General Conditions Research Articles

Einflussfaktoren auf die eigene Anwendung der Sepsis-Kompetenz und ihre Förderung bei Patientinnen und Patienten: Ergebnisse einer Mixed-Methods-Studie mit Gesundheitsfachpersonen

BackgroundSepsis is a life-threatening and relatively common emergency which is often recognized too late or not at all. Therefore, the “SepsisWissen” (SepsisKnowledge) project aimed to bring about changes in health care professionals’ behavior in the area of sepsis prevention and early detection. It addressed the health care professionals themselves (e. g., their own vaccination, hygiene and early detection behavior) and their patient counseling behavior. To promote this behavior, the SepsisWissen campaign included offers such as trainings or print products. The subsequent core question is: From the health professionals’ perspective, which barriers and facilitators affect their own application of sepsis competence and their promotion of their patients’ sepsis competence? MethodsThis paper was based on a cross-sectional mixed-methods study part of “SepsisWissen” witha)semi-structured interviews with 17 providers andb)a quantitative survey among 135 providers.Part a) was analyzed using qualitative oriented content analysis based on Mayring, part b) was analyzed descriptively.The interviewees included physicians, nurses, pharmacists, assistants to physicians and pharmacists and, additionally, one paramedic in the quantitative sample. Some of them had attended “SepsisWissen” trainings. ResultsThe qualitative data analysis identified 41 conducive and hindering factors, which can be assigned to the following eight major topics: 1) syndrome sepsis; 2) predisposing factors for health professionals' own acquisition and application of sepsis competence; 3) enabling factors for health professionals themselves; 4) behavior and lifestyle of patients; 5) reinforcing factors for patients; 6) public health education; 7) political, administrative, and organizational context; 8) environmental factors. In the qualitative and quantitative surveys, the suggestion to improve the sepsis competence of the population and to reduce misinformation, respectively, through public education (e.g., via schools or the media). DiscussionSepsis training for health professionals was considered as a facilitating factor for taking potential sepsis symptoms and patients’ respective statements more seriously. Future training formats should convey more explicitly how health professionals can better communicate their own sepsis knowledge to their patients. They request instruments to support their communication, such as checklists for lay persons. According to the interviews, health workers themselves need recurring external reminders for the topic of sepsis. Organizational and political conditions should be improved. From the health professionals’ point of view, it is essential to offer better reimbursement for prevention and counseling services and to allocate adequate time resources for both. ConclusionHealth professionals could increase their potential to apply and promote sepsis competence if general conditions were optimized. From their perspective, it is most important to relieve them of some of their patient counselling burden by initiating more public education.

Local Detailed Balance Invariant States of Markov Generators of Low Density Limit

We introduce the notion of local detailed balance for low density limit generators of quantum Markov semigroups and explore the consequences of this condition on the structure of the corresponding set of invariant states. The local detailed balance condition allows us to include the case of degenerate reference Hamiltonian and due to this degeneracy, we can compute nonequilibrium invariant states by combining the local detailed balance with generic, quasi-generic and [Formula: see text]-generic conditions, obtaining LDL Markov generators with pure invariant states.

Polynomial solution of Cauchy-type singular integro-differential equations with bivariate kernels

In this paper, we present Chebyshev and ultraspherical polynomials method to obtain numerical solutions of Cauchy-type singular integro-differential equations. We prove that the singular integro-differential equations with smooth/non-smooth bivariate kernels and general boundary conditions can be transformed into a constrained least square problem and solved via generalized QR factorization. By using open-source Chebfun code, low-rank approximate solutions of singular integro-differential equations can be obtained efficiently in the spectral accuracy range. The method can be easily extended to solve those singular integro-differential equations with smooth bivariate kernels, or convolution kernels with absolute value symbols (non-smooth cases), or when the solutions have (inverse) square root singularities.

A Semianalytical Solution for the Transient Response of One-Dimensional Unsaturated Single-Layer Porous Media with General Boundary Conditions

A Semianalytical Solution for the Transient Response of One-Dimensional Unsaturated Single-Layer Porous Media with General Boundary Conditions

Application of Delayed Repeated Enema With Sedation in Pediatric Intussusception: A Single Center Retrospective Study

ObjectiveThis study aimed to evaluate the clinical application of delayed repeated air enema (DRE) with sedation in pediatric intussusception. MethodWe retrospectively assessed cases of idiopathic intussusception treated with air enema reduction at the emergency department of Beijing Children's Hospital affiliated to Capital Medical University from January 2016 to August 2019. The included cases were assigned to the success or failure groups based on the outcomes of DRE with sedation. General patient information, clinical manifestations, test results, and surgical conditions were collected for comparative analysis. ResultsA total of 3052 cases were initially diagnosed with intussusception and underwent air enema reduction. Ultimately, 211 cases were included, with 162 in the success group and 49 in the failure group. The success rate of DRE with sedation was 76.8% (162/211), with an overall reduction success rate of 97.8% (2984/3052). Univariate logistic regression analysis showed that patients in the failure group had a significantly higher proportion of patients with age ≤1 year, bloody stools, and left-sided intussusception before DRE compared to the success group (OR = 2.3, 95%CI: 1.1∼4.6, P = 0.023; OR = 3.4, 95%CI: 1.6∼7.2, P = 0.002 and OR = 12.6, 95%CI: 4.6∼34.6, P < 0.001). Multiple logistic regression analysis based on these three factors revealed that the risk of DRE failure was 10.1 times higher in cases with the left-sided intussusception before DRE. ConclusionsDRE with sedation can improve the overall enema reduction success rate for intussusception and has good feasibility and safety profiles. Left-sided intussusception before DRE is an independent risk factor for enema failure.

Modified FOLFOXIRI plus bevacizumab as a salvage regimen for patients with refractory metastatic colorectal cancer.

e15559 Background: The triplet FOLFOXIRI (fluorouracil, leucovorin, oxaliplatin, and irinotecan) plus bevacizumab showed improved outcomes for patients with metastatic colorectal cancer (mCRC) as first-line systemic treatment. However, those who progressed on standard therapies still faced the lack of optimal treatments in the third or later lines. There is a lack of data on applying triplet chemotherapy plus bevacizumab in later-line settings. We conducted a retrospective study to evaluate the efficacy and safety of modified FOLFOXIRI (mFOLFOXIRI) plus bevacizumab as a salvage regimen for patients with refractory metastatic colorectal cancer. Methods: Patients with refractory mCRC were retrospectively analyzed, who received mFOLFOXIRI plus bevacizumab in the third or later lines. The key inclusion criteria were:(1) 15-75 years old; (2) histologically confirmed mCRC; (3) treatment failure to at least two lines of treatments containing oxaliplatin, irinotecan, and 5-FU. Those with poor general condition (ECOG score &gt; 2), or continuous grade 3-4 neuropathy and allergy to oxaliplatin were excluded. The mFOLFOXIRI regimen consists of oxaliplatin 85 mg/m² intravenous infusion for 2 hours; irinotecan 150 mg/m² intravenous infusion for 90 min; following intravenous infusion of leucovorin 400 mg/m² for 2 hours then 5-FU 2400 mg/m² for 46–48 hours continuous intravenous infusion, Q2W. Bevacizumab 5 mg/kg was administered by intravenous infusion Q2W. Results: 95 patients treated between January 2020 and December 2022 were retrospectively studied. The median age at diagnosis was 50.8 years (range 23-72 years). 50.5% of the patients had previously received at least four regimens. At the last follow-up date on December 31, 2023, the objective response rate (ORR) was 11.6% (1 complete response and 10 partial responses) and the disease control rate (DCR) was 68.4% (54 stable diseases). The median progression-free survival (PFS) was 6.2 months (95% CI, 5.4-7.0) and the median OS was 13.6 months (95% CI, 12.2-14.9). The most common adverse event was neutropenia (23.2%). Grade 3-4 adverse events were reported in 37 (38.9%) patients, including neutropenia (9.5%), oxaliplatin-related allergy (7.4%), thrombocytopenia (4.2%), thrombocytopenia (4.2%), diarrhea (4.2%), anemia (3.2%), nausea (3.2%), and neuropathy (2.1%). Conclusions: Modified FOLFOXIRI plus bevacizumab is effective as a salvage regimen in patients with refractory mCRC and with an acceptable safety profile.

Homotopy in Exact Categories

In this monograph we develop various aspects of the homotopy theory of exact categories. We introduce different notions of compactness and generation in exact categories, and use these to study model structures on categories of chain complexes C h ∗ ( E ) Ch_{*}(\mathcal {E}) which are induced by cotorsion pairs on E \mathcal {E} . As a special case we show that under very general conditions the categories C h + ( E ) Ch_{+}(\mathcal {E}) , C h ≥ 0 ( E ) Ch_{\ge 0}(\mathcal {E}) , and C h ( E ) Ch(\mathcal {E}) are equipped with the projective model structure, and that a generalisation of the Dold-Kan correspondence holds. We also establish conditions under which categories of filtered objects in exact categories are equipped with natural model structures. When E \mathcal {E} is monoidal we also examine when these model structures are monoidal and conclude by studying some homotopical algebra in such categories. In particular we provide conditions under which C h ( E ) Ch(\mathcal {E}) and C h ≥ 0 ( E ) Ch_{\ge 0}(\mathcal {E}) are homotopical algebra contexts, thus making them suitable settings for derived geometry.

Evaluating the significance of next-generation sequencing (NGS) testing in Indian patients with advanced malignancies: An observational study on clinical outcomes and treatment costs.

e15091 Background: The widespread use of Next-Generation Sequencing (NGS) panels to guide targeted therapy in advanced malignancies has raised questions regarding their real-world impact on clinical outcomes and affordability. Methods: This observational study included 126 patients, conducted between January 2022 and December 2023 aimed to assess the utility of NGS testing in both the initial and subsequent lines of treatment for Indian patients facing advanced malignancies. Results: In the first-line setting, NGS was extensively employed for patients with metastatic Colorectal Cancer (mCRC) and Non-Small Cell Lung Cancer (NSCLC). Analysis of RAS and BRAF mutations in mCRC patients (n=21) informed the choice between EGFR and VEGFR-directed therapy, resulting in a median Progression-Free Survival (PFS) of 7.5 months. In NSCLC patients (n=37), the NGS identified targetable mutations in 30 cases, leading to significantly improved mPFS (12 months vs 6 mo with chemotherapy alone). NGS was also employed for HRR, HRD and BRCA testing in advanced breast (n=45) and ovarian carcinoma (n=11), which helps in determining prognosis, role of targeted therapy and genetics. No adverse events noted till date. For patients undergoing subsequent lines of treatment (n=12), NGS detected targetable mutations in 9 cases. NGS revealed actionable mutations (ERBB2, CD74/NRG1fusion and KRAS12C mutation) in metastatic NSCLC patients (n=3), leading to appropriate treatment and PFS of 4-6 months. In metastatic NSCLC patients, T790M mutation was detected in 1 patient confering PFS of 6 months with change to Osimertinib and EGFR exon 20 insertion mutation detected in another, survival didn't improve with addition of amivantamab due to poor general condition. Alpelisib was started for PIK3CA mutation in metastatic Ca Breast (HR+,HEr2-), which was discontinued due to poor tolerance after 3 months. In Metastatic Neuroendocrine Carcinoma (NEC) Lung, detection of EGFR l858R mutation did not confer a PFS benefit despite the addition of Geftinib to chemotherapy. Due to financial constraints, targeted therapy couldn't be started for 2 patients with pathogenic target detected. Conclusions: The study's findings suggest that NGS testing offers tangible clinical benefits in both initial and subsequent lines of treatment for advanced malignancies in the Indian population. Despite the varying costs of NGS in India (ranging from 240 to 1800 USD), the data implies an overall affordability, making it a viable option for patients with advanced malignancies. However, NGS didn't improve outcomes in patients with rapidly progressing disease, poor general condition and financial constraints.

Immune checkpoint inhibitor retreatment in second-line treatment of esophageal cancer: A real-world study.

e16034 Background: Immunotherapy combined with chemotherapy has been recommended in several guidelines and consensus for the first-line treatment of advanced esophageal cancer(EC), but it is controversial whether to continue immune checkpoint inhibitors (ICIs) after the progress of first-line immunotherapy. Methods: This was a single-center, retrospective, observational, real-world study to collect general conditions and clinical data of EC patients hospitalized in the First Affiliated Hospital of Henan University of Science and Technology between February 2020 and December 2023. All patients received programmed cell death protein 1 (PD-1) or its ligand (PD-L1) inhibitor combination therapy in the first-line and received at least two cycles of PD-1/PD-L1 inhibitor-based therapy in the second-line setting after progression. We evaluated the efficacy and safety including overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), grade 3-5 treatment-related adverse effects (TRAE) and immune-related adverse events (irAEs). We also evaluated the relationship between clinical features and outcomes using univariate and multivariate analyses. Results: We enrolled 214 patients, with a median age 67.9 (47 – 87) years, male sex 66.8%, 201(93.9%) ESCC and 11(5.1%) EAC. In all patients, the mOS and mPFS were 9.6 (95%CI 9.1-10.1) months and 4.4 (95%CI 4.1-4.7) months; The ORR was 33.2%, DCR was 65.9%. 162 (75.7%) patients treated with immunochemotherapy(I+C), 37 (17.3%) patients received immunotherapy combined with anti-angiogenic drugs(I+A) and 15 (7.0%) patients treated with immunotherapy combined with chemotherapy and anti-angiogenic drugs(I+C+A). The mOS were 9.1 (95% CI 8.4 – 9.8) months, 10.0 (95% CI 8.7 – 11.3) months and 11.5 (95% CI 10.7 – 12.3) months, respectively. The mPFS were 4.3m (95%CI 4.0-4.6) months, 4.3 (95%CI 4.0-14.6) months and 6.0 (95%CI 4.2-6.4) months. mPFS and mOS did not have significant difference between these groups. Univariate and multivariate analyses showed that PFS more than 6 months on first-line therapy was an independent prognostic factor for PFS and OS in second-line therapy. The incidence of grade ≥ 3 TRAEs and irAEs were 25.7% and 5.6%. No treatment-related deaths occurred. Conclusions: This real-world data showed PD-1 or PD-L1 inhibitors retreatment might have good efficacy and manageable safety in EC patients who progress after first-line immunochemotherapy. [Table: see text]

A Postmortem Finding of a Colloid Goiter in an American Black Bear (Ursus Americanus)

Abstract The present case report aims to describe a postmortem finding of a colloid goiter, without obvious clinical signs of endocrine disease in a 30-year-old American black bear (Ursus americanus) from the “Zoo” in the city of Sofia, Bulgaria. A clinical examination due to a bad general condition was performed under anesthesia and a computed tomography was conducted. After the established irreversible spondylarthrosis changes the bear was euthanized. Postmortem, the thyroid gland was pathologically examined and typical findings for a colloid goiter were observed. Hibernating mammals such as the American black bear have been shown to enter a state of physiological hypothyroidism during hibernation. Hormonal signals from the thyroid gland have been suggested to be a key mediator of hibernation. From the presented case could be assumed that the captive life conditions and the prolonged life of the zoo bears may affect the function of their thyroid gland.

Correlation of plasma GDF15 with aging, organ disfunction, sarcopenia, and postoperative infectious complication in patients with esophageal cancer.

e16088 Background: The age of cancer incidence is increasing every year. Along with it, cancer patients getting has more comorbidity and decreasing muscle strength which may lead to increase postoperative complications. Especially, since esophageal cancer (EC) patients have heavy drinking and smoking history and high age of morbidity, they usually have multiple comorbidities and so that they particularly have high incidence of cachexia. A novel inflammatory marker known as growth differentiation factor 15 (GDF15) has been recently reported relation with cancer cachexia. This study conducted to evaluate correlation between clinical data which suggested cachexia of EC patients and plasma GDF15. Methods: Eighty-one esophageal cancer patients who first visited our outpatient ward from July 2021 to March 2023 were enrolled in this study. After obtaining consent for the study, plasma samples collected before starting any treatment for the cancer. The quantification of GDF15 was performed by ELISA. Clinical information was collected from clinical record including age, comorbidities, biochemical data, Controlling Nutritional Status (CONUT) score, and Skeletal Mass Index (SMI). GDF15 was then evaluated for clinical impact by comparison with postoperative results. Mann-Whitney U test, student-t test, ANOVA were used appropriately to analyze the relationship between the GDF-15 and patient characteristics and post operative complications. Multivariate analysis ware used logistic regression analysis. P-values &lt; 0.05 were considered statistically significant for all statistical analyses. Results: Mean age was 68.3-year-old and 80.3% of these were male. Malnutrition patients diagnosed by using CONUT were 24 (29.6%) and sarcopenia patients diagnosed by using SMI were 21 (25.9%). The median value of GDF15 was 1165 pg/mL with its range were from 298 to 9100 pg/mL. Plasma GDF15 was statistically correlated with age ( P&lt; 0.001), performance status ( P= 0.046), prevalence of hypertension ( P= 0.045) and/or diabetes ( P= 0.018), serum level of aspartate aminotransferase (AST) ( P&lt; 0.001)/ γ-glutamyltransferase (γ-GTP) ( P&lt; 0.001)/ creatinine ( P= 0.004)/ blood sugar ( P= 0.028), and SMI ( P= 0.003). Seventy-two patients underwent curative surgery, and no perioperative death was observed. The patients who occurred anastomotic leakage and infectious complication observed statistically higher GDF15 than those without (P = 0.030, P = 0.016). Optimal cut-off value was detected as 940 ng/mL for detecting infectious complication by ROC-curve with AUC value of 0.68. Conclusions: This study showed GDF15 is potentially suggesting deterioration of general condition, which came from aging, organ disfunction, and decreasing muscle mass, which may lead to cachexia in EC patients. In addition, higher GDF15 patients have risk of postoperative infectious complication.

Synchronization transitions in phase oscillator populations with partial adaptive coupling.

The adaptation underlying many realistic processes plays a pivotal role in shaping the collective dynamics of diverse systems. Here, we untangle the generic conditions for synchronization transitions in a system of coupled phase oscillators incorporating the adaptive scheme encoded by the feedback between the coupling and the order parameter via a power-law function with different weights. We mathematically argue that, in the subcritical and supercritical correlation scenarios, there exists no critical adaptive fraction for synchronization transitions converting from the first (second)-order to the second (first)-order. In contrast to the synchronization transitions previously deemed, the explosive and continuous phase transitions take place in the corresponding regions as long as the adaptive fraction is nonzero, respectively. Nevertheless, we uncover that, at the critical correlation, the routes toward synchronization depend crucially on the relative adaptive weights. In particular, we unveil that the emergence of a range of interrelated scaling behaviors of the order parameter near criticality, manifesting the subcritical and supercritical bifurcations, are responsible for various observed phase transitions. Our work, thus, provides profound insights for understanding the dynamical nature of phase transitions, and for better controlling and manipulating synchronization transitions in networked systems with adaptation.

Bilateral Diaphragm Paralysis in Deep Neck Infection: Mimicking Respiratory Distress in Sepsis

Background: This case report highlights an occurrence of bilateral diaphragm paralysis following surgical drainage for deep neck infection. Case: A 56-year-old male underwent surgical drainage and tracheostomy for a deep neck infection. Before the second surgical drainage, he exhibited tachypnea (&gt;30 bpm), although his general condition was not significantly compromised. Following a successful drainage procedure, he was transferred to the intensive care unit and placed on mechanical ventilation. Despite attempts at spontaneous breathing trials (SBT), he failed each trial, leading to a deterioration in his general condition. Subsequently, he was diagnosed with diaphragm paralysis. Conclusion: The clinical manifestations of bilateral diaphragm paralysis closely resemble the common symptoms of sepsis. Therefore, it is crucial to recognize that surgical interventions for deep neck infections may pose a risk of developing diaphragm paralysis, likely associated with phrenic nerve palsy.

Experimental animal research on the subchronic toxicity of “Dứa Tre Lão Nhà Quê” extract

“Dứa tre Lão nhà quê” extract (DTLNQ extract) was intended to treat several diseases such as dyslipidemia and venous insufficiency. To provide information on the its safety, this study evaluated the subchronic toxicity of DTLNQ extract. Wistar rats were divided into three groups and were given orally for 12 weeks: group 1 distilled water; group 2 and group 3: DTLNQ extract at 0.6g and 1.8g/kg b.w./day, respectively. General conditions and body weight change, hematological and biochemical parameters, and hepatic and renal histological examinations were evaluated in treated rats compared with the control group and baseline. The results showed that DTLNQ extract did not cause significant changes in general conditions, body weight gain, hematological parameters, biochemical parameters of hepatic and renal function tests and the histological examination of the liver and kidneys. Though the values of AST and ALT increased after 12 weeks of administration compared with the control group and baseline, they were within the normal limits or slightly greater than the upper limit of normal in rats.

Space-time error estimates for approximations of linear parabolic problems with generalized time boundary conditions

Abstract We first give a general error estimate for the nonconforming approximation of a problem for which a Banach–Nečas–Babuška (BNB) inequality holds. This framework covers parabolic problems with general conditions in time (initial value problems as well as periodic problems) under minimal regularity assumptions. We consider approximations by two types of space-time discretizations, both based on a conforming Galerkin method in space. The first one is the Euler $\theta -$scheme. In this case, we show that the BNB inequality is always satisfied, and may require an extra condition on the time step for $\theta \le \frac 1 2$. The second one is the time discontinuous Galerkin method, where the BNB condition holds without any additional condition.

Self-Reliance in Community-Based Rural Tourism: Observing Tourism Villages (Desa Wisata) in Sleman Regency, Indonesia

Self-reliance is essential for community-based rural tourism (CBRT), ensuring effective running in the long term. However, existing studies have focused on general self-reliance conditions while overlooking details surrounding the community’s self-reliance in each activity of the CBRT value chain. This study filled this significant gap by observing community self-reliance in CBRT and considering the tourism value chain (TVC) framework. Built upon the abduction method, this study applied the systematic combining approach to observe three aspects of self-reliance, i.e., goals or objectives, rights and abilities, and owned resources, in the TVC of CBRT entities. Taking the case of CBRT in Sleman Regency, Indonesia, the data collection involved representatives of 49 community-based tourism villages (desa wisata). The results showed that observing community self-reliance in CBRT allows for the identification of multifaceted self-reliance problems in rural tourism communities. Apparently, the observed CBRT initiatives are unable to achieve complete self-sufficiency across all aspects of self-reliance. Reliance on external collaboration and support networks persists out of necessity rather than an inability to self-manage. Policy protections, capacity building, and collaborative partnerships are necessary to develop resilient and sustainable rural tourism amidst necessary dependencies. CBRT planning and policies should hence consider the abovementioned aspects of self-reliance to empower CBRT toward sustainable rural development.

Stability based on single-agent deviations in additively separable hedonic games

Coalition formation is a central concern in multiagent systems. A common desideratum for coalition structures is stability, defined by the absence of beneficial deviations of single agents. Such deviations require an agent to improve her utility by joining another coalition. On top of that, the feasibility of deviations may also be restricted by demanding consent of agents in the welcoming and/or the abandoned coalition. While most of the literature focuses on deviations constrained by unanimous consent, we also study consent decided by majority vote and introduce two new stability notions that can be seen as local variants of another solution concept called popularity. We investigate stability in additively separable hedonic games by pinpointing boundaries to computational complexity depending on the type of consent and friend-oriented utility restrictions. The latter restrictions shed new light on well-studied classes of games based on the appreciation of friends or the aversion to enemies. Many of our positive results follow from a new combinatorial observation that we call the Deviation Lemma and that we leverage to prove the convergence of simple and natural single-agent dynamics under fairly general conditions. Our negative results, in particular, resolve the complexity of contractual Nash stability in additively separable hedonic games.

Prevalence and Impact of Psychiatric Co-Morbidity in Patients with Spinal Pathology in Basrah, Iraq

Background and objective: to minimize complications by proper selection of patients for surgery and to evaluate what is the impact of psychiatric co-morbidity in patients admitted to a spinal surgical unit in Basrah, Iraq. Patients and Methods: A multi-center cross-sectional prospective cohort study was conducted on 247 patients. In Basrah province. During admission complete history was taken in form of identity, complaint, past medical and surgical history, drug history, type of previous and the coming surgery and lastly special emphasis on the questioner to assess patient psychological status using the Patient Health Questioner. Somatic Anxiety Depressive Symptoms (PHQ.SADS) After one week and one-month the same questions were addressed to the patient to check the general condition,and any complications or readmission. Results: Out of the 247 patients: Eight patients refuse to be part of this study, thirty-one patients lost follow up, three patients excluded from the study due to exclusion criteria, five patients their surgery postponded because they were psychologically unstable and advised for psychiatrist consultation. 111 patients (55.5%) of the sample size were male patients. A 90 (45%) patients were at age of 38-57 years, 111 (55.5%) of the sample were male 82 patients (41%) were of moderate degree using the PHQ.SADS. 62 patients (31%) were within the severe scale PHQ.SADS.132 patients (66%) complained from radiculopathy with or without backache,192 (96%) patients discharged safely postoperatively. 41(39.4%) patients were diagnosed with lumber canal stenosis belongs to the severe group. Psychological break down occurs in 10 (5%) patients, 9 (90%) of those patients belong to severe grade category of PHQ.SADS. Conclusion: There was a strong association between pre-operative psychological conditions and post-operative complications in form of repeated visit after surgery and persistence of pain and disability.

Thermalization and Hydrodynamics in an Interacting Integrable System: The Case of Hard Rods

We consider the relaxation of an initial non-equilibrium state in a one-dimensional fluid of hard rods. Since it is an interacting integrable system, we expect it to reach the Generalized Gibbs Ensemble (GGE) at long times for generic initial conditions. Here we show that there exist initial conditions for which the system does not reach GGE even at very long times and in the thermodynamic limit. In particular, we consider an initial condition of uniformly distributed hard-rods in a box with the left half having particles with a singular velocity distribution (all moving with unit velocity) and the right half particles in thermal equilibrium. We find that the density profile for the singular component does not spread to the full extent of the box and keeps moving with a fixed effective speed at long times. We show that such density profiles can be well described by the solution of the Euler equations almost everywhere except at the location of the shocks, where we observe slight discrepancies due to dissipation arising from the initial fluctuations of the thermal background. To demonstrate this effect of dissipation analytically, we consider a second initial condition with a single particle at the origin with unit velocity in a thermal background. We find that the probability distribution of the position of the unit velocity quasi-particle has diffusive spreading which can be understood from the solution of the Navier–Stokes (NS) equation of the hard rods. Finally, we consider an initial condition with a spread in velocity distribution for which we show convergence to GGE. Our conclusions are based on molecular dynamics simulations supported by analytical arguments.

Drug reaction with eosinophilia and systemic symptoms (DRESS): ahypersensitivity reaction with various symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) is an illness which is difficult to diagnose because of its various symptoms. In our case, apatient with small spotted exanthema with nearly erythroderma and eosinophilia presented to the emergency room. Systemic steroid therapy was started on suspicion of a drug reaction. Over the course of time, the patient's general condition deteriorated significantly and the patient developed cholecystitis, Staphylococcus aureus bacteremia, pneumonitis and cytomegalovirus reactivation. With this case report, we want to show that DRESS is adisease that is difficult to treat and can develop after along delay.