Creutzfeldt-Jakob Disease Experience in Patients Presenting to A Tertiary Care Hospital: A Case Series

Creutzfeldt-Jakob disease (CJD) is a rare cause of rapidly progressive dementia, it is a neurodegenerative disorder caused by the misfolding of prion proteins in the brain, and misfolded proteins further propagate by causing misfolding of other proteins. It presents with insidious onset of neurobehavioral symptoms that rapidly develop into cognitive and motor decline and uncontrolled seizures. The diagnosis is established with help of clinical signs and symptoms, and using imaging and lab investigations to rule out other treatable causes. Some imaging findings point to the diagnosis of CJD that will be viewed in the cases below. Diagnosis can be augmented by CSF studies but due to the risk of biohazard and spread of CJD, special care needs to be taken. Confirmation is only via brain biopsy. In this article we share our experience with four cases of CJD that presented to our hospital

Fillers and methods to improve the effective (out-plane) thermal conductivity of polymeric thermal interface materials – A review

[Abstract]: The internet of things and growing demand for smaller and more advanced devices has created the problem of high heat production in electronic equipment, which greatly reduces the work performance and life of the electronic instruments. Thermal interface material (TIM) is placed in between heat generating micro-chip and the heat dissipater to conduct all the produced heat to the heat sink. The development of suitable TIM with excellent thermal conductivity (TC) in both in-plane and through-plane directions is a very important need at present. For efficient thermal management, polymer composites are potential candidates. But in general, their thermal conductivity is low compared to that of metals. The filler integration into the polymer matrix is one of the two approaches used to increase the thermal conductivity of polymer composites and is also easy to scale up for industrial production. Another way to achieve this is to change the structure of polymer chains, which fall out of the scope of this work. In this review, considering the first approach, the authors have summarized recent developments in many types of fillers with different scenarios by providing multiple cases with successful strategies to improve throughplane thermal conductivity (TPTC) (k⊥). For a better understanding of TC, a comprehensive background is presented. Several methods to improve the effective (out-plane) thermal conductivity of polymer composites and different theoretical models for the calculation of TC are also discussed. In the end, it is given a detailed conclusion that provides drawbacks of some fillers, multiple significant routes recommended by other researchers to build thermally conductive polymer composites, future aspects along with direction so that the researchers can get a guideline to design an effective polymer-based thermal interface material.This research was funded by Ministry of Science and Technology of the People’s Republic of China, “Light Shipbuilding Fire- Resistant Sandwich Panels with Improved Balance of Acoustic Insulation, Mechanical and Environmentally-Friendly Properties”, grant number 2019YFE0124000.China. Ministry of Science and Technolog

Phytochemical investigation and antioxidant activities of tamarind (Tamarindus indica L.)

Tamarind (Tamarindus indica) is a common worldwide medicinal plant. Due to high medical importance, tamarind seed and pulp fraction and sub fractions were compared. The present study was aimed to investigate the phytochemical investigation and antioxidant activities of different extracts of tamarind by demonstrating different extraction methods and then selection of best and less time taking method. Biological activities including 2, 2-diphenyl-1-picrylhydrazyl (DPPH) showed maximum inhibition for seed (74.09±0.76) as compare to pulp (72.09±0.43) at 300 μg/ml for butanol fraction, 2, 2'-azino-Bis-3-ethylbenzothiazoline-6-sulfonic acid (ABTS) showed maximum inhibition for seed (79.19±0.36) as compare to pulp (75.69±0.23) at 300 μg/ml for butanol. Metal chelation showed maximum inhibition for seed (81.39±0.70) as compare to pulp (77.49±0.93) at 300 μg/ml for butanol fraction, whereas lipid-peroxidation of thiobarbituric acid reactive substances (TBARS) inhibition showed maximum value for seed at 120 μg/ml as compare to pulp with FeSo4 for butanol fraction and with single nucleotide polymorphisms (SNP), TBARS inhibition showed maximum values for seed at 120 μg/ml as compare to pulp for butanol faction. The total antioxidant activity phosphomolybdenum assay was performed, which showed maximum values for seed at 120 μg/ml as compare to seed for butanol fraction. Total phenolic contents of seed for butanol fraction were 1.83 ± 0.31 mg/g for seed and 2 .83 ± 0.44 mg/g for pulp. Similarly, high amount of flavonoid content for seed was 1.31 ± 0.09 mg/g was given for dichloromethane and for pulp it was given as 1.91 ± 0.96 mg/g for butanol fraction. The results suggested that the extract of T. indica is potential source of the phytochemical investigation and antioxidant activity and utilized in diseases arising from oxidative stress in near future by using ultra-sonication method which is precise and time-consuming method

Prospective observational study of peripheral intravenous cannula utilisation and frequency of intravenous fluid delivery in the emergency department—Convenience or necessity?

Background Peripheral Intravenous Cannulas (PIVCs) are frequently utilised in the Emergency Department (ED) for delivery of medication and phlebotomy. They are associated with complications and have an associated cost to departmental resources. A growing body of international research suggests many of the PIVCs inserted in the ED are unnecessary.Methods The objective of this study was to determine the rates of PIVC insertion and use. This was a prospective observational study conducted in one UK ED and one Italian ED. Adult ED patients with non-immediate triage categories were included over a period of three weeks in the UK ED in August 2016 and two weeks in the Italian ED in March and August 2017. Episodes of PIVC insertion and data on PIVC utilisation in adults were recorded. PIVC use was classified as necessary, unnecessary or unused. The proportion of unnecessary and unused PIVCs was calculated. PIVCs were defined as unnecessary if they were either used for phlebotomy only, or solely for IV fluids in patients that could have potentially been hydrated orally (determined against a priori defined criteria). PIVC classified as unused were not used for any purpose.Results A total of 1,618 patients were included amongst which 977 PIVCs were inserted. Of the 977 PIVCs, 413 (42%) were necessary, 536 (55%) were unnecessary, and 28 (3%) were unused. Of the unnecessary PIVCs, 473 (48%) were used solely for phlebotomy and 63 (6%) were used for IV fluids in patients that could drink.Conclusions More than half of PIVCs placed in the ED were unnecessary in this study. This suggests that clinical decision making about the benefits and risks of PIVC insertion is not being performed on an individual basis

High-Grade B-cell Lymphoma, Not Otherwise Specified: A Multi-Institutional Retrospective Study

In this multi-institutional retrospective study, we examined the characteristics and outcomes of 160 patients with high-grade B-cell lymphoma, not otherwise specified (HGBL-NOS)-a rare category defined by high-grade morphologic features and lack of MYC rearrangements with BCL2 and/or BCL6 rearrangements ( double hit ). Our results show that HGBL-NOS tumors are heterogeneous: 83% of patients had a germinal center B-cell immunophenotype, 37% a dual-expressor immunophenotype (MYC and BCL2 expression), 28% MYC rearrangement, 13% BCL2 rearrangement, and 11% BCL6 rearrangement. Most patients presented with stage IV disease, a high serum lactate dehydrogenase, and other high-risk clinical factors. Most frequent first-line regimens included dose-adjusted cyclophosphamide, doxorubicin, vincristine, and etoposide, with rituximab and prednisone (DA-EPOCH-R; 43%); rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP; 33%); or other intensive chemotherapy programs. We found no significant differences in the rates of complete response (CR), progression-free survival (PFS), or overall survival (OS) between these chemotherapy regimens. CR was attained by 69% of patients. PFS at 2 years was 55.2% and OS was 68.1%. In a multivariable model, the main prognostic factors for PFS and OS were poor performance status, lactate dehydrogenase \u3e3 × upper limit of normal, and a dual-expressor immunophenotype. Age \u3e60 years or presence of MYC rearrangement were not prognostic, but patients with TP53 alterations had a dismal PFS. Presence of MYC rearrangement was not predictive of better PFS in patients treated with DA-EPOCH-R vs R-CHOP. Improvements in the diagnostic criteria and therapeutic approaches beyond dose-intense chemotherapy are needed to overcome the unfavorable prognosis of patients with HGBL-NOS

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Association Between Structural Empowerment and Nurses Outcomes Among the Public Hospitals of Lahore, Pakistan

Purpose: The purpose of the study was to determine the effect of Structural Empowerment on nursing outcome (Job Satisfaction). The aim of the study was to maintain an empowering work environment that enhances job satisfaction and nurses’ retention and also for the better organizational outcome.Method: A descriptive cross-sectional study was performed to determine the effect of empowering work environment on nursing outcome. A convenient sampling technique was used for the purpose to collect data from respondents.  Job satisfaction was measured on Job Diagnostic Survey Questionnaire a five item Likert scale adapted from (Hackman & Oldham, 1975). Structural empowerment is measured on work effectiveness questionnaire adapted from (Lschinger, 2001). Result: The main findings of the study are that Structural empowerment has a significance positive influence on nursing job satisfaction. In future broad study is recommended to explore the relationship between structural empowerment and job satisfaction further study is required to further elaborate the effect of work environment on nursing outcome.Conclusion: The study concluded that mostly nurses are satisfied with their job due to empowered work environment. Those nurses who are working in empowered environment are satisfied with their job as compare to those nurses who are working in lack of empowered work environment. Structural empowerment is considering as one of the important factor for the nurse’s job satisfaction their retention and better organizational outcome. Key terms: work Environment, Structural Empowerment, and Job satisfaction DOI: 10.7176/JHMN/115-01 Publication date: April 30th 202

Metal-insulator transition in ZnO nanopowder during thermal cycling by impedance spectroscopy

We have investigated the electrical response on the pellet of ZnO nanopowder by impedance spectroscopy. Different trends of impedance plane plots have been discussed due to the modulations of relaxation time with temperatures. Thermal cycling induces irreversible changes in the resistance of the material which has been explained by incorporating the role of extended defects like oxidation of Zn interstitials at surfaces and intrinsic/extrinsic grain boundaries. Metal-insulator transition has been reported and discussed in term of combined effects of Zn interstitials and oxygen vacancies. Irreversible increase in the values of dielectric constant have been conferred with thermal cycling's