Clinicopathologic Spectrum of Nephrotic Syndrome in the Elderly

The elderly population is affected by a wide range of kidney diseases like young adult patients. However, their clinical course and morphological manifestations are affected by aging. Recognition, diagnosis, and management of glomerular disease in elderly persons have several unique challenges. We aimed to study the clinicopathologic spectrum of elderly patients with nephrotic syndrome (NS). In this retrospective study, we looked at 234 patients of adult NS who were biopsied during the last 5 years. Among them, 31 patients were above the age of 60 years (Elderly). Mean age in elderly patients was 67.48 ± 6.11 years, with age range from 60 to 86 years. Elderly NS patients constituted 13.2% of total adult NS patients. Nineteen patients (61.2%) were males and 12 (38.7%) were females. Hematuria was observed in 19% and hypertension in 48% patients. Mean serum albumin was 2.79 ± 0.39 g/dl and mean 24 h urinary protein was 3.77 ± 0.8 grams. Membranous nephropathy (MN) followed by minimal change disease (MCD) was the most common diagnosis. No major complication with biopsy was reported in our study as has been the case with most studies

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Heat transfer and frictional pressure drop of crop fiber suspensions in closed conduit flow and nanofluid flow in backward-facing step / Syed Muzamil Ahmed

Study of heat transfer and frictional pressure losses in fiber suspension a non- Newtonian fluid flow is one of the significant scientific interests as the characteristics of fiber suspension flow considerably changes with the addition of little amounts of fiber. The characteristics of the fiber suspension flow depends on the shear stress, consistency, fiber source, fiber properties, the treatments done on the fibers and the fluid velocity. The non-Brownian motion of fibers in suspension flow are found in many applications, such as fiber composites, pulp and paper, textile, long-chain polymer etc. There are noticeable investigations conducted on properties of fiber suspensions but they are mainly wood pulp and family of pine groups. Study of the hydrodynamic behavior of non-wood fiber suspensions has become imminent due to increasing demand for non-wood fibrous materials. The nescience of non-wood fiber suspensions flowing in pipe elevated concerns regarding handling of non-wood fiber suspensions in papermaking process. As there are no significant reporting regarding non-wood pulp fibers flowing in pipes. So, it has become essential to investigate heat transfer and pressure drop of non-wood fiber suspensions in pipeline flow. A set up was built with a straight pipe test section to evaluate the heat transfer and frictional pressure drop characteristics of turbulent flowing pulp fiber suspensions, where the data were taken at different velocities and consistencies at constant heat flux. Several experiments were conducted for different types of non- wood pulp fibers (Kenaf core, Kenaf bast, blend of non-wood and blend of wood pulp fibers) at different consistencies and flow rates. The measured heat transfer coefficient (hc) and frictional pressure drop (ΔP/L) data were correlated with the fiber and paper properties.The results revealed that most of the fiber and paper properties could be correlated with both hc and ΔP/L data. A specific range of hc or ΔP/L can be used to monitor quality variations of fibers in suspension long before the paper is made, so that corrective action can be taken and the amount of rejected paper production could be minimized. The magnitude of hc and ΔP/L were found depending on flow velocity, consistency, fiber population, fiber length, flexibility, and fiber surface topography. Nanofluid flow and heat transfer to fully developed turbulent forced convection flow in a uniformly heated tubular horizontal backward-facing step were studied experimentally. Five different types of water based (Al2O3, SiO2 and MWNT) nanofluids have experimentally investigated. The experiments were conducted for concentration range of 0 to 0.1 wt.% and Reynolds number of 4000 to 16000 at uniform and constant heat flux. Heat transfer coefficient increases nonlinearly with the increase of both the concentration and Reynolds number. The peak of the heat transfer coefficient has occurred after the sudden expansion and it moved far from the step height with the increase of Reynolds number for both the cases of pure water and nanofluids. The pressure drop variation increases with the increase of Reynolds number and nanoparticles concentration but the changes observed are insignificant in the present range of investigation

Federated learning based futuristic biomedical big-data analysis and standardization.

Medical data processing and analytics exert significant influence in furnishing dependable decision support for prospective biomedical applications. Given the sensitive nature of medical data, specialized techniques and frameworks tailored for application-centric processing are imperative. This article presents a conceptualization for the analysis and uniformitarian of datasets through the implementation of Federated Learning (FL). The realm of medical big data stems from diverse origins, necessitating the delineation of data provenance and attribute paradigms to facilitate feature extraction and dependency assessment. The architecture governing the data collection framework is intricately linked to remote data transmission, thereby engendering efficient customization oversight. The operational methodology unfolds across four strata: the data origin layer, data acquisition layer, data classification layer, and data optimization layer. Central to this endeavor are multi-objective optimal datasets (MooM), characterized by attribute-driven feature cartography and cluster categorization through the conduit of federated learning models. The orchestration of feature synchronization and parameter extraction transpires across multiple tiers of neural networking, culminating in the provisioning of a steadfast remedy through dataset standardization and labeling. The empirical findings reflect the efficacy of the proposed technique, boasting an impressive 97.34% accuracy rate in the disentanglement and clustering of telemedicine data, facilitated by the operational servers within the ambit of the federated model

Corrosion Inhibition Performance and Adsorption Mechanism of Novel Quinazoline Schiff Base on Low Alloy Steel in HCl Media

The inhibition performance of synthesized Quinazoline Schiff Bases 2-(3,3-Dimethyl-2,3-dihydro-indol-2-ylidene)-3-[(2-hydroxyphenyl) imino] propylidene (DHIP1) and 2-(3,3-Dimethyl-2,3-dihydro-indol-2-ylidene)-3-[(2-hydroxyphenly) imino] propanal (DHIP2) on low carbon steel (LAS) in 1 M HCl has been examined using weight loss, electrochemical measurements and scanning electron microscopy (SEM). The obtained experimental results indicated that both DHIP1 and DHIP2 have fairly enhanced the corrosion resistance of LAS and extremely exhibited better inhibitive efficiencies at a concentration of 5 mM. The results of potentiodynamic polarization results clarified that investigated Schiff Bases acts as mixed-type inhibitors and follow Langmuir adsorption isotherm is fitted well for adsorption. It was found that the inhibition efficiency increases with increase in inhibitor concentration as confirmed by all the measurements

Association of metabolic syndrome with stroke, myocardial infarction, and other postoperative complications following carotid endarterectomy: A multicenter, retrospective cohort study

Background: Metabolic syndrome (MetS) is a constellation of hypertension, insulin resistance, obesity, and dyslipidemia and is known to increase the risk of postoperative morbidity. This study aimed to assess the impact of MetS on stroke, myocardial infarction, mortality, and other complications following carotid endarterectomy (CEA).Methods: We analyzed data from the National Surgical Quality Improvement Program. Patients undergoing elective CEA between 2011 and 2020 were included. Patients with American Society of Anesthesiologists status 5, preoperative length of stay (LOS) \u3e 1 day, ventilator dependence, admission from nonhome location, and ipsilateral internal carotid artery stenosis of \u3c 50% or 100% were excluded. A composite cardiovascular outcome for postoperative stroke, myocardial infarction, and mortality was generated. Multivariable binary logistic regression analyses were used to assess the association of MetS with the composite outcome and other perioperative complications.Results: We included 25,226 patients (3,613, 14.3% with MetS). MetS was associated with postoperative stroke, unplanned readmission, and prolonged LOS on bivariate analysis. On multivariable analysis, MetS was significantly associated with the composite cardiovascular outcome (1.320 [1.061-1.642]), stroke (1.387 [1.039-1.852]), unplanned readmission (1.399 [1.210-1.619]), and prolonged LOS (1.378 [1.024-1.853]). Other clinico-demographic factors associated with the cardiovascular outcome included Black race, smoking status, anemia, leukocytosis, physiologic risk factors, symptomatic disease, preoperative beta-blocker use, and operative time ≥ 150 min.Conclusions: MetS is associated with cardiovascular complications, stroke, prolonged LOS, and unplanned readmissions following CEA. Surgeons should provide optimized care to this high-risk population and strive to reduce operative durations

Barriers to surgical outcomes research in low- and middle-income countries: A scoping review

Introduction: Systematic collection and analysis of surgical outcomes data is a cornerstone of surgical quality improvement. Unfortunately, there remains a dearth of surgical outcomes data from low- and middle-income countries (LMICs). To improve surgical outcomes in LMICs, it is essential to have the ability to collect, analyze, and report risk-adjusted postoperative morbidity and mortality data. This study aimed to review the barriers and challenges to developing perioperative registries in LMIC settings.Methods: We conducted a scoping review of all published literature on barriers to conducting surgical outcomes research in LMICs using PubMed, Embase, Scopus, and GoogleScholar. Keywords included \u27surgery\u27, \u27outcomes research\u27, \u27registries\u27, \u27barriers\u27, and synonymous Medical Subject Headings derivatives. Articles found were subsequently reference-mined. All relevant original research and reviews published between 2000 and 2021 were included. The performance of routine information system management framework was used to organize identified barriers into technical, organizational, or behavioral factors.Results: Twelve articles were identified in our search. Ten articles focused specifically on the creation, success, and obstacles faced during the implementation of trauma registries. Technical factors reported by 50% of the articles included limited access to a digital platform for data entry, lack of standardization of forms, and complexity of said forms. 91.7% articles mentioned organizational factors, including the availability of resources, financial constraints, human resources, and lack of consistent electricity. Behavioral factors highlighted by 66.6% of the studies included lack of team commitment, job constraints, and clinical burden, which contributed to poor compliance and dwindling data collection over time.Conclusions: There is a paucity of published literature on barriers to developing and maintaining perioperative registries in LMICs. There is an immediate need to study and understand barriers and facilitators to the continuous collection of surgical outcomes in LMICs

Effect of various refining processes for Kenaf Bast non-wood pulp fibers suspensions on heat transfer coefficient in circular pipe heat exchanger

Heat transfer coefficients were obtained for a range of non-wood kenaf bast pulp fiber suspensions flowing through a circular pipe heat exchanger test loop. The data were produced over a selected temperature and range of flow rates from the flow loop. It was found that the magnitude of the heat transfer coefficient of a fiber suspension is dependent on characteristics, concentration and pulping method of fiber. It was observed that at low concentration and high flow rates, the heat transfer coefficient values of suspensions were observed higher than that of the heat transfer coefficient values of water, on the other hand the heat transfer coefficient values of suspensions decreases at low flow rates and with the increase of their concentration. The heat transfer were affected by varying fiber characteristics, such as fiber length, fiber flexibility, fiber chemical and mechanical treatment as well as different pulping methods used to liberate the fibers. Heat transfer coefficient was decreased with the increase of fiber flexibility which was also observed by previous researchers. In the present work, the characteristics of fibers are correlated with the heat transfer coefficient of suspensions of the fibers. Deviations in fiber properties can be monitored from the flowing fiber suspensions by measuring heat transfer coefficient to adjust the degree of fiber refining treatment so that papers made from those fibers will be more uniform, consistent, within the product specification and retard the paper production loss

Toward improved heat dissipation of the turbulent regime over backward-facing step for the AL2O3-water nanofluids: An experimental approach

Experimental study of nanofluid flow and heat transfer to fully developed turbulent forced convection flow in a uniformly heated tubular horizontal backward-facing step has reported in the present study. To study the forced convective heat transfer coefficient in the turbulent regime, an experimental study is performed at a different weight concentration of Al2O3 nanoparticles. The experiment had conducted for water and Alumina-water nanofluid for the concentration range of 0 to 0.1 wt.% and Reynolds number of 4000 to 16000. The average heat transfer coefficient ratio increases significantly as Reynolds number increasing, increased from 9.6% at Re of 4000 to 26.3% at Re of 16,000 at the constant weight concentration of 0.1%. Alumina-water nanofluid exhibited excellent thermal performance in the tube with a backward-facing step in comparison to distilled water. However, the pressure losses increased with the increase of the Reynolds number and/or the weight concentrations, but the enhancement rates were insignificant