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BackgroundSome literature has shown a high prevalence of pre-clinical diastolic dysfunction in subjects with type 2 diabetes mellitus. The current study was carried out to determine the association of glycosylated hemoglobin (HbA1c) levels with left ventricular diastolic dysfunction (LVDD) in patients with type 2 diabetes.MethodsAn observational cross-sectional study was conducted in a tertiary health care center in Jharkhand. A total of 100 subjects diagnosed with type 2 diabetes mellitus who gave informed consent and fulfilled the inclusion and exclusion criteria were studied in our center from April 2019 to September 2020. Logistic regression was carried out to determine the association of potential variables with outcomes. Multivariable logistic regression analysis was conducted to determine the independent effects of variables for LVDD prediction.ResultsThe mean HbA1c of the population with LVDD was found to be higher (11.07 ± 3.66%) as compared to the population with normal LVDD (9.11 ± 2.95%), which was found statistically significant (probability value (P) =0.004). This signifies that a higher level of HbA1c in a patient with diabetes will have a higher incidence of LVDD. On applying multivariate analysis to determine the independent effect of variables for LVDD, HbA1C was found to be significant with an odds ratio (OR) of 1.26, 95% CI 1.08-1.48. The duration of diabetes was also found to be significant with OR 1.48 and CI 95 % (1.20-1.82) P <0.001. On plotting the receiver operating characteristic curve (ROC), the area under the ROC curve to predict the left ventricular function with the model was 0.8137.ConclusionsPatients who have higher HbA1C are linked to a higher risk of left ventricular diastolic dysfunction in patients with type 2 diabetes. The combination of diabetes and left ventricular dysfunction can lead to increase morbidity and mortality in those patients in whom it is not identified timely and appropriate measures are not taken. Our work emphasizes the requirement of screening intermittently symptomless diabetic patients for diastolic dysfunction through a Doppler echocardiography so that timely action can be taken.

Validation of a risk factor in a multifactorial disease like ischemic stroke is necessary to practice precision medicine. Many risk factors have been attributed to causing ischemic stroke but contribute very little to it. There are many risk factors that need to be validated, and fibrinogen is one such risk factor. Using a meta-analysis technique, we investigated fibrinogen as a risk factor for ischemic stroke. We searched the computerized databases such as PubMed, Google Scholar, and Cochrane to explore articles on ischemic stroke. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random effects model. A total of 10 case-control studies with 6877 cases and 7219 controls were included in the study that match inclusion and exclusion criteria. The Asiatic population was portrayed in four studies, whereas the Caucasian population was portrayed in six studies. Under the recessive model, an elevated level of serum fibrinogen is linked to an increased risk of ischemic stroke as shown by pooled odds ratio (OR: 1.47, 95% CI: 1.19-1.76, I = 78.3%, P = 0.000). Our meta-analysis concluded that a high level of fibrinogen is associated with an increased risk of ischemic stroke.

A lipase/amylase (L/A) ratio of more than three may be a tool for differentiating alcoholic pancreatitis from non-alcoholic pancreatitis. We conducted a systematic literature review to identify published studies. A thorough data search of various databases was conducted using keywords. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 survey. Data were extracted under the following headings: country, sample size, baseline characteristics, specificity, and sensitivity of the L/A ratio. Studies were analyzed using a bivariate random-effects model, and the sensitivity and specificity of the L/A ratio were pooled separately. Summary receiver operating characteristic (SROC) curves were plotted using the hierarchical method. A total of nine studies with 1,825 patients were identified for inclusion. SROC showed estimates of the area under the curve to be 0.75 (confidence interval (CI) = 0.71-0.79). Forest plots for sensitivity and specificity showed pooled estimates of sensitivity to be 74% (95% CI = 62-83%) while that of specificity was 63% (95% CI = 47-77%). The pooled diagnostic odds ratio was estimated to be 5 (95% CI = 3-9), the pooled positive likelihood ratio was estimated at 2.0, and the pooled negative likelihood ratio was estimated to be 0.41. We concluded that an L/A ratio of more than 3 has moderate accuracy for the diagnosis of alcoholic pancreatitis.

PurposeThe regulatory framework may be construed as the existence of supporting infrastructure that assists in control, direction/implementation of a proposed course of law, rule or action. The regulatory order is now more formalized, expert-driven, transparent, independent and pervasive across countries and sectors. As a result, regulatory reforms enable markets to function efficiently by providing a supportive environment for increased investment, private sector growth and market-led economic growth. This study aims to review previous literature for understanding the impact of sectoral regulatory framework on sectoral performance.Design/methodology/approachThis paper has adopted a systematic literature review to understand dynamics between the sectoral regulatory framework and sectoral performance. While seven multidisciplinary databases were used to identify 51 research articles, the bibliometric research profiling was executed to broaden academic research.FindingsThe results are organized into three broad categories: research context, research area and research methods. The identified articles exhibited association with 12 distinct sectors/industries, with maximum articles belonging to telecom, energy and finance industries. The study has focused on evolution of regulatory studies, impact of regulatory framework on sectoral performance and commonality in regulatory studies. Among the 15 distinct research contexts identified in this systematic literature review (SLR), the highest mapping was registered (from 23 articles) by the research context “impact of regulatory framework on the sector–institutions, infrastructure and performance indicators.”Practical implicationsPublic administration researchers are increasingly using mixed methods research approaches to add diverse and novel perspectives on wicked problems. The qualitative approach (grounded theory, action research, phenomenology and participant observations) is appropriate for understanding the native viewpoints of regulatory practitioners and reducing the gap between rigor and relevance.Originality/valueThe study addresses lack of systematic review of articles covering the impact of regulatory framework on sectoral performance encompassing all sectors by, inter alia, collating important bibliometric profiles of the identified articles.

Tuberculous meningitis is the most serious complication of tuberculosis. Early diagnosis is crucial to start relevant treatment to prevent death and disability. Electronic databases PubMed, Google Scholar, and Cochrane Library were used to find relevant articles from January 1980 to June 2022. The random-effect model in terms of pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence interval was adopted to derive the diagnostic efficacy of cerebrospinal fluid (CSF) adenosine deaminase (ADA) for the diagnosis of tuberculous meningitis (TBM) in adult patients. A total of 22 studies (20 prospective and two retrospective data) have been included in this meta-analysis, having 1927 participants. We perceived acceptable pooled sensitivity, specificity, summary receiver operating characteristics (SROCs), and diagnostic odds ratio (DOR) of 0.85 (95% CI: 0.77-0.90), 0.90 (95% CI: 0.85-0.93), 0.94 (95% CI: 0.91-0.96) and 48 (95% CI: 26-86), respectively, for CSF-ADA for differentiating TBM from non-TBM in adult patients. To ascertain the certainty of evidence for CSF-ADA as a diagnostic marker for TBM, Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) analysis was used. CSF-ADA is an auspicious diagnostic test with a high degree of specificity and acceptable sensitivity for the diagnosis of tuberculous meningitis, however, with very low certainty of evidence.

PurposeThe study explores the evolution of Indian domestic electronics manufacturing post-economic reforms and also investigates the lack of natural growth stages among Indian start-up/SME electronics manufactures.Design/methodology/approachThe theoretical framework is inspired by Dawar and Frost's survival strategy theory that local companies may follow to overcome competitive threats from MNCs. The study adopts a qualitative methodology, more precisely, a phenomenological approach to walking through policy/regulatory reforms amid market distortions, technological gaps and colonial mindset from the perspective of Indian domestic electronics manufacturers. The study has adopted Gioia method of data analysis to inductively suggest a few research propositions.FindingsThe phenomenological approach revealed eight essential structure (essence) narratives to explore the complex issue that plague the industry: make in India, made in India, preferential market access strategy, equitable market access strategy, blue ocean strategy, competitive positioning strategy, technical capability and importance of policy/regulatory arbitrage.Practical implicationsThe situation of Indian electronics manufacturing units is comparable to the bonsai tree situation, where natural evolution in business stages does not exist; they are born and die as start-ups/MSMEs. The study advocates for equitable market access by removing market distortions. The long-term solution may lie in making available locally manufactured products as a dependable alternative to the imported products or produced locally by MNC OEMs in terms of cost, quality, technology, volume, after-sale service and integrated supply chain.Originality/valueWhile the favorable FDI policies, digital India and make-in India initiatives have strengthened domestic electronics production, it is yet to significantly impact India's position in global trade, including manufacturing and exports.

Electric power interruption is becoming a day to day phenomenon in our distribution system. For distribution system to be effective there should be less outage in the system and if fault occur these faults should be cleared as soon as possible. Sustained power interruption occurs several times a day from few minutes to hours. Interruptions may be due to failure of substation equipment or failure of distribution network elements. This paper attempts to identify different causes of interruption and problems that customers in Nepal have been facing due to frequent planned and unplanned sustained interruptions by evaluating various reliability indices and parameters of Lainchaur distribution substation and its associated feeders operated under Nepal Electricity Authority. First, reliability analysis of substation configuration only is done followed by analysis of reliability improvement measures like use of double bus bar, parallel distribution feeders and underground cables in DIgSILENT PowerFactory only considering sustained failures of equipment and feeders. Calculated reliability indices like System Average interruption Duration Index (SAIDI), System Average Interruption Frequency Index (SAIFI), Energy Not Served (ENS) are compared for different cases so that it will be easy to make choice between options to the utility to upgrade/improve the system. Considering all feeders, result shows that main cause of interruption in the distribution system is failure of distribution lines showing 104 interruptions for total duration of 107 hours per annum in the system, followed by failure of distribution transformers indicating 19 interruptions for total duration of 47 hours per annum. Simulation result in DIgSILENT shows yearly total ENS of distribution system is high due to present configuration, and can be reduced by the use of parallel feeders and underground cables respectively. It is seen that ENS due to failure of substation components only is very low and huge revenues can be saved if auto-reclosures are used or a provision of charging feeders as soon as possible is made.

The price allocation of transmission line usage for an open access system considering Integrated Nepal Power System (INPS) has been discussed in this paper using the MVA (mega volt ampere) - KM (kilometer) and MVA cost method. The price allocation has been compared for INPS (Integrated Nepal Power System) and IEEE 14 bus system. The transmission line costs in IEEE 14 bus system is based on average construction and operation cost whereas, the costs in the INPS is an actual cost of the present transmission system. The price has been first calculated for different bus with reference to slack bus and for different bilateral and multilateral transactions, using MW KM - MW cost and MVA KM - MVA cost methods. The active and apparent powers for the base case and transaction cases have been calculated using Newton Raphson Method. The prices from MVA KM - MVA cost method are higher than MW KM - MW cost method for both bilateral transaction and multi-lateral transaction indicating more reactive power support in addition to the real power loading due to transactions in the system. The result shows that MVA KM - MVA cost method requires incentives for reactive power support to the system such as INPS.

Background Hemodialysis patients have high rates of sudden death, but relationships between serum electrolytes, the dialysis prescription, and intra-dialytic shifts in fluid and electrolyte with arrhythmia are uncertain. Methods We analyzed sixty-six hemodialysis patients who underwent loop recorder implantation with continuous electrocardiographic monitoring, weekly to bi-weekly testing of pre- and post-dialysis electrolytes, and detailed capture of dialysis prescription and flow sheet data for 6 months. The incidence rate ratio (IRR) of reviewer confirmed arrhythmias (RCA) during dialysis through 8 h after dialysis and associations with serum chemistries and dialytic parameters were assessed using adjusted, negative-binomial regression. Results Among 66 individuals with a mean age of 56 years, 12,480 events were detected in 64 (97%) patients. RCA nadired 12–24 h after dialysis and increased during the final 12 h of the inter-dialytic interval through the first 8 h after dialysis. Higher pre-dialysis serum magnesium concentration was associated with lower incidence rate ratio for arrythmia (IRR per 1 mg/dL increase 0.49, 95% CI; 0.25, 0.94), as was dialysate calcium concentration > 2.5 mEq/L vs. 2.5 mEq/L (IRR 0.52, 95% CI: 0.39, 0.70). Neither intradialytic serum potassium nor weight change were significantly associated with RCA rate. However, there was effect modification such that arrhythmia rate was maximal with concurrently high intradialytic volume and potassium removal (P interaction  = 0.01). Conclusions Intra and post-dialytic arrhythmias are common in hemodialysis. Additional studies designed to further elucidate whether modification of the serum magnesium concentration, dialysate calcium concentration, and the extent of intradialytic potassium and fluid removal reduces the risk of per-dialytic arrhythmia are warranted. Trial registration Clinicaltrials.gov NCT01779856. Prospectively registered on January 22, 2013.