Metformin and nitrosamine impurities

Metformin is considered as gold standard anti-diabetic drug and is the preferred initial pharmacologic agent for most of the patients with type 2 diabetes mellitus. Metformin is cheap, widely available and safe, backed by pharmaco-epidemiological evidence of more than 60 years regular use in clinical practice. Due to its durable efficacy, once initiated, metformin will be continued as long as it is tolerated and not contraindicated.  It has got additional benefits on cholesterol, liver, cardio vascular system and cancer. Recent evidence and recall of metformin extended release formulation due to detection of excess amount of cancer-causing nitrosamine impurities has created concern among health care providers and patients. Adherence to regulatory guidelines and use of approved technologies in manufacturing and quality control may help in solving the issue

Postoperative morbidity following Whipple’s procedure for periampullary carcinoma: a retrospective study spanning 5 years

Background: The morbidity rates for Whipple’s procedure has remained high even as mortality rates were coming down. This study was intended to assess postoperative morbidity rates in  a tertiary care centre and to compare it with other centres.Methods: Data was collected from various registers and medical records for this retrospective cohort study. All Whipple’s procedures for 5 years were included in the study. Statistical analysis was done using R statistical software and the results were tabulated.Results: There were 48 patients and half of them developed morbidity. Surgical site infection was the most common complication (18.8%) followed by pulmonary complications (12.5%) and bile leak (6.25%). Half of the patients having pulmonary complications died while nobody with surgical site infection or bile leak died.Conclusions: In this study the morbidity rates were comparable to other centres. Hypoalbuminemia is a significant predictor of morbidity. Surgical site infection was the most common morbidity. Pulmonary complications were the most common cause for death. Morbidity rate is comparable to other centres and Whipple’s procedure is a safe surgery in the tertiary centre where the study was conducted

An analysis of factor-product relationship in prawn farming-a production function approach.

A perusal of fisheries development programmes of different countries of the world reveals that the development of prawn culture is a field to which most of the countries have attached great importance. Among the two general kinds of prawn culture being practiced in different parts of the world, extensive or traditional culture involves operations in more or less natural aminities available and is devoid of proper management procedures. The more systematic method of cultivation Involves preparation of ponds, selective stocking of prawns and implementation of management procedures (Bensam , 1982). In the former method, the production is rather low, but in the latter, it is quite high

A CASE REPORT ON ENTERIC FEVER INDUCED HYPOPHOSPHATEMIA

ABSTRACTHypophosphatemia is critical ill patients are a common entity which causes unnoticed most of the time. This can lead to considerable morbidity and insome cases contribute to mortality. A 20-year-old female patient presented to Emergency Medicine with complaints of diarrhea, breathing difficulty, andtachypnea. Her routine electrolyte investigation showed low phosphate level. Once hypophosphatemia was corrected with intravenous phosphorous,patient became symptomatically better. In this study, we encounter that enteric fever can also be a factor for symptomatic hypophosphatemia andit should be corrected even if it is mild. Therefore, this case emphasis on importance of correcting symptomatic hypophosphatemia in critically illpatients.Keywords: Enteric fever, Hypophosphatemia, Emergency medicine

Probing the large scale structure using gravitational-wave observations of binary black holes

Third generation gravitational-wave (GW) detectors are expected to detect a large number of binary black holes (BBHs) to large redshifts, opening up an independent probe of the large scale structure using their clustering. This probe will be complementary to the probes using galaxy clustering -- GW events could be observed up to very large redshifts ($z \sim 10$) although the source localization will be much poorer at large distances ($\sim$ tens of square degrees). We explore the possibility of probing the large scale structure from the spatial distribution of the observed BBH population, using their two-point (auto)correlation function. We find that we can estimate the bias factor of population of BBH (up to $z \sim 1$) with a few years of observations with these detectors. Our method relies solely on the source-location posteriors obtained the GW events and does not require any information from electromagnetic observations. This will help in identifying the type of galaxies that host the BBH population, thus shedding light on their origins.Comment: 7 pages, 5 figure

Negative Emission Power Plants:Thermodynamic Modeling and Evaluation of a Biomass-Based Integrated Gasification Solid Oxide Fuel Cell/Gas Turbine System for Power, Heat, and Biochar Co-Production—Part 1

This article is the first of a two-part series presenting the thermodynamic evaluation and techno-economics of developing negative-emission power plants. The aim of this research is to evaluate the potential of biochar co-production in negative-emission power plants based on biomass-fed integrated gasification solid oxide fuel cell systems with carbon capture and storage (BIGFC/CCS) units. The influence of two gasification agents, namely, air and steam-oxygen, on the proposed system is investigated. In Part I, we present the thermodynamic models. A sensitivity analysis is carried out to investigate the system response to stepwise increase in biochar co-production (up to 10% by weight). Providing a secondary oxy-combustor in the steam-oxygen gasification case has been shown to be a solution to meet the heat requirements of the allothermal gasification process. A comprehensive exergy analysis indicated significant efficiency improvement for the steam-oxygen gasification case. The results show that the biomass steam-oxygen gasification yields the higher electrical exergy efficiency (48.3%) and combined heat and power (CHP) exergy efficiency (54.6%) for the similar rates of biochar co-production. The specific power output per unit of CO2 stored is 2.65 MW/(kg/s) and 3.58 MW/(kg/s) for the air and steam-oxygen gasification cases, respectively, when the biochar is co-produced at 10% by weight for the given biomass flow of 20 kg/s. Moreover, the total CO2 stored due to the proposed system is calculated as 133.9 t/h, and it is estimated to remove 1.17 Mt of CO2 from the atmosphere annually (when the biochar-based carbon storage is also considered). The models are used for the techno-economic analysis presented in Part II of the series

An Energy Efficient and Cost Reduction based Hybridization Scheme for Mobile Ad-hoc Networks (MANET) over the Internet of Things (IoT)

Wireless networks are viewed as the best-used network and specifically Portable Specially Appointed Organizations (MANETs) have tracked down numerous applications for its information transmission progressively. The plan issues in this organization are to confine the utilization of energy while communicating data and give security to the hubs. Soa protocol needs to be energy efficient to avoid network failures. Thereby this paper brings an effective energy efficient to optimize LEAR and make it energy efficient. The energy-mindfulness element is added to the LEAR guiding convention in this work using the Binary Particle Swarm Optimization method (BPSO). The recommended method selects programmes taking into account course length in addition to the programme level of energy when predicting the future. To get good results, the steered challenge is first designed using LEAR. The next step is to choose a route that enhances the weighting capability of the study hours and programming power used.This MANET has been secured using the cryptographic method known as AES.According to experimental findings, the proposed hybrid version outperformed other cutting-edge models

Clinical rabies: is cure possible?

Rabies is a fatal disease in humans and till date survivors of the disease after the clinical onset of the illness are rare. The approach to management of rabies is usually palliative. In rare cases of paralytic rabies a trial for cure has been tried. No single therapeutic agent is likely to be effective, but a combination of specific therapies could be considered, including rabies vaccine, rabies immunoglobulin, monoclonal antibodies, ribavirin, interferon alpha, ketamine etc. the only reported cases in literature were with rare success of the Milwaukee protocol. This is the case report of a 45 year old male who presented with clinical rabies and was started on the trial. Has the treatment had any benefit is to be debated and further options discussed

Outcome Of Newborn Hearing Screening Program in A Tertiary Care Centre, South India.

Objective To determine the coverage and outcome of Universal Newborn Hearing Screening (UNHS) Program in Government Medical College Manjeri, South India. To study the prevalence of hearing loss (HL) among those children screened, to describe the characteristics of confirmed cases, and the status of speech and language development acquired by them at follow up. Design Hospital based retro prospective study. Methods Data were collected from all newborns who underwent Universal Newborn Hearing Screening (UNHS) over a four-year period (November 2014 to October 2018). Cases with confirmed hearing loss were studied by pre-structured questionnaire and telephonic interview. Speech and language assessments of 10 confirmed cases were conducted after a period of intervention. Results Out of 17,260 babies, 16,625 were screened (96.3%). HL was confirmed for 13 of these, resulting in a prevalence rate of 0.08%. Risk factors for HL were not present in 61.5% of these cases. Confirmation was done at a median age of 6 months with an Interquartile Range (IQR) (4; 12). Interventions in the form of speech therapy and hearing aid were started at a median age of 17.5 months with an IQR (13;25) and the median duration of intervention till the time of assessment was 30 months with an IQR (17;43) Out of 13, five children were managed with hearing aid. Another five required cochlear implant at a median age of 24 months with an IQR (17.5; 33). All received speech therapy. Three children were lost during follow up. On assessment using ISD and REELS, eight out of the remaining 10 children showed a lag in the speech and language development, with a median delay of 19.3 months with an IQR (2; 34.5) Conclusions Coverage of the program was optimal, with almost all newborns successfully screened. More than half of the confirmed children did not exhibit risk factors for HL and therefore might not have been identified early without UNHS. The observed median age of starting intervention for confirmed cases was higher than the age recommended by AAP guidelines and most of the children had language development below those of typically hearing age mates after months of intervention. Key words: Universal Newborn Hearing Screening, Outcome, Oto Acoustic Emission, Hearing loss, Neonates