Comparison of Antibiotic Usage - Third Generation Cephalosporin Single Dosage Vs Multiple Dosage in case of Emergency Open Uncomplicated Appendicectomy

INTRODUCTION: Acute Appendicitis is the most common general surgical emergency and early surgical intervention improves outcome which makes Appendicectomy, the most commonly performed emergency operation in the world.Most patients with acute appendicitis are managed by prompt surgical removal of the appendix.If untreated or delay in treatment would result in fatal complications.If simple acute appendicitis is encountered,there is no benefit in extending antibiotic coverage beyond 24 hrs . For intraabdominal infections of GI tract origin that are of mild to moderate severity,the Surgical Infection society has recommended single-agent therapy with cefoxitin, cefotetan or ticarcillinclavulanic acid. But in daily practice multiple doses are used to prevent complications like wound infection and intra abdominal abscess.Antibiotics should be administered 30 minutes prior to incision to achieve adequate tissue levels. In non-perforated appendicitis single preoperative dose of antibiotic suffices. In cases of perforation, an extended course of atleast 5 days of antibiotics is advocated. AIMS & OBJECTIVES: • To know the outcome of single dose antibiotic (cefaperazone sulbactam) in cases of emergency open uncomplicated appendectomy. • To compare single dose (cefaperazone sulbactam) with multiple doses of antibiotics in case of emergency open uncomplicated appendectomy. Duration: Jan 2014 TO Sep 2014. Study Design: Prospective study. Sample Size: 300. Inclusion Criteria: Patients presenting with clinical features suggesting of acute appendicitis - anorexia,right iliac fossa pain,nausea,vomiting and fever are included in the study. Exclusion Criteria: • Patients with perforated appendicitis,appendicular abscess, appendicular mass formation METHODOLOGY: • Patients presenting with clinical features suggesting of acute appendicitisanoreixia, right iliac fossa pain,nausea,vomiting and fever admitted in emergency department of our hospital from January 2014 to November 2014 will be enrolled in our study. • These patients will be given single dose of cefaperazone sulbactam 1.5gm IV half an hour prior to incision. • The above group will be compared to those cases with admistration of multiple doses of antibioctics • The results are analyzed using Microsoft Excel for tabular transformation and graphical representation. For comparing the parameters and statistical analysis 2 sample z-test will be used. CONCLUSION; It is evident that prophylactic multiple doses of Cefaperazone sulbactam postoperatively confer no additional benefit over a single preoperative dose of Cefaperazone sulbactam. With additional benefits of the greater ease of administration and decreased cost, single dose Cefaperazone sulbactam is the prophylaxis of choice for appendicectomy in patients with nonperforated appendicitis in our study. It is essential for Surgeons and Surgical departments to update their routine practice of antibiotic prophylaxis to comply with updated guidelines and evidence base so as to avoid overuse of antibiotics and their multiple dosage schedule in order to prevent the emerging menace of drug resistance as well prevent the side effects in patient’s perspective

Endovascular stenting of a chronic ruptured type B thoracic aortic dissection, a second chance: a case report

<p>Abstract</p> <p>Introduction</p> <p>We aim to highlight the need for awareness of late complications of endovascular thoracic aortic stenting and the need for close follow-up of patients treated by this method.</p> <p>Case presentation</p> <p>We report the first case in the English literature of an endovascular repair of a previously stented, ruptured chronic Stanford type B thoracic aortic dissection re-presenting with a type III endoleak of the original repair.</p> <p>Conclusion</p> <p>Endovascular thoracic stenting is now a widely accepted technique for the treatment of thoracic aortic dissection and its complications. Long term follow up is necessary to ensure that late complications are identified and treated appropriately. In this case of type III endoleak, although technically challenging, endovascular repair was feasible and effective.</p

Influence of season and feeding intensity on the fatty acid composition of wild cobia (Rachycentron canadum, Linnaeus, 1766) in the Dungun coast, Malaysia

Aim: This study investigates the variations in the fatty acid contents of cobia from Dungun coast, Malaysia with respect to changes in seasons and feeding intensity. Methodology: Cobia samples were collected from a commercial fish landing center at Dungun, Terengganu, Malaysia to analyze the gut content and fatty acid composition of muscle and liver. Specimens were immediately dissected to determine sex as well as weight of food items in the stomach. Food items were identified and categorized as fish, mollusks and crustacean. The fatty acid composition in the liver and muscle tissue samples was determined by first extracting lipids using chloroform: methanol (2:1, v/v) mixture.? The physical water quality parameters (salinity, temperature, DO and pH) were measured in situ using an YSI multi parameter (model 6600, YSI, US). Results: Saturated fatty acids (FAs) comprised the majority of FAs in the muscle, followed by monoenes, total poly-unsaturated fatty acids (PUFAs) (n-3) and then total PUFAs (n-6) with no seasonal variation in quantity. A similar trend was observed in the liver but the total saturated FAs were significantly higher during the inter-monsoon while total monoenes significantly accumulated during the monsoon. During low feeding intensity, there was a significant accumulation of PUFAs (n-6) in the muscle tissue (P 0.05). Interpretation: Cobia lipids are composed of a significant quantity of omega-3 and omega-6 FAs, which have important health benefits. Environmental variability, especially salinity fluctuations and prey abundance that accompany seasonal changes, significantly impact the nutritional composition of cobia in Malaysian waters, however, their nutritional quality is maintained

Primary recovery factor as a function of production rate: implications for conventional reservoirs with different drive mechanisms

This study evaluates the dependency of production rate on the recovery of hydrocarbon from conventional reservoirs using MBAL simulator. The results indicated that the recoveries are sensitive to the production rate in almost all hydrocarbon reservoirs. It was also found that the recovery of volumetric gas drive reservoirs is not impacted by the production rate. In fact, any increase in the production rate improves gas recovery in weak and strong water drive reservoirs. Moreover, increasing the production rate in oil reservoirs decreases the recovery with a significant effect observed in the weak water drive reservoirs. The results of this study demonstrate the need for implementing an effective reservoir management in order to obtain a maximum recovery

Pathogenic Mouse Hepatitis Virus or Poly(I:C) Induce IL-33 in Hepatocytes in Murine Models of Hepatitis.

International audienceThe IL-33/ST2 axis is known to be involved in liver pathologies. Although, the IL-33 levels increased in sera of viral hepatitis patients in human, the cellular sources of IL-33 in viral hepatitis remained obscure. Therefore, we aimed to investigate the expression of IL-33 in murine fulminant hepatitis induced by a Toll like receptor (TLR3) viral mimetic, poly(I:C) or by pathogenic mouse hepatitis virus (L2-MHV3). The administration of poly(I:C) plus D-galactosamine (D-GalN) in mice led to acute liver injury associated with the induction of IL-33 expression in liver sinusoidal endothelial cells (LSEC) and vascular endothelial cells (VEC), while the administration of poly(I:C) alone led to hepatocyte specific IL-33 expression in addition to vascular IL-33 expression. The hepatocyte-specific IL-33 expression was down-regulated in NK-depleted poly(I:C) treated mice suggesting a partial regulation of IL-33 by NK cells. The CD1d KO (NKT deficient) mice showed hepatoprotection against poly(I:C)-induced hepatitis in association with increased number of IL-33 expressing hepatocytes in CD1d KO mice than WT controls. These results suggest that hepatocyte-specific IL-33 expression in poly(I:C) induced liver injury was partially dependent of NK cells and with limited role of NKT cells. In parallel, the L2-MHV3 infection in mice induced fulminant hepatitis associated with up-regulated IL-33 expression as well as pro-inflammatory cytokine microenvironment in liver. The LSEC and VEC expressed inducible expression of IL-33 following L2-MHV3 infection but the hepatocyte-specific IL-33 expression was only evident between 24 to 32h of post infection. In conclusion, the alarmin cytokine IL-33 was over-expressed during fulminant hepatitis in mice with LSEC, VEC and hepatocytes as potential sources of IL-33

Behavior and Impact of Zirconium in the Soil–Plant System: Plant Uptake and Phytotoxicity

Because of the large number of sites they pollute, toxic metals that contaminate terrestrial ecosystems are increasingly of environmental and sanitary concern (Uzu et al. 2010, 2011; Shahid et al. 2011a, b, 2012a). Among such metals is zirconium (Zr), which has the atomic number 40 and is a transition metal that resembles titanium in physical and chemical properties (Zaccone et al. 2008). Zr is widely used in many chemical industry processes and in nuclear reactors (Sandoval et al. 2011; Kamal et al. 2011), owing to its useful properties like hardness, corrosion-resistance and permeable to neutrons (Mushtaq 2012). Hence, the recent increased use of Zr by industry, and the occurrence of the Chernobyl and Fukashima catastrophe have enhanced environmental levels in soil and waters (Yirchenko and Agapkina 1993; Mosulishvili et al. 1994 ; Kruglov et al. 1996)

Systems genetics identifies miRNA-mediated regulation of host response in COVID-19.

peer reviewed[en] BACKGROUND: Individuals infected with SARS-CoV-2 vary greatly in their disease severity, ranging from asymptomatic infection to severe disease. The regulation of gene expression is an important mechanism in the host immune response and can modulate the outcome of the disease. miRNAs play important roles in post-transcriptional regulation with consequences on downstream molecular and cellular host immune response processes. The nature and magnitude of miRNA perturbations associated with blood phenotypes and intensive care unit (ICU) admission in COVID-19 are poorly understood. RESULTS: We combined multi-omics profiling-genotyping, miRNA and RNA expression, measured at the time of hospital admission soon after the onset of COVID-19 symptoms-with phenotypes from electronic health records to understand how miRNA expression contributes to variation in disease severity in a diverse cohort of 259 unvaccinated patients in Abu Dhabi, United Arab Emirates. We analyzed 62 clinical variables and expression levels of 632 miRNAs measured at admission and identified 97 miRNAs associated with 8 blood phenotypes significantly associated with later ICU admission. Integrative miRNA-mRNA cross-correlation analysis identified multiple miRNA-mRNA-blood endophenotype associations and revealed the effect of miR-143-3p on neutrophil count mediated by the expression of its target gene BCL2. We report 168 significant cis-miRNA expression quantitative trait loci, 57 of which implicate miRNAs associated with either ICU admission or a blood endophenotype. CONCLUSIONS: This systems genetics study has given rise to a genomic picture of the architecture of whole blood miRNAs in unvaccinated COVID-19 patients and pinpoints post-transcriptional regulation as a potential mechanism that impacts blood traits underlying COVID-19 severity. The results also highlight the impact of host genetic regulatory control of miRNA expression in early stages of COVID-19 disease

Maize for Changing Climate - Chasing the Moving Target

The average annual growth rate of harvested maize area from 1993 to 2013 was 2.7% in Africa, 3.1% in Asia, and 4.6% in Latin America (FAOSTAT, 2018). Maize has emerged as the cereal with largest global production, which surpassed rice in 1996 and wheat in 1997, and its production is increasing at twice the annual rate of rice and three times that of wheat (Fischer et al., 2014). Among cereals, including rice, wheat and other coarse cereal, maize has recorded highest increase in area and productivity during 2006-2015 and is projected to keep the momentum during 2016-2025 (OECD/FAO, 2016). Asia, with its 31% share in global maize production from about 34.0% of the total global area harvested, is the second largest maize producer in the world. The current decade continued impressive growth in maize production, as all the sub-regions showed significant increase in maize production (Figure 1), including Southeast Asia -10.8%, Southern Asia - 27.3% and East Asia - 30.6%, which resulted in an overall 27.7% maize production increase in Asia within a short period of 2010-2016 (FAOSTAT, 2018). These gains in maize production were contributed by increase in productivity per unit area and increase in maize growing areas in some countries