Factors Leading to Acute Pancreatitis in Tertiary Care Hospitals in Pakistan – A Multicenter Study

Background: To determine the prevalence,etiological spectrum and outcomes of acutepancreatitis patients .Methods: In this was descriptive, observational,study patients presenting with clinical features ofacute pancreatitis, increased serum amylase and/orlipase levels and/or CT scan abdomen with featuressuggestive of acute pancreatitis were included.Ranson’s scoring was done over the first 48 hours.Contrast- enhanced CT scan abdomen withpancreatic protocol was done in selected patients.Cochrane-Armitage trend test was used to determinesignificance of correlation between complicationsand severity indices.Results: Out of 154 patients 59.1% were female.Gall stones (74%) was the commonest aetiology,followed by idiopathic ( 13%). Same admissioncholecystectomy was done in 44.7% of patients withgallstone pancreatitis. On admission, 14.9% of serumamylase and 18.8% (n=29) of serum lipase levelswere within 3 times the upper limit of normalvalues. Higher Ranson’s score and modified CTseverity index were associated with highercomplication and mortality rates. The complicationrate was 21.4 % and mortality was 7.1 % .Conclusion: Gallstone pancreatitis was found tobe the most common cause. The higher rate ofidiopathic pancreatitis in our study, along withhigher mortality in this subgroup, could be partiallyexplained due to lack of advanced diagnostics suchas MRCP and EUS. Overall complication andmortality rate was higher for which healthcareinfrastructure needs to be improved

Intercloud Message Exchange Middleware

ABSTRACT Cloud Interoperability has been a core issue pertaining Intercloud and Cloud Federation. Several vendor-based proprietary solutions and open-source middleware are present for the resolution; however, these solutions are highly coupled to particular cloud environments. For heterogeneous clouds to exist in an interoperable environment, the need of a vendor-independent, secure and reliable message exchange middleware is critical. In this paper, considering general cloud architecture, we are presenting a Publish-Subscribe based middleware for Intercloud Message Exchange. Intercloud Message Exchange is an implementation of Data Distribution Service (DDS). DDS's reliable pub-sub messaging in conjunction with our devised Information Model can be a novel candidate for messaging domain of Intercloud Interoperability Standards. This Information Model also hosts an OWL based Cloud Resource Description Ontology, utilized by cloud environments for resource cataloguing and possible matchmaking prior to workload migration between heterogeneous clouds

Invasive Mucormycosis Induced Pneumopericardium: A Rare Cause of Pneumopericardium in an Immunocompromised Patient

Mucor and Rhizopus cause life-threatening infections primarily involving the lungs and sinuses, which disseminate very rapidly by necrosis and infarction of the contiguous tissues. We present a case of a 64-year-old African American posttransplant patient who presented with a productive cough and weight loss. He had a past surgical history of renal transplant for renal cell carcinoma and was on dual immunosuppressive therapy, that is, mycophenolate and tacrolimus. During his hospital stay, he developed a pneumopericardium due to the direct extension of a lung lesion. The diagnosis was made by radiological imaging and PCR result which was consistent with Mucor species. He was treated with antifungal therapy. The purpose of this report is to highlight the unusual association of mucormycosis with pneumopericardium

Electrochemical comparison of SAN/PANI/FLG and ZnO/GO coated cast iron subject to corrosive environments

ZnO/GO (Graphene Oxide) and SAN (Styrene Acrylonitrile)/PANI (polyaniline)/FLG (Few Layers Graphene) nanocomposite coatings were produced by solution casting and sol-gel methods, respectively, to enhance corrosion resistance of ferrous based materials. Corrosive seawater and ‘produced crude oil water’ environments were selected as electrolytes for this study. Impedance and coating capacitance values obtained from Electrochemical Impedance Spectroscopy (EIS) (AC technique) showed enhanced corrosion resistance of nanocomposites coatings in the corrosive environments. Tafel scan (DC technique) was used to find the corrosion rate of nanocomposite coating. SAN/PANI/FLG coating reduced the corrosion of bare metal up to 90% in seawater whereas ZnO/GO suppressed the corrosion up to 75% having the impedance value of 100 ohms. In produced water of crude oil, SAN/PANI FLG reduced the corrosion up to 95% while ZnO/GO suppressed the corrosion up to 10%. Hybrid composites of SAN/PANI/FLG coatings have demonstrated better performances compared to ZnO/GO in the corrosive environments under investigation. This study provides fabrication of state-of-the-art novel anti corrosive nanocomposite coatings for a wide range of industrial applications. Reduced corrosion will result in increased service lifetime, durability and reliability of components and system and will in turn lead to significant cost savings

Improving the Probiotics Viability and Quality Characteristics of Yoghurt Enriched with Barley Bran

Results of current study reported that increase in addition of barley bran in yogurt containing bifidobacterium BB-12, L. bulgaricus and S. thermophillus significantly influence the probiotics numbers. Samples fortified with barley bran has more numbers of probiotics as compare to control samples during storage. Correlation between concentration of barley bran and bifidobacterium was optimistic. Maximum numbers of L. bulgaricus and bifidobacterium were found in yogurt containing 1.5%25 barley bran. Addition of barley bran increased the acidity percentage of yogurt and decreased viscosity value during 3 weeks of storage. Sensory scores of functional yogurt decreased with increased in barley bran. However sensory score of sample with (0.5%25 barley bran) did not significantly changed from control sample and number of bifidobacterium bacteria in this sample was higher than minimum standard level (log106 CFU%252Fg) of world health organization (WHO). Syneresis value of control sample was significantly reduced with storage period but yogurt sample enriched with different concentration of barley bran were showed minimum decreased in syneresis percentage of yogurt. Barley bran level 1%25 can be added to yogurt successfully. Barley bran enrichment increased the color parameters of yogurt during storage this may be due to the results of blueness color of barley bran

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Trends in HIV/AIDS morbidity and mortality in Eastern Mediterranean countries, 1990–2015: findings from the Global Burden of Disease 2015 study

OBJECTIVES: We used the results of the Global Burden of Disease 2015 study to estimate trends of HIV/AIDS burden in Eastern Mediterranean Region (EMR) countries between 1990 and 2015. METHODS: Tailored estimation methods were used to produce final estimates of mortality. Years of life lost (YLLs) were calculated by multiplying the mortality rate by population by age-specific life expectancy. Years lived with disability (YLDs) were computed as the prevalence of a sequela multiplied by its disability weight. RESULTS: In 2015, the rate of HIV/AIDS deaths in the EMR was 1.8 (1.4–2.5) per 100,000 population, a 43% increase from 1990 (0.3; 0.2–0.8). Consequently, the rate of YLLs due to HIV/AIDS increased from 15.3 (7.6–36.2) per 100,000 in 1990 to 81.9 (65.3–114.4) in 2015. The rate of YLDs increased from 1.3 (0.6–3.1) in 1990 to 4.4 (2.7–6.6) in 2015. CONCLUSIONS: HIV/AIDS morbidity and mortality increased in the EMR since 1990. To reverse this trend and achieve epidemic control, EMR countries should strengthen HIV surveillance, and scale up HIV antiretroviral therapy and comprehensive prevention services

The global burden of injury: Incidence, mortality, disability-adjusted life years and time trends from the global burden of disease study 2013

Background The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disabilityadjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. Methods Injury mortality was estimated using the extensive GBD mortality database, corrections for illdefined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. Results In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. Conclusions Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made