Effects of cross flow on the heat transfer and flow characteristics of a circular jet are numerically investigated. The numerical results are compared with the experimental results. Studies have been ...conducted in the range of Reynolds number (Re) 5100-23 000, dimensionless jet-to-plate spacing (<inline-formula> <tex-math notation="LaTeX">Z/D </tex-math></inline-formula>) 2-8, and ratio of cross flow Reynolds number to jet Reynolds number (<inline-formula> <tex-math notation="LaTeX">\alpha </tex-math></inline-formula>) 0-2. Heat transfer in the stagnation, transition, and wall jet regions is studied. At all Reynolds numbers, maximum heat transfer is obtained at <inline-formula> <tex-math notation="LaTeX">Z/D </tex-math></inline-formula> = 6. Without cross flow, at higher <inline-formula> <tex-math notation="LaTeX">Z/D </tex-math></inline-formula> and in the range of Reynolds number investigated, maximum heat transfer occurs at the stagnation point. At low <inline-formula> <tex-math notation="LaTeX">Z/D </tex-math></inline-formula> and high Reynolds numbers, there are secondary peaks in the transition region due to the high turbulent kinetic energy (TKE). In certain cases, the Nusselt number at the secondary peak is more than that at the stagnation point. In the wall jet region, the Nusselt number calculated using equivalent flat plate correlations is much lower than the actual values. Cross flow results in increase in peak Nusselt number at low <inline-formula> <tex-math notation="LaTeX">Z/D </tex-math></inline-formula> and <inline-formula> <tex-math notation="LaTeX">\alpha </tex-math></inline-formula>. Furthermore, the heat transfer in the upstream region deteriorates and that in the downstream region improves. The degradation in heat transfer is more at smaller <inline-formula> <tex-math notation="LaTeX">Z/D </tex-math></inline-formula>.
Abstract Background and Purpose Intracranial space-occupying lesions are a sine qua non for neoplastic lesions; however, occasionally non-neoplastic lesions mimic neoplastic lesions, leading to ...diagnostic dilemmas. We report our experience with three patients who presented with a progressive hemispheric syndrome and the diagnostic considerations involved in the cases. Materials and Methods In this retrospective study, we included three patients with primary angiitis of central nervous system (PACNS) who underwent craniotomy and biopsy, suspecting it to be mass lesions. Demographic features, clinical features, radiological features, histopathology, treatment, and clinical outcomes were studied. Results Majority were males. The male:female ratio was 2:1. Lobar involvement was common. MR brain with contrast showed features of high-grade glioma. Despite hemispheric involvement, there was no mass effect. Perilesional edema was seen in all cases. All underwent craniotomy and biopsy; histopathology was consistent with PACNS. All patients were treated with corticosteroids and cyclophosphamide. Rituximab was used in addition to cyclophosphamide in one patient. At 2 years follow-up, two patients were in disease remission and one patient died due to disease progression. Conclusion PACNS has a protean clinical manifestation. A high index of suspicion is required in cases with atypical clinical presentations, radiological features, and normal angiograms. Early histological diagnosis and aggressive immunotherapy with high-dose corticosteroids combined with intravenous cyclophosphamide yields favorable outcomes.
Introduction : Primary hyperparathyroidism (PHPT) is a common endocrine disease with a variable presentation. There is a recent increase in the number of asymptomatic cases due to the use of ...multichannel automated analyzers. Aim : To analyze the changing trend of PHPT patients from South India. Materials and methods : We collected the data on clinical presentation, biochemistry, radiological features, and operative findings of patients with PHPT treated in our hospital over a period of six years and looked at the differences between symptomatic and asymptomatic PHPT. Results : Our study included 80 patients. A significant proportion (~41%; n=33) of the patients were asymptomatic. Fifty-seven percent of asymptomatic patients were females. Mean age at presentation of asymptomatic patients was 50.58 (±14.67) compared to 47.28 (±14.78) for the symptomatic group, which was not statistically significant ( p =0.34). The mean levels of serum calcium, phosphorous, 25(OH)D, iPTH, and 24-hour urinary calcium in symptomatic vs. asymptomatic patients were 12.47 (±2.26) mg/dl vs. 12.27 (±1.82) mg/dl ( p =0.70), 2.59 (±0.74) mg/dl vs. 2.38 (±0.77) mg/dl ( p =0.27), 12 (±1.2) ng/ml vs. 10.85 (±1) ng/ml ( p =0.78), 1212.5 pg/ml vs. 678.5 pg/ml ( p =0.31), and 292.6 mg/day vs. 262 mg/day ( p =0.64), respectively. When Ca and gland weight were compared with variations in the iPTH levels, there was a significant positive correlation with PTH >600 pg/ml ( p =0.001) with no between-group differences. The adenoma weight increased by 0.5291 mg for every unit increase in iPTH in the entire cohort, with no between-group differences ( p =0.52). Conclusion : Asymptomatic hyperparathyroidism is increasingly being identified in clinical practice and constitutes a significant proportion of primary hyperparathyroidism. Though asymptomatic PHPT is expected to be milder, such a difference in presentation was not obvious in our study.
Introduction: In 2019-20, the American College of Radiology (ACR) introduced Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging (O-RADS MRII). Application of the O-RADS MRI in ...routine clinical practice can increase lesion characterization accuracy, promote better interdisciplinary communication, and help in personalized patient management of adnexal masses. Aim: To assess the diagnostic performance of the ACR O-RADS MRI scoring system for the predicting malignancy in adnexal mass in routine clinical radiology practice by using histology/ imaging findings during a minimum 4 month follow-up as the reference standard. Materials and Methods: In this single- tertiary center prospective cohort study done in Jorhat Medical College, Assam, 42 patients with 46 adnexal masses who underwent MRI between April 2020 and June 2021 were assessed. The ACR O-RADS MR scores were assigned using the MRI protocol with a dynamic study. Sensitivity, specificity, positive and negative predictive values along with the area under the Receiver Operating Characteristic (ROC) curve were calculated (cut-off score ≥4 was considered malignancy,). Histopathologic diagnosis or >4 months followup imaging findings was the reference standard used. Logistic regression analysis of MRI parameters used in identifying malignant masses was assessed. Statistical analysis was done using 95% confidence intervals (CIs). The p-values <0.05 was considered statistically significant. Results: The mean age of subjects in the study was 35.9 (range 10-75 years), and 84.8% of adnexal masses (39) were premenopausal. Malignancy was more common in postmenopausal patients (57.1%). Of 46 lesions, 13 (33.3%) were malignant. The ACR O-RADS-MR scoring system, using a dynamic MRI protocol, showed 92.3% sensitivity and 87.8%specificity in malignancy prediction. The area under the ROC curve for predicting malignancy was 0.962. The positive and negative predictive values were 75% and 89.1%, respectively. Conclusion: In a teaching hospital in assam, the O-RADS MRI scoring system, based on a dynamic MRI protocol demonstrated good sensitivity, specificity and area under the Receiver Operator Characteristic (ROC) curve in identifying malignant adnexal masses. The ACR O-RADS MRI system enables standardized MRI reporting with uniform lexicon and interpretation guide on adnexal masses.This will help to improve communication between radiologists and referring physician and in patient management, particularly in indeterminate masses on ultrasound.
BackgroundMultiple cerebral venous sinus thrombosis (CVT) registries from various geographical regions indicate that female gender, the use of contraceptive pills, pregnancy and puerperium are ...important risk factors. In this study, we report the changes in the epidemiology of patients with CVT managed over the past 26 years.MethodsThe CMC Vellore CVT registry is a prospectively maintained database at the Christian Medical College, Vellore since January 1995. Stata software was used to analyse the data and assess the changes in the incidence, age and gender distribution over the previous 26 years.ResultsAmong 1701 patients treated during the study period, 908 (53%) were women and 793 (47%) were men. The mean incidence of CVT was 49 per 100 000 admissions before 2010, which increased to 96 per 100 000 after 2010. Male gender had a higher odds of developing CVT (OR – 2.07 (CI 1.68 to 2.55, p<0.001). This could be attributed to the declining incidence of postpartum CVT after 2010 compared with the decade before 2010 (50% vs 20%). The mean age at presentation had increased from 24.5 to 33.2 years in the last decade.ConclusionsThere was a clear change in the gender pattern from being a condition with female preponderance, to one where equal or more men are being affected. Lower incidence of postpartum CVT cases could be the driving factor. An increase in the overall incidence of CVT cases was noted, probably due to a higher index of clinical suspicion and better diagnostic imaging modalities.
Background: Oral nonsteroidal anti-inflammatory drugs have been used in the management of musculoskeletal pain due to inconsistent skin penetration of topical formulations. The quick penetrating ...solution of diclofenac is a novel topical solution of diclofenac diethylamine (4.64%), which has increased skin penetration. The present study was designed to compare the efficacy and safety of quick penetrating solution of diclofenac with diclofenac gel in patients with acute musculoskeletal pain. Materials and Methods: A randomized controlled clinical trial was conducted in 140 patients suffering from acute musculoskeletal pain who were randomized to receive diclofenac diethylamine 4.64% w/v topical solution (Group A) or diclofenac diethylamine 1.16% gel (Group B). The pain intensity difference (PID) between patients in both groups at rest and during movement of the affected area on day 3 and day 7 after injury was noted using the visual analog scale (VAS) and were compared with the baseline. A comparison of the requirement of oral rescue analgesics and adverse effects in both groups was also carried out. Results: The PID in VAS from baseline was significantly better in patients in Group A than patients in Group B on days 3 (3.74 and 2.42;P< 0.05) and 7 (6.8 and 5.54,P< 0.05), respectively, at rest. The PID in VAS from baseline was significantly better in patients in Group A than patients in Group B on day 3 (4.05 and 2.65;P< 0.05) and day 7 (7.34 and 6.00,P< 0.05), respectively, during movement. The number of patients requiring rescue medications were significantly lower in Group A (n = 1) compared to Group B (n = 16) (P < 0.05). Conclusions: Diclofenac diethylamine 4.64% w/v is more effective in relieving acute pain in painful musculoskeletal conditions in comparison with diclofenac diethylamine topical gel 1.16% w/w with lesser requirement of rescue analgesics and minimal adverse effects.
Background: Tolosa-Hunt Syndrome (THS) is one of the causes of cavernous sinus syndrome causing painful ophthalmoplegia. Literature on long-term outcome of this rare condition is scarce. Aims and ...Objectives: The aim is to study the recurrence and role of steroid-sparing agents in THS. Methodology: All cases of THS treated at a tertiary-level teaching hospital during a 10-year period were studied. Clinical and radiological profile, response to treatment and recurrences were noted. Results: A total of 44 cases were studied. The mean age was 49.5 years, Males constituted 23/44 (52%). The first symptom was pain in 90%. Ptosis with ophthalmoplegia was the most common deficit 29/44 (66%). Lesions confined to cavernous sinus 27/44 (61%) was the most frequent magnetic resonance imaging finding. All patients received steroids as the initial treatment and 15/44 (34%) received steroid-sparing agents. Follow-up ranged from 6 to 120 months (Mean 39 months). Two patients had alternative diagnosis of leptomeningeal malignancy and hypertrophic pachymeningitis on follow-up. Recurrences occurred in 18/37 (48.6%). Time for recurrence varied from 8 months to 7 years. (Mean 18 months). No clinical or radiological predictors for recurrence were identified. Patients who received steroid-sparing agents had a significantly lower recurrence 3/15 (20%) versus 14/26 (53.8%)P < 0.034. Conclusions: Around 50% of patients with THS can have recurrence. Steroid-sparing agents appear to prevent recurrence. A prospective multicenter randomized controlled trial may help to evaluate the risk and benefits of steroid-sparing therapy and to identify any possible predictors for recurrence.
Objective: Parkinson's disease (PD) is a neurodegenerative condition that is characterized by bradykinesia, rigidity, and gait instability. Inherent to this condition is an increased predisposition ...to falls and fractures. Bone health in Parkinson's disease in India has not been studied thus far. This study aimed to assess the bone mineral density (BMD), trabecular bone score (TBS), and hip structural analysis (HSA) in Indian men with PD and compare them with matched controls. Methodology: A case-control study done at a tertiary care center from southern India. Bone biochemistry, BMD, TBS, and HSA were assessed. Results: Among 40 cases and 40 age, gender, and body mass index (BMI)-matched controls, there was no significant difference in BMD between both groups. The mean (SD) TBS at the lumbar spine 1.349 (0.090) was significantly (P = 0.019) lower in men with PD as compared to matched controls 1.401 (0.089). Among the parameters of HSA, the buckling ratios were significantly higher at the femoral neck 11.8 (2.2) vs 9.4 (2.2); P = 0.001 and inter-trochanteric region 9.4 (2.1) vs 7.8 (1.4); P = 0.002 among cases as compared to matched controls. Vitamin D deficiency was significantly higher in this cohort of patients as was bone turnover marker indicating bone loss and a high bone turnover state. Conclusion: A comprehensive bone health assessment comprising BMD, TBS, and HSA may be required to capture all aspects of bone strength in Indian men with PD as BMD assessment as a stand-alone tool may not suffice to obtain all information pertaining to fracture risk in these individuals.
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