bluuebunny/crossref_metadata_2025 huggingface dataset:
Hemoglobin A1c to Detect Prediabetes or Type 2 Diabetes Mellitus in a Rural Population of Wardha District in India
Authors: Gaidhane Shilpa , Sah Ranjit , Zahiruddin Quazi Syed , Khatib Nazli , Telrandhe Shital , Choudhari Sonali , Gaidhane Abhay
Published: June 2024

Background:

Global diabetes prevalence has doubled since 1980; India has the second-largest diabetic population. Nearly half of type 2 diabetes mellitus (T2DM) cases go undiagnosed. This study assesses glycated hemoglobin A1c (HbA1c) for diagnosing T2DM and prediabetes in at-risk individuals.

Materials and Methods:

We conducted a community-based cross-sectional study in a rural area. We assessed glucose intolerance risk factors among 1353 individuals (age >20 years), categorizing participants into low and moderate–high risk using the Indian Diabetes Risk Score (IDRS). For 363 participants with moderate- or high-T2DM risk, we evaluated fasting plasma glucose, hemoglobin, and HbA1c. Receiver Operating Characteristics (ROC) were constructed for HbA1c against gold standard fasting plasma glucose and 2-h-postload glucose to determine diagnostic accuracy and cut-point values for prediabetes and T2DM. We used decision curve analysis (DCA) to assess the utility of the new HbA1c cut point for T2DM diagnosis.

Results:

The prevalence of newly diagnosed T2DM and prediabetes was 44.63% (95% CI: 39.44–49.91) and 48.48% (95% CI: 43.24–53.76), respectively in people with moderate to high risk of T2DM on IDRS. On ROC, the area under the curve was 90.36% and 79.18%, respectively, reflecting high diagnostic accuracy. The optimum cut point of HbA1c for diagnosis of T2DM was 6.34%, with sensitivity and specificity of 74% and 94%, respectively. The HbA1c cut point for prediabetes was 5.65%, with a sensitivity and specificity of 80% and 75%, respectively. The new cut point of 6.34% on DCA gives substantial net benefit at a 40% probability risk, identifying 31 additional cases per 100 individuals at risk of T2DM and reducing the false positive by 47%.

Conclusion:

Our findings offer potential for developing a diagnostic protocol for T2DM and prediabetes (impaired fasting glucose) using HbA1c cut-point in people with moderate- to high-T2DM risk in rural settings.
Development and Evaluation of an Edutainment Tool for Imparting Education and Awareness among Type 1 Diabetes Children in Qatar
Authors: Al Hamaq Abdulla , Elasyouti Ahmed A , Abou-Amona Rasha T , ElKhatib Nedaa G
Published: June 2024

Background:

Appropriate initial education for type 1 diabetes mellitus (T1DM) is important to prevent late complications. However, type 1 children with diabetes do not appreciate traditional learning methods since they rarely contain the elements of fun and interactivity. In this study, we developed, implemented, and evaluated an edutainment tool for the initial education of type 1 children with diabetes.

Materials and Methods:

The Health Park pack is an edutainment tool that contains three games, two board games “The Health Park, Slides & Ladders” and one card game “Match-Up.” The games were designed to provide essential information about food, exercise, and insulin. A total of 46 children with T1DM evaluated the degree of entertainment, usability, and clinical usefulness of the games with the structured questionnaire.

Results:

More than 95% of T1DM children showed interest in the edutainment approach as the game was useful for initial education for T1DM. More than 90% agreed that they had fun playing the game, and 68% agreed to play the game again. The majority of them recommended the game to friends with diabetes and friends without diabetes.

Conclusion:

Using games could be an interesting edutainment tool for children with T1DM to motivate and educate them.
Management of Type 1 Diabetes in Children During the COVID-19 Pandemic in Turkey: Before, During, and After the Lockdown Period
Authors: Çağlar Seda , Kaş Alay Gamze , Sağlık Dilek Sönmez , Karadede Huriye
Published: June 2024

Aim and Objectives:

Metabolic control in type 1 diabetes (T1D) depends on many factors such as sleep patterns, eating habits, and exercise. The study aimed to determine the difficulties experienced by Turkish children with T1D and their parents during the COVID-19 pandemic, and the effects of the pandemic on children’s activities of daily living and physiologic parameters.

Materials and Methods:

This study, which was carried out with a descriptive and retrospective design, was conducted in the pediatric endocrinology outpatient clinic of a university hospital in Turkey. Data were obtained from 38 children with T1D and their parents who were followed up in this clinic between April 2020 and May 2022.

Results:

The mean age of the children was 14.79 ± 3.05 years, and 65.8% were diagnosed as having T1D 6 years or more ago. When the difficulties experienced by the children during lockdown were examined, it was determined that 50% had difficulties with eating and sleeping patterns. Compared with the other periods, the children’s compliance with diet and regular activity decreased significantly, their sleep duration and screen time increased significantly, and the frequency of communication with peers decreased significantly during lockdown (P< 0.001). It was observed that the mean body mass index (P< 0.001) and HbA1c levels (P= 0.02) of the children increased significantly in the full reopening period after lockdown compared with the prepandemic period and the lockdown period (P< 0.001), and the frequency of blood glucose monitoring was found to be higher during lockdown (P< 0.001).

Conclusion:

This study reflects how T1D management has changed between prepandemic, lockdown, and postpandemic periods and its impact on children with T1D. It appears that frequent follow-up of children has an effect on their glycemic control as well as long-term physiological parameters including sleep, exercise, and eating patterns.
Clinical and Biochemical Features Used to Classify Type-1 and Type-2 Diabetes: A Scoping Review
Authors: Venkatesan Ulagamadesan , Amutha Anandakumar , Anjana Ranjit Mohan , Unnikrishnan Ranjit , Mappillairajan Bagavandas , Mohan Viswanathan
Published: June 2024

The classification of diabetes into type-1 (T1D) and type-2 (T2D) is a critical step in tailoring effective treatment strategies. This distinction relies on a nuanced evaluation of clinical and biochemical features. While age at diagnosis, autoimmune markers, and beta-cell function are among the crucial clinical parameters, biochemical indicators like C-peptide levels and antibody analyses play a pivotal role. This review comprehensively examines the utility of these features in accurately categorizing individuals into T1D and T2D subtypes, providing valuable insights for clinical practice.

This scoping review systematically analyses 32 studies aimed at classifying T1D and T2D using various predictor variables. Clinical parameters including family history of diabetes, age at diagnosis, sex, history of insulin use, percent desirable weight or body mass index, waist, and blood pressure emerge as pivotal diagnostic tools. C-peptide measures, encompassing urinary C-peptide to creatinine ratio (UCPCR), and serum fasting and stimulated C-peptide levels further augment classification. Biochemical markers beyond C-peptide, such as serum level of adiponectin, triglycerides (TG), high-density lipoprotein–cholesterol (HDL-C), low-density lipoprotein (LDL-C), Total cholesterol, fasting and postprandial plasma glucose, and glycated hemoglobin (HbA1c), provide supplementary information for classification. Ketonuria and postglucagon or meal-stimulated C-peptide measurements contribute to nuanced classification, particularly in insulin-treated populations. Antibody analyses, particularly presence of GAD65, Zinc Transporter, and IA2 antibodies, highlight the autoimmune nature of T1D. In conclusion, this scoping review underscores the importance of a comprehensive approach that integrates clinical, biochemical, and immunological markers in accurately differentiating between T1D and T2D in clinical practice.
Study of Association of Vitamin D Receptor Gene Polymorphisms with Diabetic Nephropathy
Authors: Esha Bhuiya , Yogaprabhu Saravanan , Sneha Janaki , Vijayalakshmi Karthick , Mohan Viswanathan , Radha Venkatesan , Bodhini Dhanasekaran
Published: June 2024

Background:

Type 2 diabetes leads to many microvascular complications, including diabetic nephropathy, also referred to as diabetic kidney disease. Vitamin D deficiency may play a role in the development of type 2 diabetes and nephropathy. The functions of vitamin D are mediated through vitamin D receptor (VDR). Three single nucleotide polymorphisms (SNPs) in VDR gene, namely, TaqI (rs731236), ApaI (rs7975232), and BsmI (rs1544410), have been widely studied in association with diabetes and nephropathy. The objective of this study was to investigate the association of these VDR gene SNPs with nephropathy in the South Indian population. Additionally, the effect of VDR gene variants on vitamin D levels was also investigated.

Subjects and Methods:

Two hundred forty-eight individuals with type 2 diabetes without nephropathy (T2DM) and 399 individuals with type 2 diabetes with nephropathy (T2DN) were genotyped for this study. Genotyping of TaqI was performed using the polymerase chain reaction-restriction fragment length polymorphism method. BsmI and ApaI were genotyped using MassArray. Anthropometric and biochemical data were collected for all participants. Vitamin D levels were measured in a subset of 47 T2DM and 74 T2DN individuals. Statistical analysis was performed using Statistical Package for the Social Sciences version 21.0 (IBM Corporation, Armonk, NY).

Results:

The genotype and minor allele frequencies of TaqI, BsmI, and ApaI were not significantly different between T2DM and T2DN groups. However, vitamin D levels were significantly reduced in T2DN (15.5 ± 1.16 ng/ml) compared to T2DM (20.5 ± 2.11 ng/ml, P = 0.027). No significant differences were found in the vitamin D levels when the T2DM and T2DN groups were stratified based on TaqI, BsmI, and ApaI genotypes.

Conclusion:

This study did not find a significant association of VDR SNPs (TaqI, BsmI, and ApaI) with T2DN. However, the study suggested a protective role of vitamin D levels in T2DN.
Neuromuscular Taping in Diabetes Mellitus: A Narrative Review of Current Understanding and Potential Therapeutic Applications
Authors: Sharma Abhishek , Sharma Nidhi , Chahal Aksh
Published: June 2024

Background:

Diabetes Mellitus (DM) poses significant challenges, including peripheral neuropathy and impaired muscle function. Neuromuscular taping has emerged as a noninvasive therapeutic approach, potentially offering benefits in managing DM-related complications.

Materials and Methods:

A comprehensive literature search was conducted to identify relevant studies investigating the use of neuromuscular taping in individuals with DM. Key databases were explored using Boolean operators (AND, OR, etc.), and articles were selected based on predefined inclusion criteria.

Results:

The review identifies 22 relevant articles, with 8 specifically addressing NMT in DM. Out of these, 5 were randomized controlled trials, highlighting the research interest in assessing the effectiveness of NMT. The findings suggest that NMT may positively impact the Ankle Brachial Index, indicative of improved peripheral blood circulation and many other health-related parameters. Neuromuscular taping principles and application methods are outlined, providing a foundation for understanding its potential therapeutic effects.

Discussion:

The potential therapeutic mechanisms of neuromuscular taping are explored, emphasizing its influence on sensory feedback, muscle activation, and circulation. Safety considerations and the feasibility of integrating neuromuscular taping into comprehensive DM management are discussed.

Conclusion:

Neuromuscular taping holds promise as an adjunctive therapy for managing DM-related complications. This structured narrative review provides a comprehensive overview for health care limitations such as a lack of standardized protocols and heterogeneity in study designs are noted.
Presentation and Outcome of Infection in Hospitalized Patients with Diabetic Foot at a Tertiary Care Hospital
Authors: Miyan Zahid , Waris Nazish , Zafar Awn Bin , Shafiq Uroosa , Ulhaque Muhammad Saif , Muneeb Muhammad Danish , Tahir Bilal , Basit Abdul
Published: June 2024

Background and Aim:

To observe presentation and outcome of diabetic foot infection (DFI) in hospitalized patients at a tertiary care center.

Materials and Methods:

This prospective clinical study included all those patients who visited the out-patient department (OPD) of the foot clinic of Baqai Institute of Diabetology and Endocrinology and were admitted to the hospital due to DFI from August 2020 to April 2021. Patients with DFI were assessed and classified into mild, moderate, and severe infections according to the Infectious Disease Society of America (IDSA)/International Working Group On Diabetic Foot guideline protocol. Primary outcome was healing either without amputation, or with minor or major amputation.

Results:

A total of 2405 patients visited the OPD and 658 got admitted. Of these 211 patients with DFI were included. Males 158 (75%) were predominant. As per IDSA classification, 99 (46.9%) had severe infection, 94 (44.5%) had moderate, while 18 (8.53%) had mild infection. Overall, 150 (71.1%) infected Diabetic Foot Ulcers (DFUs), 67 (44.6%) and 65 (43.3%) DFUs with moderate infection and severe infection respectively were healed without any amputation.

Conclusion:

Infection was found to be the major cause of amputation in most patients with toe amputation being more common. Early referral of patients to the tertiary care unit and a multidisciplinary approach may help prevent DFI from major and minor amputations.
Anatomical Snuffbox for Interventional Cardiology
Authors: Thirumurugan E
Published: June 2024

Cardiovascular catheterization has traditionally been done through transradial access. Vascular complications, primarily radial artery (RA) occlusion, continue to exist despite their rarity. In recent times, interventionalists have reported using the anatomical snuffbox (ASB) or distal transradial approach for cardiac catheterization. This distal radial approach has been promoted to lower the risk of bleeding and vascular access site complications as well as RA occlusion at the forearm. This state-of-the-art review outlines the feasibility and safety of left versus right ASB in interventional cardiology.
LMCA Aneurysm and a Fistula Resulting with a Giant Extracardiac Aneurysm
Authors: Atilgan Kivanc , Onuk Burak Emre , Zafer Cengiz E R , Yesil Fahri Gurkan , Colak Abdullah , Aybek Tayfun
Published: June 2024

A 54-year-old, asymptomatic, disease-free female patient was operated for an incidentally detected left main coronary artery aneurysm (CAA) associated with fistula to a giant aneurysm associated with the right atrium (RA). The patient had an extremely rare left main CAA and a fistula connection of a giant aneurysm connecting to the RA.
Tuberculosis with New Onset of Diabetes and Hypertension Following Recovery from Coronavirus Disease 2019 Infection
Authors: Chatterjee Rupak , Chakraborty Aitihya , Sarkar Kumkum , Pramanik Netai , Mukherjee Shatavisa
Published: June 2024

The sign and symptoms of coronavirus disease 2019 (COVID-19) and infectious disease caused by severe acute respiratory syndrome coronavirus 2 are not only restricted to the respiratory system but includes a myriad of clinical manifestations involving various systems. There are various sequelae of COVID-19 reported. Here, we report a series of three cases of tuberculosis along with new onset of diabetes mellitus and hypertension in previously euglycemic, normotensive patients following recovery from COVID-19.
Comparative Analysis of Different Prognostic Markers in Predicting Outcome in Advanced Heart Failure
Authors: Godhiwala Parth , Kumar Sunil , Acharya Sourya , Patel Mansi
Published: June 2024

Introduction:

Heart failure (HF) is a debilitating condition with an adverse outcome, especially during the advanced stage having higher morbidity and mortality rates. Various parameters have been used as prognostic markers in advanced HF. This study highlights about the comparative analysis of different prognostic markers in predicting mortality in advanced HF.

Methods:

This prospective observational study was conducted in patients of advanced HF admitted to the department of medicine intensive care unit in a rural tertiary care hospital from 2018 to 2020. Advanced HF was diagnosed using the updated HF Association-European Society of Cardiology criteria. The serum N-terminal pro-B-type natriuretic peptide (NT-proBNP), six-minute walk test (6MWT), left ventricular ejection fraction (LVEF), estimated glomerular filtration rate, and glycosylated hemoglobin type A1c levels were measured on admission. Receiver operating characteristic (ROC) curve was also studied for the above-mentioned variables, and the area under ROC curve (AUROC) was also determined.

Results:

Seventy-five patients with an average age of 60.55 ± 14.04 years were evaluated. Out of 75, 48 (64%) were male and 27 (36%) were female. There was inhospital mortality in 20 (26.67%) patients. The mean NT-proBNP levels among the mortality group was 9826.95 ± 3485.10 pg/mL, while in nonmortality group, it was 6135.40 ± 2342.77 pg/mL (P= 0.001). The cutoff range in this study for on-admission serum NT-proBNP levels was 8990 pg/mL, with AUROC of 0.81, the sensitivity of 70.0%, and specificity of 90.9%. In multiple regression analysis keeping mortality as the dependent variable, it was seen that variables NT-proBNP, 6MWT (<300 m), and LVEF were significantly associated with mortality.

Conclusion:

Serum NT-proBNP and 6MWT (<300 m) were important predictors of mortality in advanced HF.
A Narrative Review on Serum Biomarkers of Cardiac Fibrosis
Authors: Kumari Santoshi , Sharma Urvashi , Jindal Deepika , Basak Traymbak
Published: June 2024

Myocardial fibrosis is the excessive deposition of extracellular matrix (ECM) proteins in the cardiac interstitium leading to pathological conditions of the heart. The objective is to understand the pathophysiology of cardiac fibrosis and the quest for serum biomarkers that will assist in early diagnosis before the occurrence of major cardiac events. There are many serum biomarkers that get elevated highlighting ECM remodeling during cardiac fibrosis. Lysyl oxidase like -2 is one such ECM protein, plays a crucial role in the up-regulation of TGF - β, the transformation of cardiac fibroblast to myoblast, the migration of collagen, and cross-linking of collagen and elastin. However, assessment of lysyl oxidase like-2 (LOXL-2) in different pathologically driven cardiac fibrosis is limited. Also, none of the serum biomarkers has proved to be the most accurate diagnostic tool for assessing fibrosis independently; hence, meticulous, less invasive, and cost-effective serum biomarkers need to be scrutinized. Hence lysyl oxidase Like-2 (LOXL-2) in combination with other serum biomarkers like PICP/PINP/TIMP-1/ST-2, or Galectin-3 can be combined to assess the presence of fibrosis in the heart. This review includes the journal, articles, and research paper on cardiac fibrosis which was published in the last 10–15 years to highlight the huge gap in the treatment of cardiac fibrosis and the need for a new combination of biomarkers with better prognostic and diagnostic value.
Expert Opinion on the Identification and Pharmacological Management of Worsening Heart Failure
Authors: Seth Sandeep , Bauersachs Johann , Mittal Sanjay , Rastogi Vishal , Rajput Rajeev Kumar , Gandotra Dheeraj , Gupta Ripen , Sahu Manoj , Pathak S N , Bhagwati Mohit , Minocha Simmi , Sharma Pawan , Vatsa Deepankar , Aggarwal Raghav , B Singh Gyanti R , Arora Gaurav , Kubba Samir , Rajeev Meera , Jha Pratik , Vivek B S , Gupta Mohit , Bishnoi Rameshwar , Khare Rashi , Gupta Vipul , Goyal Naresh Kumar , Dhall Aseem , Madan Amit , Sharma B D , Abhyankar Atul D , Kahale Pravin , Meeran Talha , Ezhumalai Babu , Kalmath B C , Shah V T , Rungta Sandip , Kumar P Ashok , Christopher Sunil , Shah Alok A , Dargad Ramesh , Sheth Kaushik , Khode Abhay , Mehta Sunil P , A Ranga Reddy Bommareddy V , Gupta Puneet , Tripathi B K , Bhuyan Ritwick Raj
Published: June 2024

Worsening heart failure (WHF) is a distinct under-diagnosed and under-treated condition, independent of location of care. Heart failure (HF) progression is punctuated by repeated WHF events, each resulting in reduced cardiac function. One-third of the patients with HF with reduced ejection fraction experience a decompensation event. These decompensation events often result in the emergency department visits and HF hospitalization. Despite its inclusion in recent guidelines, there is no precise definition of WHF or its various forms. It is worth noting that WHF signals a need for treatment optimization as per guideline-directed medical therapy and the addition of novel drugs like a stimulator of soluble guanylate cyclase that benefit this high-risk patient population. This practical document is based on the expert opinion of cardiologists, cardiothoracic surgeons, and physicians that discussed the definition, assessment, pharmacological management, and monitoring of WHF patients in a hospitalized setting. In addition, there is also a need for an expert opinion for the management of WHF in an outpatient setting.
Postheart Transplant Prolonged Hospital Stay Due to Massive Ascites
Authors: Sahu Manoj Kumar , Premkumar Azaria Jayaraj , Singh Sarvesh Pal , Dhatterwal Ummed Singh , Hote Milind Padmakar , Seth Sandeep
Published: June 2024

Heart transplantation (HTx) is a gold standard for end-stage heart failure (ESHF). Cardiomyopathies form the majority of patients who undergo HTx. Grown-up congenital heart disease, with or without prior palliative surgery, progresses to ESHF requiring HTx. They constitute the least among all heart recipients. The immediate posttransplant management may become challenging due to severe right heart failure, massive ascites, pleural effusion, and cardiac cachexia. Scarce data are available on this subset of patients. We describe one such patient's post-HTx management. A 15-year-old male with Ebstein's anomaly, restrictive cardiomyopathy, severe right ventricular (RV) dysfunction, atrial flutter, left atrial clot, postradiofrequency ablation, New York Heart Association III, and early cardiac cirrhosis underwent HTx successfully. He had significant mediastinal hemorrhage postoperatively, and managed medically; echocardiography showed a good biventricular function with mild tricuspid regurgitation (TR), and he was extubated on the 1st postoperative day. However, progressive RV function deterioration was observed over the next 72 h (tricuspid annular plane systolic excursion of 7 mm with mild TR) with massive worsening ascites and pleural effusion. He was treated with milrinone and furosemide infusion and noninvasive ventilation, but response to optimal diuretic doses was poor, and the ascites did not decrease. Hence, intermittent paracentesis was done, and 10 L of ascitic fluid was removed over 10 days. Then, he responded to diuretics; his RV function improved. His respiratory support and inotropes were discontinued. His immunosuppressants consisted of tacrolimus and prednisolone. Mycophenolate mofetil was withheld due to leukopenia. At 6-month follow-up, his cardiac functions were normal, ascites completely resolved, appetite improved, and he gained weight.
Subacute Stent Thromboses in Marijuana user Associated with Isolated Protein S Deficiency
Authors: Jariwala Pankaj V , Gude Dilip
Published: June 2024

We present the case of a young professional male, marijuana user who experienced subacute stent thromboses following percutaneous coronary intervention. We identified that he also had a protein S deficiency when we investigated the medical causes of procoagulant conditions. The patient was subjected to a surgical revascularization and began direct oral anticoagulant combined with antiplatelet agents to prevent recurrent thrombotic events. There is no proven way of revascularization in these cases, and antithrombotic medications are ineffective in preventing recurrent ischemia episodes, necessitating more research to determine definitive therapeutic methods for these subsets of cases.
Coronary Cameral Fistula with Left Main Coronary Artery Aneurysm
Authors: Desai Devvrat , Kothari Jignesh
Published: June 2024

Coronary fistulae with cardiac chambers (cameral fistulae) are rare congenital vascular anomalies. Here, we are reporting a case of a 25-year-old male patient who presented with a history of palpitation and chest pain. He was evaluated further and on cardiac multi-slice computed tomography, he was diagnosed to have an extremely rare coronary cameral fistula arising from the left main coronary artery, traversing tortuously between aortic roots anteriorly and left atrium posteriorly, and culminating into superior vena cava just before the cavoatrial junction. Intraoperative complexity was encountered due to the presence of a large left main coronary aneurysm and aneurysmally dilated superior vena cava. Elective surgery was performed on cardiopulmonary bypass with aortic and bicaval (high superior vena cava) cannulation. Cardioplegia delivery was challenging due to the presence of a large fistulous connection between the aortic root and superior vena cava. The patient was operated on successfully for coronary cameral fistula and symptoms resolved.
Concerns of Non-Hodgkin's Lymphoma in Open-Heart Surgery for Rheumatic Heart Disease
Authors: Gupta Anish , Darbari Anshuman , Nath Uttam Kumar , Abisho R S
Published: June 2024

There are concerns regarding safe conduct of open-heart surgery in a patient with hematological malignancy, both in intraoperative and postoperative management of the patient. There is a paucity of literature regarding this problem and limited data have been published regarding the conduct of coronary artery bypass surgery on pump in a patient with hematological malignancies. We describe our experience in a patient with rheumatic heart disease with non-Hodgkin's lymphoma requiring mitral valve replacement.
Recommendations for Cardiovascular Disease Prevention in Women
Authors: Khan Zakia , Rao Sarita , Bhatia Ritu , Ray Saumitra , Dalal Jamshed J
Published: June 2024

Cardiovascular disease (CVD) is one of the leading causes of death in women. On an average, coronary artery disease develops 10 years later in women than men, but they represent the majority of patients when age above 75 years is considered. Men and women share most of the classic cardiovascular risk factors, but the relative importance of each risk factor may be gender specific. This review explores the recommendations for the management of cardiovascular risk and CVD prevention in women in the Indian clinical setting based on multiple advisory board meetings conducted with cardiology experts across India. The experts concurred that women have distinct patterns of ischemic heart disease (IHD) and that the presence of traditional risk factors, female-specific risk factors, and nontraditional risk variables may add to the increasing risk of IHD. Transition to postmenopausal status is associated with a worsening coronary heart disease risk profile in women. Evidence suggests that both traditional and novel cardiovascular risk factors are often under recognized and undertreated in women. Several female-specific risk factors such as preterm delivery, preeclampsia, gestational diabetes, and polycystic ovary syndrome are not included in primary prevention nor are they routinely considered in a cardiovascular assessment at the clinical level. Understanding and good diagnostic tools are necessary to evaluate the different pathophysiological aspects and early detection of CVD in women.
Successful Surgical Extraction of an Entrapped Intra-Aortic Balloon Pump
Authors: Pai Jayarama , Mukkannavar Shivaprasad Babu , Siddharth Bharat , Geethika R , Shriram D Krishna
Published: June 2024

Intra-aortic balloon pump use is an approach for the provision of mechanical support to improve cardiac output and perfusion in the perioperative period in patients undergoing coronary intervention. Despite its beneficial use, rupture of the balloon and entrapment of blood clots in the lumen may occur in very rare cases. We discuss a postoperative presentation, plan, and operative management for the removal of an entrapped balloon catheter.
Assessment of environmental radioactivity and groundwater quality around Tummalapalle uranium mining site, Andhra Pradesh, India
Authors: Rana Barendra Kumar , Jha S. K. , Molla Samim , Dhumale M. R. , Kulkarni M. S.
Published: June 2024

A comprehensive background radiological status in the surrounding environment of the Tummalapalle U mining and processing facilities was evaluated. Radioactivity in soil and rock was estimated by high-resolution gamma spectroscopy with a high-purity p-type germanium detector. The external gamma radiation level, outdoor 222Rn concentration, radioactivity in the groundwater, and water quality parameters around the Tummalapalle site were studied. The terrestrial radioactivity in soil was higher than the national and global averages in the study region. Radium equivalent activity (Raeq) in soil and rock was much lower than the safe limit of 370 Bq/kg and therefore safe to use as a construction material. Hydrogeochemical analysis indicated that the groundwater in the study region is neutral to medium basic, oxic, fresh to brackish, and predominantly Ca2+-Mg2+-HCO3
− (62.5%) type. The hydrogeochemistry of groundwater was primarily governed by rock-aquifer interaction in this region. The data generated in this study can serve as the baseline for this region to understand the change in environmental conditions, if any, due to prolonged anthropogenic activities.
A study on the level of terrestrial gamma and gross alpha activity in Gulf of Mannar, South coast of India, Tamil Nadu
Authors: Krishnamoorthy Raju , Basith O. , Mohamed Jaffer M. Jamal
Published: June 2024

This study presents the results of outdoor ambient gamma and gross alpha activity of Gulf of Mannar, and these measurements were carried out using Scintillation Counter (UR-705). Results showed that the terrestrial Gamma radiation levels of the Gulf of Mannar ranged from 4.10 μR/h to 76.33 μR/h. The Gross alpha radioactivity levels of the Gulf of Mannar ranged between 3.67 Bq/kg and 51.34 Bq/kg. The calculated ambient gamma and gross alpha activity were found to be lower than the world average. Gamma absorbed dose rates in air outdoors were calculated to be in the range between 35.67 nGy/h and 664.07 nGy/h with an arithmetic mean of 98.98 ± 20.54 nGy/h. This value is lower than the population-weighted world-averaged of 60 nGy/h. Inhabitants of Northern Gulf of Mannar are subjected to external gamma Annual dose exposure ranging between 0.30 and 5.65 mGy/y with an arithmetic mean of 0.84 ± 0.17 mGy/y.
Optimization of FLUKA detector model for HPGe array
Authors: Charubala C. S. , Santhanakrishnan V. , Ganesh G. , Kulkarni M. S.
Published: June 2024

Monte Carlo codes, such as FLUKA, are widely used to optimize calibration of spectrometric systems. HPGe detector array (HDA) for lung monitoring was modeled in FLUKA code using available information about their geometry and optimized for efficiency using 241Am point source at smaller distances (<10 cm) as in case of in-vivo monitoring scenarios. Thickness of dead layer (DL) on the top and lateral detector surfaces for low energy counting was determined by considering the experimental and simulated efficiency for various energies. Using trial and error method, optimized DL thickness was found out to be 2.5 μm on top surface and 1.8 mm on lateral surfaces for each HPGe detector in the array. For the optimized model, it was found that the simulated and experimental efficiency and the simulated and experimental spectra were in reasonable agreement. Optimization of the HDA was an important benchmarking step to reduce the simulation errors before they are implemented in complex numerical problems using computational phantoms.
Estimation of aquatic dilution factor for liquid effluent discharges from Kaiga Generating Station using tritium as a tracer
Authors: Reji T. K. , Joshi R. M. , Ajith T. L. , Jain Sanyam , Vishnu M. S. , Saradhi I. V. , Vinodkumar A.
Published: June 2024

Very low-level radioactive liquid effluents much below the approved discharge limits are discharged to Kadra reservoir after dilution with condenser cooling water at Kaiga Generating Station. In addition, further dilution occurs from the discharge point to the nearest public utilization point in Kadra reservoir (Hartuga). The dilution obtained in Kadra reservoir is estimated by simultaneous measurements of tritium at the discharge point and at Hartuga. The on-site measurement indicates a dilution factor of 12.2 ± 2.4 for tritium. A dilution factor of 13.3 ± 3.4 was obtained using aquatic dispersion model.
Equilibrium status of naturally occurring 226Ra with radon daughters and estimation of 238U activity from 235U using natural radioactivity ratio of 238U/235U in soil around Rawatbhata, Rajasthan
Authors: Gocher Ajay Kumar , Sisodia Mohit , Tiwari S. N. , Saradhi I. V. , Kumar A. Vinod
Published: June 2024

Equilibrium status among 226Ra and radon daughters was studied in soil samples around Rawatbhata, Rajasthan. It was found that the increase in radioactivity of 214Bi (radon daughter) due to complete radon buildup in the sealed container is within 15% which establishes that 226Ra remains in equilibrium with radon daughter in soil of Rawatbhata. Radioactivity of 238U was estimated from the radioactivity of 235U using natural uranium isotopic radioactivity ratio (238U/ 235U) of 21.5. 238U radioactivity in soil was found in the range 25.8–49.5 Bq/kg with an average of 36.7 Bq/kg which is comparable to the global average of 35 Bq/kg.
Ensuring Zero Defects Through Effective Design Failure Modes and Effects Analysis Processes in the Aerospace Industry
Authors: Shah Achint , Shea Rachelle , Siskowski Bruce
Published: June 2024

The Aerospace Industry's drive towards zero defects has seen a significant shift to prevent defects and improve product quality during the design phase, instead of waiting until post-production inspection to discover and troubleshoot problems. Trying to ensure zero defects during the post-production inspection phase is too late in the product life cycle because it can lead to substantial costs. Aerospace Engine Supplier Quality (AESQ) introduced the Advanced Product Quality Planning (APQP) [2] process to realize zero defects. In APQP Phase 2 [2], Product and Design Development, a key output is performing a Design Failure Modes and Effects Analysis (DFMEA). Moog has effectively implemented a DFMEA process that adeptly identifies and mitigates design risks. This work showcases Moog's successful deployment of DFMEA, exemplifying the industry best practices. This work also presents simplified and innovative interpretations of DFMEA definitions and approaches. By addressing defects during the design phase, the resulting product design optimizes performance, achieves higher reliability, and may also minimize waste and promote sustainability.
Generating Reduced-Order Image Data and Detecting Defect Map on Structural Components Using Ultrasonic Guided Wave Scan
Authors: Kolappan Geetha Ganesh , Ravi Nitin. B , Roy Mahapatra Debiprosad
Published: June 2024

The paper presents a theoretical framework for the detection and first-level preliminary identification of potential defects on aero-structure components by employing ultrasonic-guided wave-based structural health monitoring strategies, systems and tools. In particular, we focus our study on ground inspection using a laser-Doppler scan of the surface velocity field, which can also be partly reconstructed or monitored using point sensors and actuators structurally integrated. Using direct wavefield data, we first question the detectability of potential defects of unknown location, size, and detailed features. Defects could be manufacturing defects or variations, which may be acceptable from a design and qualification standpoint; however, those may cause significant background signal artefacts in differentiating structure progressive damage or sudden failure like impact-induced damage and fracture. We consider the surface velocity field over continuous time stamps obtained from laser-doppler scan experiments using surface-integrated piezoelectric transducers on a composite panel. We consider such likely uncertainty in material properties and measurement noise issues while studying specific defects such as delamination. We use the physics of wave interaction with these different defects to show the detectability of hotspots and their preliminary identification ability, whether they could be material manufacturing uncertainty or structure damage such as delamination. We then discuss advanced algorithms based on reduced-order imaging techniques with certain invariance properties, such as signal phase change associated with stationary features compared to moving features or noise. A novel first-order cross-correlation using surface velocity similarity is developed and applied to study the stationary and non-stationary features in the image. The defect map is then generated from the high-dimensional temporal field data, where a detection threshold is used to define the defect hot spot. To this end, the nature of wave mode conversion and attenuation across these defects are discussed, which are important precursors for full-fledge SHM system-based automated detection.
A Multi-Scale Computational Scheme for Prediction of High-Cycle Fatigue Damage in Metal Alloy Components
Authors: Kumar Ravi , D S Karan , Roy Mahapatra Debiprosad
Published: June 2024

High-cycle fatigue damage causing micro-crack initiation is a critical concern in aerospace structural components and alloys due to intense thermo-mechanical stress and vibration. Vibration or overload/impact can initiate small cracks near the stress concentration zones. These cracks may expand erratically before being detectable in subsequent inspections, emphasizing the need to predict the effects of usage and aging on components. This predictive ability would significantly aid material refinement, design enhancements, and inspection planning. Prediction of fatigue damage leading to the formation of cracks is a great challenge for many reasons, including microstructure anisotropy and uncertainties in complex stress states compared to design stress used in testing and qualifying a component. These uncertainties undermine inspection reliability and effectiveness. The elastic moduli of the material are considered isotropic and homogeneous at the macroscopic level of continuum plasticity. Effective properties at the microscopic level are anisotropic and are strongly correlated to constituent phases, interphases, and geometric factors like shape, size, and orientation, which are the reasons for anisotropy in elastic moduli. Statistical modeling of microstructure is vital to identify the scatter in the properties, which involves the generation of synthetic microstructure, that is statistically equivalent to experimental microstructure. A multi-scale computational scheme and tool are developed to accurately estimate adequately resolved fatigue damage-induced plastic strain. The damage evolution model developed from constitutive properties at the microstructure level is the precursor for predicting continuum damage. The model developed correlates the damage accumulation and life (in terms of number of cycles). A polygonal finite element scheme developed recently in our previous studies employing a numerical integration scheme is used for modeling complex grain geometries.
Analysis of Possible Flight Operational Cost Savings by Automating Weather Forecast Updates
Authors: Kushwaha Dinesh , Kottackal Sebin K
Published: June 2024

A GE Aviation Systems report for a project, conducted under the CLEEN Program to develop the Flight Management System Weather Input Optimizer (FWIO), documents that the National Oceanic and Atmospheric Administration (NOAA) provided weather forecast data has a bias of 15 knots and a standard deviation of 13.3 knots for the 40 flights considered for the research. It also had a 0.47 bias in the temperature with a standard deviation of 0.27. The temperature errors are not as significant as the wind. There is a potential opportunity to reduce the operational cost by improving the weather forecast.

The flight management system (FMS) currently uses the weather forecast, available before takeoff, to identify an optimized flight path with minimum operational costs depending on the selected speed mode. Such a flight plan could be optimum for a shorter flight because these flight path planning algorithms are very less susceptible to the accuracy of the weather forecast. However, the flight plan for longer flights may require changes with the latest weather data since the weather forecast used initially might have become inaccurate. The errors in the weather forecast negatively impact predictions on ground speeds, which increases the time and fuel costs for a flight. The older the weather forecast, the higher the errors.

It is recommended to automate the uplink request to obtain the latest weather forecast and to ensure the availability of highly accurate weather forecasts. Simulations were conducted to estimate the savings using a narrowbody aircraft. The simulation results show an average saving of 10-15 pound of fuel for a 1000Nm flight, which can result in $15,000-$20,000 savings annually per aircraft. The proposed approach helps to achieve more fuel-time savings and eases the pilots’ workload as they do not need to monitor the error in the weather forecast.
Static Aeroelastic Analysis and Study of Control Effectiveness of a Typical Reusable Launch Vehicle
Authors: Pavanasam Ashok  Gandhi , Anil Mary , Rose Jancy
Published: June 2024

Launch vehicles are vulnerable to aeroelastic effects due to their lightweight, flexible, and higher aerodynamic loads. Aero elasticity research has therefore become an inevitable concern in the development of the Reusable Launch Vehicle (RLV). RLV is a unanimous solution to achieve more affordable access to space. The lightweight control surface of the RLV signifies the relevance of the study on static aeroelastic effects on the control surfaces. Control effectiveness is the capability of a control surface to produce aerodynamic forces and moments to maneuver the vehicle along the intended path. The static aeroelastic problem determines the efficiency of control, aircraft trim behavior, static stability, and maneuvering quality in steady flight conditions. In this paper, static aeroelastic analysis was performed on a typical RLV using MSC/NASTRAN inbuilt aerodynamics. This study is performed using a finite-element structural model (MSC/NASTRAN, MSC/PATRAN) coupled to an aerodynamic model (Doublet Lattice Method) based on Panel method, along the descent phase trajectory of the launch vehicle. The main aim of this analysis is to quantify the control effectiveness of the typical RLV. This paper also focuses on the parametric study of the control effectiveness of the elevon for diverse parameters, including altitudes, density, dynamic pressure, and Mach numbers.
Using Generative Models to Synthesize Multi-Component Asset Images for Training Defect Inspection Models
Authors: Bhate Ujwal , Jha Ashish , Kalyan Vijayasri , Gupta Rahul , Kulkarni Ninad
Published: June 2024

Industries have been increasingly adopting AI based computer vision models for automated asset defect inspection. A challenging aspect within this domain is the inspection of composite assets consisting of multiple components, each of which is an object of interest for inspection, with its own structural variations, defect types and signatures. Training vision models for such an inspection process involves numerous challenges around data acquisition such as insufficient volume, inconsistent positioning, poor quality and imbalance owing to inadequate image samples of infrequently occurring defects. Approaches to augmenting the dataset through Standard Data Augmentation (SDA) methods (image transformations such as flipping, rotation, contrast adjustment, etc.) have had limited success. When dealing with images of such composite assets, it is challenging to correct the data imbalance at the component level using image transformations as they apply to all the components within an image. Even though existing methods would aid in increasing the dataset volume, the continued data imbalance leads to a biased model whose accuracy is adversely impacted. This paper presents an approach to synthesizing composite asset images using Deep Learning, particularly focusing on organically inserting specific components with defect signatures in a composite image without compromising the integrity of the composite asset. The described approach leverages diffusion-based models to generate images, enabling granular control over the location and appearance of the synthesized components in the image. The exercise of this granular control over individual components of an image leads to the creation of a refined and balanced dataset across multiple-components and defect categories. The utility of the approach is established through experiments conducted with real-world asset images. The synthetic data is assessed through metrics that measure how well it represents the real data distribution as well as its impact on downstream asset inspection models through accuracy metrics. The paper concludes by contrasting the efficacy of the presented approach against other family of algorithms including Generative Adversarial Networks.
Neolitik’ten Demir Çağı’na Anadolu'da Tilki-İnsan İlişkileri: Zooarkeolojik ve Etnoarkeolojik Bir Değerlendirme
Authors: Dalar Muhammed Eyyub
Published: June 2024

Bu çalışma, zooarkeolojik ve etnoarkeolojik veriler kullanarak Erken Neolitik Çağ'dan Kalkolitik, Tunç ve Demir Çağ’a dek Anadolu'daki tilkilerin rollerini araştırmaktadır. Anadolu'daki 31 farklı yerleşimden toplanan zooarkeolojik verilerle, tilki-insan ilişkilerinin gelişim süreci incelenmiştir. Bunlarla birlikte çalışmada, tilkilerin beslenme, kürk, sembolizm ve ritüel gibi çeşitli yönleri ele alınmıştır. Ayrıca Anadolu’da ve günümüz avcı-toplayıcı topluluklarının etnografik verileri kullanılarak, tilki-insan ilişkilerinin bilinmeyen yönlerine dair etnoarkeolojik bir değerlendirme yapılmıştır. Elde edilen bulgulara göre; avcılık-toplayıcılık dönemlerinde tilkilerin küçük memeli hayvan avcılığının beslenme ekonomisinde önemli bir rol oynadığı, Neolitik Çağ'ın gelişimiyle birlikte ise kürk, sembolizm, ritüel gibi pek çok amaçla kullanıldığı anlaşılmaktadır. Neolitik Çağ sonra tilkilerin kullanımındaki çeşitliliğin azaldığı ve daha çok pastoral grupların tilkileri beslenme ve sembolik amaçlarla kullandıkları ortaya çıkmıştır. Tunç Çağ boyunca devletleşme süreciyle paralel olarak, sadece edebi metinlerde tilkiler hakkında kayıtlar bulunmuştur. Ancak, edebi metinlerde yansıtılmayan ilişkilerin arka planı hakkında yeterli veri olmamasına rağmen, Anadolu'da arkeolojik dönemler boyunca tilkilerle insanlar arasındaki ilişkilerin pastoralist topluluklar tarafından sürdürüldüğü anlaşılmaktadır.