Intraarticular versus intravenous tranexemic acid in reducing blood loss after primary total knee arthroplasty

Background: One of the substantial complications of total knee arthroplasty is major blood loss. Postoperative blood loss can range up to 2000 ml and 10-38% of patients may require blood transfusion. Among the sundry methods of preventing this prob, tranexamic acid, an anti-fibrinolytic, is one of the most effective options. It can be administered directly into the blood or injected locally. The purpose of this study was to compare the hemostatic effects of intraarticular versus intravenous administration of tranexamic acid in primary total knee arthroplasty. Methods: A prospective comparative observational study was done from done September 2020 to February 2022 at Civil Service Hospital, Kathmandu. 64 patients randomized into two groups: an intraarticular tranexamic acid group (31 patients who received 3.0 grams of intraarticular tranexamic acid) and intravenous tranexamic acid group (31 patients who received 15 mg/kg intravenous tranexamic acid in two instances). The primary measure was the amount of hemoglobin loss. Secondary outcomes included comparison of hemoglobin level pre- and post- operatively at first and fifth day, drain volume at 48 hours and amount of blood transfusion. There were no significant differences in demographics or preoperative laboratory values between the groups. Results: The baseline data, preoperative hemoglobin, and tourniquet time were similar in both groups. Hemoglobin at first and fifth operative day and drain volume at 48 hours were measured in both categories. There was no significant difference in perioperative blood loss, drain volume, rates of allogeneic blood transfusion between the two groups.  No any thromboembolic complications occurred. Conclusions: Intra-articular administration of tranexamic acid was found to be as effective and safe as intra-venous administration in reducing blood loss in primary total knee arthroplasty

Weed dynamics, wheat (Triticum aestivum) yield and irrigation water-use efficiency under conservation agriculture

A field experiment was conducted to evaluate the impacts of a 12-year old conservation agriculture (CA)- based pigeon pea-wheat system on weeds, wheat crop, and resource use during winter (rabi) 2021–22. Results indicated that surface retention of residue irrespective of ZT permanent bed and N dose led to significant reduction in weed interference at 60 DAS. CA-based systems reduced weed density and dry weight considerably than CT. CA- based systems led to significantly higher wheat grain yield (by 11.6–14.9%) and net B:C (by 24.0 –28.0%) than CT, and PFBR100N and PBBR100N were slightly superior to others. PBBR100N and PBBR75N had lower irrigation water use and significantly higher irrigation water productivity than CT. Contrast analysis showed that wheat yield and water productivity were comparable between 75% N and 100% N in CA, indicating a saving of 25% N under CA

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Clinical outcomes of chemotherapy in cancer patients with different ethnicities

Abstract Background Choosing the most effective chemotherapeutic agent with safest side effect profile is a common challenge in cancer treatment. Although there are standardized chemotherapy protocols in place, protocol changes made after extensive clinical trials demonstrate significant improvement in the efficacy and tolerability of certain drugs. The pharmacokinetics, pharmacodynamics, and tolerance of anti‐cancer medications are all highly individualized. A driving force behind these differences lies within a person's genetic makeup. Recent findings Pharmacogenomics, the study of how an individual's genes impact the processing and action of a drug, can optimize drug responsiveness and reduce toxicities by creating a customized medication regimen. However, these differences are rarely considered in the initial determination of standardized chemotherapeutic protocols and treatment algorithms. Because pharmacoethnicity is influenced by both genetic and nongenetic variables, clinical data highlighting disparities in the frequency of polymorphisms between different ethnicities is steadily growing.  Recent data suggests that ethnic variations in the expression of allelic variants may result in different pharmacokinetic properties of the anti‐cancer medication. In this article, the clinical outcomes of various chemotherapy classes in patients of different ethnicities were reviewed. Conclusion Genetic and nongenetic variables contribute to the interindividual variability in response to chemotherapeutic drugs. Considering pharmacoethnicity in the initial determination of standard chemotherapeutic protocols and treatment algorithms can lead to better clinical outcomes of patients of different ethnicities

High-altitude characterization of the Hunga pressure wave with cosmic rays by the HAWC observatory

High-energy cosmic rays that hit the Earth can be used to study large-scale atmospheric perturbations. After a first interaction in the upper parts of the atmosphere, cosmic rays produce a shower of particles that sample it down to the detector level. The HAWC (High-Altitude Water Cherenkov) gamma-ray observatory in Central Mexico at 4,100 m elevation detects air shower particles continuously with 300 water Cherenkov detectors with an active area of 12,500 m2. On January 15th, 2022, HAWC detected the passage of the pressure wave created by the explosion of the Hunga volcano in the Tonga islands, 9,000 km away, as an anomaly in the measured rate of shower particles. The HAWC measurements are used to determine the propagation speed of four pressure wave passages, and correlate the variations of the shower particle rates with the barometric pressure changes. The profile of the shower particle rate and atmospheric pressure variations for the first transit of the pressure wave at HAWC is compared to the pressure measurements at the Tonga island, near the volcanic explosion. By using the cosmic-ray propagation in the atmosphere as a probe for the pressure, it is possible to achieve very high time-resolution measurements. Moreover, the high-altitude data from HAWC allows to observe the shape of the pressure anomaly with less perturbations compared to sea level detectors. Given the particular location and the detection method of HAWC, our high-altitude data provides valuable information that contributes to fully characterize this once-in-a-century phenomenon

A Comprehensive Understanding of Electro-Fermentation

Electro-fermentation (EF) is an upcoming technology that can control the metabolism of exoelectrogenic bacteria (i.e., bacteria that transfer electrons using an extracellular mechanism). The fermenter consists of electrodes that act as sink and source for the production and movement of electrons and protons, thus generating electricity and producing valuable products. The conventional process of fermentation has several drawbacks that restrict their application and economic viability. Additionally, metabolic reactions taking place in traditional fermenters are often redox imbalanced. Almost all metabolic pathways and microbial strains have been studied, and EF can electrochemically control this. The process of EF can be used to optimize metabolic processes taking place in the fermenter by controlling the redox and pH imbalances and by stimulating carbon chain elongation or breakdown to improve the overall biomass yield and support the production of a specific product. This review briefly discusses microbe-electrode interactions, electro-fermenter designs, mixed-culture EF, and pure culture EF in industrial applications, electro methanogenesis, and the various products that could be hence generated using this process

A Comprehensive Understanding of Electro-Fermentation

Electro-fermentation (EF) is an upcoming technology that can control the metabolism of exoelectrogenic bacteria (i.e., bacteria that transfer electrons using an extracellular mechanism). The fermenter consists of electrodes that act as sink and source for the production and movement of electrons and protons, thus generating electricity and producing valuable products. The conventional process of fermentation has several drawbacks that restrict their application and economic viability. Additionally, metabolic reactions taking place in traditional fermenters are often redox imbalanced. Almost all metabolic pathways and microbial strains have been studied, and EF can electrochemically control this. The process of EF can be used to optimize metabolic processes taking place in the fermenter by controlling the redox and pH imbalances and by stimulating carbon chain elongation or breakdown to improve the overall biomass yield and support the production of a specific product. This review briefly discusses microbe-electrode interactions, electro-fermenter designs, mixed-culture EF, and pure culture EF in industrial applications, electro methanogenesis, and the various products that could be hence generated using this process

Oilseed Brassica Species Diversification and Crop Geometry Influence the Productivity, Economics, and Environmental Footprints under Semi-Arid Regions

The article presents the findings of three-year field experiments conducted during 2017–2020 on the productivity, economics, and environmental footprints of the oilseed Brassica (OSB) with species diversification and crop geometry alterations in semi-arid regions of India. The objectives of the field experimentation was to assess the system of mustard intensification (SMI) in enhancing productivity and profitability with ensuring fewer environmental footprints. The results revealed that Brassica carinata gave a maximum seed productivity (3173.8 kg ha−1) and net returns (US$ 1141.72 ha−1) under a crop geometry of 60 cm × 60 cm. Further, an increase of 38% and 54% in seed yield and net returns from B. carinata was observed over the existing traditional Brassica juncea with conventional crop geometry. The maximum energy output was also recorded from B. carinata (246,445 MJ ha−1). The broader crop geometry (60 cm × 60 cm) also resulted in maximum energy output. The environmental footprint was lesser due to increased carbon gain (CG), carbon output (CO), and carbon production efficiency (CPE) and lower greenhouse gas intensity (GHGi) in B. carinata. However, the maximum water-use efficiency (WUE) was recorded in B. juncea (19.15 kg per ha-mm), with a minimum water footprint (WFP), whereas, greater crop geometry (60 cm × 60 cm) resulted in lower WFPs and better irrigation water use. Enhanced seed yield, economics, and fewer environmental footprints were observed at broader crop geometry in B. carinata over remaining OSBs