Prognostic Significance of Blood Glucose Levels and Alterations Among Patients with Aluminium Phosphide Poisoning

Objectives: This study aimed to assess the prognostic significance of blood glucose levels and blood glucose alterations (i.e. hyper- or hypoglycaemia) among patients with aluminium phosphide (AlP) poisoning. Methods: This prospective observational study was conducted at the Postgraduate Institute of Medical Education & Research, Chandigarh, India, between January 2010 and June 2011. All patients presenting to the emergency department with a definitive history of AlP ingestion or symptoms compatible with AlP poisoning were included in the study. Blood glucose levels were recorded at presentation and every six hours thereafter. Alterations in blood glucose levels and other clinical and laboratory variables were subsequently compared between survivors and non-survivors. Results: A total of 116 patients with AlP poisoning were identified. Of these, 57 patients (49%) survived and 59 patients (51%) died. At presentation, the mean blood glucose levels of survivors and non-survivors were 119.9 ± 35.7 mg/dL and 159.7 ± 92.5 mg/dL, respectively (P <0.001). In comparison to the survivors, non-survivors had significantly higher heart rates, total leukocyte counts, blood glucose level alterations and serum creatinine levels (P <0.050). In addition, systolic blood pressure, Glasgow coma scale scores, arterial blood gas pH and bicarbonate values and duration of hospital stay was significantly lower compared to survivors (P <0.001). However, neither blood glucose levels at admission nor blood glucose alterations correlated independently with mortality in a multivariate analysis. Conclusion: The role of blood glucose level alterations in predicting patient outcomes in AlP poisoning cases remains inconclusive. Further studies with larger sample sizes are required.Keywords: Aluminum Phosphide; Poisoning; Blood Glucose; Hyperglycemia; Hypoglycemia; Mortality; Prognostic Factors; India

Weaknesses in HENKOS Stream Cipher

HENKOS is a synchronous stream cipher posted by Marius Oliver Gheorghita to eprint. In this paper we are going to present some weaknesses in the cipher. We first present a chosen IV attack which is very straight forward attack on the cipher. Second we present a group of weak keys

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Cobalt free nanomaterials as positive electrodes for Lithium ion battery

Cathode materials with improved specific energy, energy density, safety and reduced cost are essential for developing next generation Li-ion battery technology. This can be made possible by exploring new chemistries of cathode materials, which exhibit either higher operating voltages or higher specific capacity compared to the materials currently available in the market. As a result, new materials’ utilizing multielectron step redox reaction has gained attention. Such materials can exchange more than one Li-ion per formula unit and therefore, specific energy is improved. In my thesis, I focus on fundamental understanding of such cathode materials and establish a strong relationship between the physical properties of the active cathode materials and their electrochemical behaviour. This study leads to a proposition that nano-sizing is the key to further improve the specific energy of cathode materials for Li-ion batteries. My thesis provides a scope to further analyse and optimize materials as well as electrode preparation methods for nano-crystalline materials, and thus realizing a high-energy Li-ion cell with materials using different redox steps. Among the polyanion-based cathode materials, layered Li9V3(P2O7)3(PO4)2 (LVPP) is investigated as a high voltage cathode. In comparison to the commercially available LiFePO4, where 1 Li-ion per formula unit is exchanged, LVPP is theoretically predicted to exchange 6 Li-ions from the structure utilizing V3+ to V5+ redox reactions at an average potential of 4.2 V, thus delivering specific capacity of 173 mA h g -1. The feasibility of multi-electron step reactions in phosphate-based LVPP cathode and the factors influencing the overall electrochemical behaviour has been explored. In addition, the mechanism of Li extraction/insertion during charge and discharge is investigated and the structural transformations are studied by means of in situand ex situ X-ray diffraction. The results obtained suggest that by optimizing the material synthesis for crystallite size and using specific cycling conditions facilitates multielectron step redox reactions in LVPP. Among the oxide based cathode materials, LiNi0.5Mn1.5O4 (LMNO) is one of the most promising cathode materials because of its high operating potential at 4.7 V, and a theoretical specific capacity of 146 mA h g -1 . Furthermore, LMNO is completely cobalt-free, which makes it cost-effective compared to the commercially available cathode materials. Even though LMNO consists of two active redox centres such as Ni and Mn, only the Ni (II) Ni (IV) redox reaction has received considerable attention. v However, when additionally utilizing the Mn redox reactions much improvement in the capacity can be obtained. The feasibility of multi-electron step reactions involving both Mn and Ni redox centres and the factors influencing the reversibility, overall capacity and kinetics have been studied. The electrochemical investigations on the Mn (IV) to Mn (III) redox reactions in LMNO clearly suggest that optimizing two important factors such as crystallite size and potential window are very important to improve both the specific capacity and kinetics. In the potential window of 2.4 – 4.9 V specific capacities from both Mn and Ni redox plateaus are exploited and a very high reversible capacity of 250 mA h g-1 has been demonstrated. This is put forth as the state of art for the cobalt free LMNO based cathodes

IMPACT OF BUFFER SIZE ON PQRS AND D-PQRS SCHEDULING ALGORITHMS

Most of the internet applications required high speed internet connectivity. Crosspoint Buffered Switches are widely used switching architectures and designing a scheduling algorithm is a major challenge. PQRS and D-PQRS are the two most successful schedulers used in Crosspoint Buffered Switches under unicast traffic. In this paper, we analysed the performance of PQRS and DPQRS algorithms by varying the crosspoint buffer size. Simulation result shows the delay performance of the switch increases if the size of the buffer increases

Real-world data on the pattern of recurrence of colorectal cancer at a tertiary cancer center in South India: A retrospective observational study

Background: Recurrent colorectal cancer may be amenable to curative treatment. As the debate on the ideal set of investigations and frequency of follow-up continues, it is important to review the pattern of recurrence in the real-world setting, which could help tailor future follow-up strategies. Objectives: Our primary objective was to study the varying clinical presentations and patterns of recurrence of colorectal cancer. The secondary objectives were to study the site of recurrence, method of diagnosis of recurrence, incidence of second primary colorectal cancer, and salvage rates after recurrence of colorectal cancer. Material and Methods: We reviewed the data of patients who were treated from January 2010 to December 2016 at the Malabar Cancer Center, a tertiary cancer center in Kerala, India. We recorded the clinicopathologic details of patients who were treated with curative intent and had serologic (carcinoembryonic antigen [CEA] elevation), clinical, or radiological evidence of disease recurrence. We also studied the timing and anatomical location of recurrence, symptoms, and the method by which the recurrence was diagnosed. Results: We included 675 patients in the study. There were 324 (48%) female patients; the median age was 55 years (interquartile range [IQR], 47.2-65). The primary diagnosis was colon cancer in 326 (48.3%) and rectal in 349 (51.7%) patients. Multimodality therapy was administered to 393 (58.2%) patients in the form of surgery with or adjuvant neoadjuvant chemoradiation adjuvant radiation, or neoadjuvant short-course radiation with neoadjuvant and adjuvant chemotherapy. Recurrences occurred in 109 (16.1%) patients, only 50 (45.9%) of whom were symptomatic. Recurrences were diagnosed by CEA elevation in 65 (59.6%), imaging in 12 (11%), clinical examination in 4 (3.7%), and colonoscopy in 1 (0.9%) patient. The median time to recurrence was 17 months (95% CI, 14-22). Local and distant recurrences occurred in 29 (4.2%) and 80 (11.9%) patients, respectively; 22 (27.5%) patients developed multisite distant recurrences. Recurrences occurred within the first 5 years of completion of therapy in 96 (88.1%) cases. Twelve (11%) patients received salvage therapy with curative intent. Six patients (0.9%) had a metachronous colorectal primary tumors. Conclusions: Colorectal cancer recurs most commonly in the first 5 years after therapy. Multisite distant recurrence and isolated liver metastases predominate. Recurrences are often asymptomatic and most commonly manifest as elevated CEA. Regular clinical evaluation, CEA testing, colonoscopy, and symptom-based cross-sectional imaging detect up to three-quarters of patients with recurrences, but the overall salvageability remains low

Expanding Indications of Nonvitamin K Oral Anticoagulants Beyond Nonvalvular Atrial Fibrillation and Venous Thromboembolism: A Review of Emerging Clinical Evidence

Direct oral anticoagulants (DOAC) have emerged as a new therapy for patients who need and can tolerate oral anticoagulation. DOACs were initially approved for nonvalvular atrial fibrillation (NVAF) and treatment for deep vein thrombosis (DVT) and pulmonary embolism (PE). Ease of administration, no requirement of bridging with other anticoagulants, and less frequent dosing have made DOACs preferable choice for anticoagulation. Studies are showing promising results regarding use of DOACs beyond the common indications. Studies have been done to show the potential benefit of DOACs in valvular atrial fibrillation, heart failure, acute coronary syndrome, stroke, and peripheral arterial disease. Data have shown safety as well as comparable bleeding incidences with DOACs compared to vitamin K antagonist anticoagulants. Naturally interest is growing to see the use of DOACs apart from the NVAF, DVT, or PE. Authors have highlighted various study results to show the potential beneficial role of DOACs in the above-mentioned situations