Quantitative Relationships between Circulating Leukocytes and Certain Enteric Bacterial Infection in Children with Acute Diarrhea

Various pathogenic microorganisms have been implicated as the cause of infectious diarrhea in children as a result of water and food contamination. The study's goal is to determine the reliability of complete blood count (CBC) in peripheral blood of children with acute diarrhea which infected by certain enteric bacteria, with an emphasis on leukocytes (WBCs). A study conducted to examine the pattern of bacterial distribution in children with acute diarrhea's stool, as well as the relationship between the presence of pathogenic bacteria in stool samples and the number of total WBCs and differential leukocyte count in peripheral blood. Samples size includes (76) of health none diarrhea and (174) diarrheal patients, statistical analysis revealed that co-infection by E. coli and Klebsiella sp. was significantly higher (P<0.001) among children which suffered by diarrhea in compare to health individuals. In addition, the logistic regression shows co-infections and infections by Klebsiella sp. (OR: 29.44, 16.288 respectively) more likelihood leads to acute diarrhea compare to E. coli infection alone (P<0.001). Neutrophils/ Lymphocyte ratio (NRL) was (2.412) times higher and neutrophils (1.069) times more in diarrheal group (P<0.001), also the AUC for NRL was 0.833(sensitivity: 81.61 and specificity: 68.42), while for percent of neutrophils was less 0.671 (sensitivity: 46.24 and specificity: 85.71). Concluded that peripheral leukocyte count, particularly the NRL index, is helpful in children with acute diarrhea and additionally that the prevalence of diarrhea is altered by different bacterial infections

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Computational Analysis of the Morphological Aspects of Triadic Hybridized Magnetic Nanoparticles Suspended in Liquid Streamed in Coaxially Swirled Disks

Currently, pagination clearly explains the increase in the thermophysical attributes of viscous hybrid nanofluid flow by varying morphological aspects of inducted triadic magnetic nanoparticles between two coaxially rotating disks. Copper metallic nanoparticles are inserted with three different types of metallic oxide nanoparticles: Al2O3, Ti2O, and Fe3O4. Single-phase simulation has been designed for the triadic hybrid nanofluids flow. The achieved expressions are transmuted by the obliging transformation technique because of dimensionless ordinary differential equations (ODEs). Runge–Kutta in collaboration with shooting procedure are implemented to achieve the solution of ODEs. The consequences of pertinent variables on associated distributions and related quantities of physical interest are elaborated in detail. It is inferred from the analysis that Cu-Al2O3 metallic type hybrid nanofluids flow shows significant results as compared with the other hybrid nanoparticles. The injection phenomenon on hybrid nanofluids gives remarkable results regarding shear stress and heat flux with the induction of hybridized metallic nanoparticles. Shape and size factors have also been applied to physical quantities. The morphology of any hybrid nanoparticles is directly proportional to the thermal conductance of nanofluids. Peclet number has a significant effect on the temperature profile

The politics of knowledge, epistemological occlusion and Islamic management and organization knowledge

This article argues that Islamic management and organization knowledge (MOK) is relatively under- and mis-represented in the literature. This conclusion is reached following a detailed literature survey and analysis which also examines some of the core representational practices used to account for Islam in the literature: the persistence of essentialism and orientalism; the disposition to refract instances of Islamic MOK through Northern lenses; and the tendency for some Southern scholars and institutions to become intellectually captive to the North’s knowledge system. We discuss this in the context of a politics of knowledge that bears on knowledge production and dissemination processes in MOK. This reveals continued intellectual and cultural imperialism, sustained Western hegemony, and the exclusionary practices of the North’s associated discourses and institutional frameworks that valorise and elevate Northern epistemology, theory and method, but devalues and marginalize alternatives. We argue that any neglect of Islam is unwarranted given (a) its global significance on a range of dimensions, (b) the particularities of its relations to the North—characterized by orientalism and Islamophobia and (c) the presence of a distinctive Islamic worldview, epistemology and ethics that informs practical action, including management and organization. This entails that an Islamic MOK offers prospects of an alternative or complement to the North’s orthodox perspective and is deserving of a proper voice in the literature. We conclude by offering practical suggestions for change