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A Comparative Study between Landmark Based and Real Time Ultrasound Guided Sub Arachnoid Block

Open Journal of Anesthesiology 2024年第4期14卷 118-125页

作者： Kunal Tewari Om Bahadur Thapa Deepak Mishra Manjot Multani Jyotsna Sharma akash Ray Mohapatra Sandhya Khwaunju Department of Anesthesiology and Critical Care Armed Forces Medical College Pune India Department of Anesthesiology and Critical Care AFMC Pune India

Background: Sub arachnoid block (SAB) performed by traditional landmark palpation technique can be inaccurate. This problem is exacerbated by altered patient anatomy due to obesity and age-related changes. A pre-procedural ultrasound scan of the lumbar spine has been shown to be of benefit in guiding lumbar epidural insertion in obstetric patients. Information on the use of real-time ultrasound (RUS) guided SAB, to date, been limited. This study compared RUS guided SAB to traditional landmark guided technique in patients undergoing spinal anesthesia for different surgical procedures. Methods: This was a prospective, single center, comparative observational study conducted in the department of anesthesiology at our center. 560 patients who underwent spinal anesthesia either by landmark based technique or real-time ultrasound-guided methods. The primary outcome was the first attempt success rate of dural puncture when employing the two methods. Results: Baseline characteristics were similar in the two study groups. The first attempt success rate of dural puncture in landmark guided group was 64.3% compared to 72.6% in the ultrasound guided group. This difference was not statistically significant. The procedure performance time was significantly shorter with landmark palpation compared to use of real-time ultrasound guided method. Conclusion: Use of RUS-guided technique does not significantly improve the first attempt success rate of SAB dural puncture during spinal anesthesia compared to the traditional landmark-guided technique.

关键词： Sub Arachnoid Block (SAB) Real Time Ultrasound (RUS)

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Comparison of efficacy of lung ultrasound and chest X-ray in diagnosing pulmonary edema and pleural effusion in ICU patients: A single centre, prospective, observational study

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Open Journal of Anesthesiology 2024年第3期14卷 41-50页

作者： Kunal Tewari Sumanth Pelluru Deepak Mishra Nitin Pahuja akash Ray Mohapatra Jyotsna Sharma Om Bahadur Thapa Manjot Multani Department of Anesthesiology and Critical Care Armed Forces Medical College Pune India Department of Anesthesiology and Critical Care Military Hospital Bhopal India

Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.

关键词： Chest X ray (CXR) Consolidation Pulmonary edema Pleural effusion Lung ultrasound (LUS) Pneumothorax

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Unreported complication of Bravo p H capsule dislodged into the pyriform sinus

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World Journal of Gastrointestinal Endoscopy 2015年第5期7卷 573-574页

作者： akash kumar Elisabeth Kramer Sita Chokhavatia Department of Medicine the Mount Sinai Medical Center Division of Gastroenterology and Nutrition Memorial Sloan-Kettering Cancer Center Division of Gastroenterology and Hepatology Robert Wood Johnson University Hospital

We report an unexpected, previously unreported complication of Bravo p H capsule dislodgement. During Bravo p H testing of a 44-year-old man with gastroesophageal reflux disease, we were unable to endoscopically visualize the capsule attached to the esophageal wall after deployment. After multiple attempts to detect the capsule, it was visualized in the left pyriform sinus. As there was significant risk for pulmonary dislodgement, ENT and pulmonary physicians were immediately consulted to review options for safe removal. Ultimately, ENT successfully retrieved the capsule with a foreign body removal forceps. The Bravo p H test is generally a well-tolerated diagnostic tool used to confirm the presence of abnormal esophageal acid reflux. While few complications have been reported, technical difficulties can occur, including poor data reception, misplacement, and early dislodgement. Rarely, more serious complications can occur, ranging from esophageal wall trauma to capsule aspiration. Gastroenterologists performing this procedure should be aware of the low, but nontrivial, risk of complications.

关键词： Gastroesophageal reflux disease EsophagealpH monitoring Bravo capsule Dislodgement Esophagogastroduodenoscopy

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Strategic recommendations for financing green and sustainable energy projects

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Clean Energy 2023年第5期7卷 1069-1077页

作者： Arindam Dutta akash Samanta Department of Energy Management Indian Institute of Social Welfare and Business ManagementIndia

The main hindrances to the large-scale development of renewable-energy projects are the lack of bankability and the inability to align investments and investors with suitable financial instruments or robust policy *** illustrate a bankable project,this paper presents a research-based case study on the installation of solar photovoltaic panels on the rooftops of 195 trains of the Indian *** information on the annual running hours,exposure to sunlight,efficiency of solar photovoltaic generation and electrical power demands of each rail coach is considered to conduct a quantitative measure of the tentative amount of fossil fuel *** purpose is to provide insight into the types of renewable-energy projects that can be highly attractive to financial institutions and promoters due to their lucrative internal return on *** seen in this case study,there are annual savings in diesel of 12323088 litres and a CO_(2) reduction of 32755 tonnes,with return on investment of 1.3 ***,this study conducts a com-prehensive analysis of the limitations of existing renewable-energy project financing mechanisms in ***,three policy measures are recommended to develop a robust financial mechanism that can effectively meet the needs of investors and *** measures include increasing equity injection through a buy-and-hold strategy,providing direct tax benefits to promoters and financing through real-estate investment *** findings are highly relevant to address the challenges associated with bridging the financial gap between access to finance and capital investment in the renewable-energy sector,especially for Asian countries.

关键词： rooftop solar railways fuel saving return on investment bankable project equity funding debt funding renewable energy

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Emerging role of non-invasive and liquid biopsy biomarkers in pancreatic cancer

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World Journal of Gastroenterology 2023年第15期29卷 2241-2260页

作者： akash Bararia Prosenjeet Chakraborty Paromita Roy Bitan kumar Chattopadhay Amlan Das Aniruddha Chatterjee Nilabja Sikdar Human Genetics Unit Indian Statistical InstituteKolkata 700108India Department of Molecular Biosciences SVYASA School of Yoga and NaturopathyBangalore 560105India Department of Pathology Tata Medical CenterKolkata 700160India Department of General Surgery IPGMER&SSKM HospitalKolkata 700020India Department of Biochemistry Royal Global UniversityAssam 781035India Department of Pathology Dunedin School of MedicineUniversity of OtagoDunedin 9061New Zealand School of Health Sciences and Technology University of Petroleum and Energy StudiesDehradun 248007India

A global increase in the incidence of pancreatic cancer(PanCa)presents a major concern and health *** traditional tissue-based diagnostic techniques provided a major way forward for molecular diagnostics;however,they face limitations based on diagnosis-associated difficulties and concerns surrounding tissue availability in the clinical *** disease development with asymptomatic behavior is a drawback in the case of existing diagnostic *** capability of cell free markers in discriminating PanCa from autoimmune pancreatitis and chronic pancreatitis along with other precancerous lesions can be a boon to ***-stage diagnosis of PanCa can be achieved only if these biomarkers specifically discriminate the non-carcinogenic disease stage from malignancy with respect to tumor *** this review,we comprehensively described the non-invasive disease detection approaches and why these approaches are gaining popularity for their early-stage diagnostic capability and associated clinical feasibility.

关键词： Non-invasive biomarkers Cell free biomarkers Proteomic biomarkers Liquid biopsy-based diagnostics Pancreatic cancer biomarkers

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Role of fibrinogen,albumin and fibrinogen to albumin ratio in determining angiographic severity and outcomes in acute coronary syndrome

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World Journal of Cardiology 2023年第1期15卷 13-22页

作者： Kunaal Makkar Yash Paul Sharma akash Batta Juniali Hatwal Prashant kumar Panda Department of Cardiology Post Graduate Institute of Medical Education and ResearchChandigarh 160012India Department of Cardiology Dayanand Medical College and HospitalLudhiana 141001PunjabIndia Department of Internal Medicine Post Graduate Institute of Medical Education and ResearchChandigarh 160012India

BACKGROUND Coronavirus disease 2019(COVID-19)pandemic unmasked the huge deficit in healthcare resources *** highlighted the need for efficient risk stratification in management of cardiovascular *** To study the applicability of the old,available and affordable nonconventional biomarkers:albumin and fibrinogen in their ability to predict angiographic severity and clinical outcomes in patients with acute coronary syndrome(ACS).METHODS In this prospective,observational study,166 consecutive patients with ACS were ***,albumin and their ratio were determined from *** with underlying chronic liver disease,active malignancy,autoimmune disease,active COVID-19 infection and undergoing thrombolysis were *** Mean age of the population was 60.5±1.5 years,74.1%being *** elevation myocardial infarction(STEMI)was most common presentation of ACS seen in 57%*** albumin ratio(FAR)≥19.2,had a sensitivity of 76.9%and specificity of 78.9%[area under the receiver operating characteristic curves(AUROC)=0.8,P=0.001]to predict≤thrombolysis in myocardial infarction(TIMI)1 flow in culprit artery in STEMI *** in non-STEMI patients,FAR≥18.85 predicted the same with 80%sensitivity and 63%specificity(AUROC=0.715,P=0.006).CONCLUSION Novel biomarkers,with their high cost,lack of availability and long turn over time are impractical for real-world ***≤TIMI 1 flow in the culprit artery has significant impact of management and *** study has shown that readily available biomarkers like fibrinogen and albumin can help identify these high-risk patients with good *** allows risk-stratification and individualization of treatment in ACS.

关键词： Acute coronary syndrome Albumin Fibrinogen Fibrinogen to albumin ratio Total occlusion of culprit artery

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On-road emissions of CO,CO2 and NOx from four wheeler and emission estimates for Delhi

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Journal of Environmental Sciences 2017年第3期29卷 39-47页

作者： Jaiprakash Gazala Habib Anil kumar akash Sharma Minza Haider Department of Civil Engineering Indian Institute of Technology DelhiNew Delhi 110016India Department of Mechanical Engineering Indian Institute of Technology DelhiNew Delhi 110016India IEC College of Engineering and Technology Greater NoidaU.P.India

This study presents the emission factor of gaseous pollutants （CO, CO2, and NOx） from on-road tailpipe measurement of 14 passenger cars of different types of fuel and vintage. The trolley equipped with stainless steel duct, vane probe velocity meter, flue gas analyzer, Nondispersive infra red （NDIR） C02 analyzer, temperature, and relative humidity （RH） sensors was connected to the vehicle using a towing system. Lower CO and higher NOx emissions were observed from new diesel cars （post 2010） compared to old cars （post 2005）, which implied that new technological advancement in diesel fueled passenger cars to reduce CO emission is a successful venture, however, the use of turbo charger in diesel cars to achieve high temperature combustion might have resulted in increased NOx emissions. Based on the measured emission factors （g/kg0, and fuel consumption （kg）, the average and 95% confidence interval （CI） bound estimates of CO, CO2, and NOx from four wheeler （4W） in Delhi for the year 2012 were 15.7 （1.4-37.1）, 6234 （386-12,252）, and 30.4 （0.0-103） Gg/year, respectively. The contribution of diesel, gasoline and compressed natural gas （CNG） to total CO, C02 and NOx emissions were 7：84：9, 50：48：2 and 58：41：1 respectively. The present work indicated that the age and the maintenance of vehicle both are important factors in emission assessment therefore, more systematic repetitive measurements coveting wide range of vehicles of different age groups, engine capacity, and maintenance level is needed for refining the emission factors with CI.

关键词： Mobile sampling systemOn-road emissionEmission factorPassengers cars

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Humans and Robots: A Mutually Inclusive Relationship in a Contagious World

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International Journal of Automation and computing 2021年第2期18卷 185-203页

作者： akash Gupta Anshuman Singh Deepak Bharadwaj Amit kumar Mondal Department of Mechanical Engineering University of Petroleum and Energy StudiesDehradun 248007India Department of Systems Engineering University of MarylandCollege ParkMaryland 20742USA Department of Mechatronics Engineering Manipal Academy of Higher EducationDubai 345050UAE

The coronavirus global pandemic has spread faster and more severely than experts had *** this has presented itself as a great challenge,researchers worldwide have shown ingenuity and dexterity in adapting technology and devising new strategies to combat this ***,implementing these strategies alone impedes the nature of everyone′s daily ***,an intersection between these strategies and the technological advantages of robotics,artificial intelligence,and autonomous systems is essential for near-to-normal *** this review paper,different applications of robotic systems,various aspects of modern technologies,including medical imaging,telemedicine,and supply chains,have been covered with respect to the COVID-19 ***,concerns over user′s data privacy,job losses,and legal aspects of the implementation of robotics are also been discussed.

关键词： COVID-19 coronavirus telepresence delivery robots medical robots

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Nanomaterials for sensing of formaldehyde in air: Principles, applications, and performance evaluation

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Nano Research 2019年第2期12卷 225-246页

作者： Deepak Kukkar Kowsalya Vellingiri Rajnish Kaur Sanjeev kumar Bhardwaj akash Deep Ki-Hyun Kim Department of Nanotechnology Sri Guru Granth Sahib World University Fatehgarh Sahib Punjab 140406 India Department of Civil and Environmental Engineering Hanyang University Seoul 04763 Republic of Korea Environmental and Water Resources Engineering Division Department of Civil Engineering IIT Madras Chennai 600036 India Central Scientific Instruments Organization (CSIR-CSIO) Sector 30C Chandigarh 160030 India

Despite the improvement in sensing technologies, detection of small and highly reactive molecules like formaldehyde remains a highly challenging area of research. Applications of nanomaterials/nanostructures and their composites have increased as effective sensing platforms (e.g., reaction time, sensitivity, and selectivity) for the detection of aqueous or gaseous formaldehyde based on diverse sensing principles. In this review, the basic aspects of important nanomaterial-based sensing systems (e.g., electrochemical, electrical, biological, and mass variation sensors) were evaluated in relation to performance, cost, and practicality of sensing gas phase formaldehyde. Accordingly, existing knowledge gaps in such applications were assessed in various respects along with suitable recommendations for building a new roadmap for the expansion of chemical sensing technology of gas phase formaldehyde.

关键词： nanomaterials formaldehyde hazardous pollutant sensing

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Deoxyribonucleic acid methylation driven aberrations in pancreatic cancer-related pathways

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World Journal of Gastrointestinal Oncology 2023年第9期15卷 1505-1519页

作者： akash Bararia Amlan Das Sangeeta Mitra Sudeep Banerjee Aniruddha Chatterjee Nilabja Sikdar Human Genetics Unit Indian Statistical InstituteKolkata 700108India Department of Biochemistry Royal Global UniversityAssam 781035India Department of Biochemistry and Biophysics University of KalyaniWest Bengal 741235India Department of Gastrointestinal Surgery Tata Medical CenterKolkata 700160India Department of Pathology Dunedin School of MedicineUniversity of OtagoDunedin 9054New Zealand School of Health Sciences and Technology University of Petroleum and Energy StudiesDehradun 248007India

Pancreatic cancer(PanCa)presents a catastrophic disease with poor overall survival at advanced stages,with immediate requirement of new and effective treatment *** genetic mutations,epigenetic dysregulation of signaling pathway-associated enriched genes are considered as novel therapeutic *** beneath the deoxyribonucleic acid methylation and its utility in developing of epi-drugs in PanCa are under *** of epigenetic medicines with conventional cytotoxic treatments or targeted therapy are promising options to improving the dismal response and survival rate of PanCa *** studies have identified potentially valid pathways that support the prediction that future PanCa clinical trials will include vigorous testing of epigenomic *** thus promises to generate a significant amount of new knowledge of biological and medical *** review could identify various components of epigenetic mechanisms known to be involved in the initiation and development of pancreatic ductal adenocarcinoma and related precancerous lesions,and novel pharmacological strategies that target these components could potentially lead to *** aim to highlight the possibilities that exist and the potential therapeutic interventions.

关键词： Methylation driven pathways Pancreatic cancer methylation markers Signaling pathway targeted therapy PanCa enriched methylated pathway Pre-cancer methylated pathways

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