in conventional synthesized catalysts.

Preparation and crystallographic analysis of gliclazide polymorphs.

Since the introduction of gliclazide in the pharmaceutical industry, a large number of research groups have been engaged in various investigations aiming to enhance its biomedical application. But, very limited efforts have been made to study polymorphism of gliclazide. Therefore, this study focuses on solvent-induced polymorphism of gliclazide and its characterization by thermal methods. Three polymorphs namely, Form-I, II and III and an amorphous powder were produced from different solvents and solvent mixtures. Crystals were analyzed using infrared spectroscopy, differential scanning calorimetry, X-ray powder diffraction and single crystal x-ray diffraction. Polymorph Form-I is found to exist in centro-symmetric triclinic P-1 space group and has endothermic peak at 162.93°. Form-II has endothermic peak from 171.2° to 172.35° and exists in centro-symmetric monoclinic P21/a space group while Form-III has endothermic peak from 168.93° to 169.86° and exists in centro-symmetric monoclinic P21/n space group. The equilibrium solubility values of Form-I, II, III and the amorphous form were 0.4825±0.025, 0.2341±0.042, 0.2581±0.038 and 0.5213±0.072 mg/ml, respectively. The Form-I has relatively higher solubility and similar to that of amorphous gliclazide. Form-II and Form-III are relatively most stable and least soluble. However, there was no remarkable difference in their aqueous solubility under the conditions in which study was conducted.

SYNTHESIS AND BIOLOGICAL EFFICACY OF NOVEL PIPERAZINE ANALOGUES BEARING QUINOLINE AND PYRIDINE MOIETIES.

A series of novel piperazine analogues bearing quinolin-8-yloxy-butan--ones/pyridin-2-yloxy-ethanones were synthesized by a simple and convenient approach based on various substituted piperazine incorporating quinoline and pyridine moieties. The analogues were evaluated for in vitro antioxidant activity against 2,2-diphenyl-1-picryl-hydrazyl (DPPH) and ferrous ion radical scavenging activities and anti-inflammatory activity by inhibition of Vipera russelli venom (PLA2) and gastric K+/H(+)-ATPase activities. Most of the title compounds exhibited promising activity. Best antioxidant and PLA2-inhibiting activities were found for piperazine analogues with phenyl and nitro phenyl groups, whereas methoxy group on phenyl piperazine indicated selectivity for the H+/K(+)-ATPase.

Neck dissection followed by definitive radiotherapy for small upper aerodigestive tract squamous cell carcinoma, with advanced neck disease: an alternative treatment strategy.

Treatment options for patients with small upper aerodigestive tracts squamous cell carcinoma (T1, T2) with advanced neck disease (N2, N3) is a topic that generates controversy in terms of thereuptic stratagies. We present the retrospective analysis of 109 patients treated, between 1991 and 2008, by "Neck dissection first approach" for N2, N3 neck node, followed by external beam radiotherapy (RT) with or without chemotherapy for the operated neck and the primary, deemed radiocurable. 94 patients completed the planned treatment and formed the material for this study. The primary (tumor) stage was as follows: T1 (29) and T2 (65) commonly arising from oropharynx; the neck nodes were predominantly N2a (n = 54), followed by N2b (n = 26) and N3 (n = 14) disease. Complete nodal clearence was achieved in 89 patients, with no major post operative complications. With a median follow up of 24 months disease free survival of 70% and overall survival of 61% at 5 years. Recurrence at primary site was noted predominantly with pyriform fossa tumors (n = 8), followed by base of tongue (n = 5) and were T2 lesions. Failure in the neck was seen in predominantly N3 nodes, R1 resection and failure to comply with adjuvant treatment. Neck dissection first approach is a valid treatment option that allows a good control of the disease in the neck, where it often fails if only RT is administered, along with preserving the pharyngolaryngeal function. Care should be excercised so that there should be no delay in initiating the RT following surgery.

Primary extracranial meningioma of paranasal sinuses.

Meningioma is the most common nonglial intracranial neoplasm, arising from meningocytes (arachnoid cap cells) of arachnoid granulation tissue and constitutes 15-20 % of all intracranial tumors. Approximately 6-17 % of all meningiomas can be found in extracranial or extra spinal sites. The head and neck is the most frequent location of extraneuraxial meningiomas, commonly seen as an extension of primary intracranial tumor (secondary extracranial meningioma). Less than 2 % of all meningiomas arise at a primary ectopic site (primary extracranial meningioma). Meningioma of nose and paranasal sinuses is a very rare tumor. The overall incidence is about 0.1 % of all tumors in the nose and sinuses. To date, very few cases of this primary extracranial meningioma of paranasal sinuses have been reported. In this report we are going to present three rare cases of primary extracranial meningioma of paranasal sinuses operated in our department over a period of 22 years (1986-2008).

Tracheal resection for thyroid cancer.

INTRODUCTION: Thyroid cancers infiltrating the upper aerodigestive tract are not uncommon. The management of these cases can be demanding, with a high level of surgical skill required to achieve adequate primary resection and reconstruction. MATERIALS AND METHODS: This study was a single institution series of seven patients, managed over two years, who underwent tracheal resection for advanced thyroid cancer. All patients were older than 45 years (range, 45-65 years) and were predominantly male (six of seven). All patients presented to us with a swelling in the neck. Fine needle aspiration cytology detected thyroid cancer in all patients. None of the patients required a tracheostomy prior to surgery; however, they all had varying levels of airway compromise. One patient had lung metastasis at presentation. In all patients, the airway was successfully secured with fibre-optic assisted intubation prior to surgery. All patients underwent a total thyroidectomy with tracheal resection and anastomosis. Montgomery's suprahyoid release was utilised to achieve adequate laryngeal drop. None of the patients required a tracheostomy in the post-operative period. All patients received adjuvant therapy with either radioiodine ablation and/or radiotherapy. CONCLUSION: Tracheal resection and primary reconstruction is a feasible surgical procedure for patients with thyroid cancer infiltrating the upper aerodigestive tract, with good clinical outcomes. However, the morbidity of the procedure mandates careful case selection, airway management and meticulous surgical technique.

The utility of second look microlaryngoscopy after trans oral laser resection of laryngeal cancer.

In the past few decades more and more number of tumors of the glottis and supraglottis are been treated with single stage transoral laser microsurgery (TOLS). TOLS for the treatment of glottic and supraglottic carcinoma with anterior commissure (A-com) and/paraglottic space involvement is associated with a high rate of recurrence. We prospectively evaluated the outcomes of laser microsurgery and the impact of second look operation in these patients. Twenty-three patients with glottic and supraglottic carcinoma underwent transoral laser micro resection of the lesions. Subsequently five patients underwent second look microlaryngeal evaluation 6-8 months later for non-satisfactory healing, poor voice, and or suspicion of recurrent disease. Patients with A-com involvement and or paraglottic space involvement were followed up longitudinally for the effectiveness and timing of second look microsurgery. After initial transoral laser micro resection, all patients achieved microscopically clear resection margins. At second look microlaryngeal evaluation, local recurrence was found in four of 23 patients. Of these, two patients were salvaged by second look surgery and are disease free, whereas in two others, the larynx had to be subjected to open surgical intervention. One of two had extensive local recurrent tumor and underwent total laryngectomy with neck dissection followed by post-operative radiotherapy. Tracheohyoidopexy was done with successful functional and oncologic outcome for another patient who had local recurrence for the third time. Only the patient who underwent total laryngectomy with neck dissection was subjected to adjuvant post-operative radiotherapy. Finally, larynx was saved in 21 out of 23 patients.

Salivary gland nocardiosis in an immunocompetent patient.

We report a case of nocardiosis in an immunocompetent patient who presented with pain and multiple swellings in the face. Nocardia asteroides was isolated from the parotid and submandibular salivary glands. The patient was successfully treated by surgical drainage and oral administration of trimethoprim and sulfamethoxazole. To the best of our knowledge, this is the first reported case from India on N. asteroides affecting the salivary gland.

Role of CT Scan in Diagnosis and Management of Otogenic Intracranial Abscess.

The existence of complications of suppurative otitis media and efforts to control it go far back into history. Early diagnosis and management have been greatly modified by the extensive use of CT scan and higher antibiotics. Despite an overall decline in the incidence of complications of otitis media, severe complications still exist with high mortality. Suggested reasons are decrease in physician's experience and changing of the virulence and susceptibility of causative organism. This series is a prospective study of 18 cases of otogenic brain abscess, carried out in Department of ENT and Head & Neck Surgery, SSG Hospital, Baroda from June 2005 to June 2008. We emphasize on confirmation of resolution of brain abscess by CT scan. This will eliminate recurrent/residual abscess and help in reduced overall mortality and morbidity.

Cherubism: presentation of a case.

Cherubism is a rare, fibro-osseous bone disease that affects the jaws. Bilateral enlargement of the mandible produces a full, round lower face. The skin over the cheeks stretches and pulls the lower eyelids down, exposing a thin line of sclera and eyes that are raised, seemingly heavenward. The patient in this report was diagnosed but not treated.