A liver fibrosis cocktail? Psoriasis, methotrexate and genetic hemochromatosis

BACKGROUND: Pathologists are often faced with the dilemma of whether to recommend continuation of methotrexate therapy for psoriasis within the context of an existing pro-fibrogenic risk factor, in this instance, patients with genetic hemochromatosis. CASE PRESENTATIONS: We describe our experience with two male psoriatic patients (A and B) on long term methotrexate therapy (cumulative dose A = 1.56 gms and B = 7.88 gms) with hetero- (A) and homozygous (B) genetic hemochromatosis. These patients liver function were monitored with routine biochemical profiling; apart from mild perivenular fibrosis in one patient (B), significant liver fibrosis was not identified in either patient with multiple interval percutaneous liver biopsies; in the latter instance this patient (B) had an additional risk factor of partiality to alcohol. CONCLUSION: We conclude that methotrexate therapy is relatively safe in patients with genetic hemochromatosis, with no other risk factor, but caution that the risk of fibrosis be monitored, preferably by non-invasive techniques, or by liver biopsy

Sharing success – understanding barriers and enablers to secondary prophylaxis delivery for rheumatic fever and rheumatic heart disease

BACKGROUND: Rheumatic fever (RF) and rheumatic heart disease (RHD) cause considerable morbidity and mortality amongst Australian Aboriginal and Torres Strait Islander populations. Secondary antibiotic prophylaxis in the form of 4-weekly benzathine penicillin injections is the mainstay of control programs. Evidence suggests, however, that delivery rates of such prophylaxis are poor. METHODS: This qualitative study used semi-structured interviews with patients, parents/care givers and health professionals, to explore the enablers of and barriers to the uptake of secondary prophylaxis. Data from participant interviews (with 11 patients/carers and 11 health practitioners) conducted in four far north Queensland sites were analyzed using the method of constant comparative analysis. RESULTS: Deficits in registration and recall systems and pain attributed to injections were identified as barriers to secondary prophylaxis uptake. There were also varying perceptions regarding responsibility for ensuring injection delivery. Enablers of secondary prophylaxis uptake included positive patient-healthcare provider relationships, supporting patient autonomy, education of patients, care givers and healthcare providers, and community-based service delivery. CONCLUSION: The study findings provide insights that may facilitate enhancement of secondary prophylaxis delivery systems and thereby improve uptake of secondary prophylaxis for RF/RHD

Intensification Insights from Chemical Looping Combustion Using Coal–Biomass Mixtures with Fe-Based Oxygen Carrier

Chemical looping combustion (CLC) is a modern technology that enables the mitigation of the CO2 concentration without any expense of energy. Experimental evidence shows that combustion of coal/biomass in CLC technology leads to negative carbon emission by replacing the portion of coal with biomass. In the present work, CLC was simulated using a mixture of coal/biomass in CLC; using their different proportions resulted in enhanced CO and CO2 fractions in the fuel reactor. The carbon capture and oxide oxygen fraction were also found to increase with the enhancement of the fuel reactor’s temperature with different proportions of coal/biomass. Increases in the carbon capture efficiency and oxide oxygen fraction of up to 98.86% and ~98%, respectively, were observed within the experimental temperature range. The simulated results of various parameters were predicted and validated with the published experimental results. The stated parameters were also predicted as a function of the different rates of solid circulation and gasification agents. Higher coal char conversion was confirmed in the fuel reactor with the presence of higher biomass concentrations

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Not AvailableTwo gynodioecious papaya varieties Arka Surya and Arka Prabhath intercropped in coconut garden are compared for the morphological traits such as internodal length, leaf traits, fruit number, fruit weight and yield were analysed. Correlations and step-wise regression equations were used to infer the relationship among the traits and fruit yield. Larger leaf area, greater internodal length, high leaf fresh weight, high leaf dry weight, small fruits and low fruit yield were observed in Arka Surya. Fresh weight, dry weight and lightness of leaf together showed significant regression (R2 = 0.528) with annual fruit yield per plant. Arka Prabhath performed better than Arka Surya under coconut canopy with optimal fruit size and yield. Arka Prabhath is an advanced generation hybrid involving Arka Surya and Tainung-1 parents and displayed better shade adaptation with high fruit yield than Arka Surya due to smaller leaves, shorter internodes and larger fruits.Rastriya Krishi Vikas Yojana (RKVY), Government of India

A case of pulmonary carcinoid in pregnancy and review of carcinoid tumours in pregnancy

Carcinoid tumours are rare slow growing tumours which arise from primitive neuroendocrine cells. The effect of the pregnant state on carcinoid tumours and vice versa remains unclear, as does the optimal management of carcinoid tumours during the pregnancy including labour. We report the rare case of a 36 year old primigravida woman with large bilateral pulmonary carcinoid tumours. The patient's disease was minimally symptomatic with no clinical suspicion of carcinoid syndrome. Under close observation, the pregnancy progressed well and the patient proceeded to a spontaneous vaginal delivery of a healthy child. We conduct the the first literature review in 30 years of all reported cases in this area and make suggestions as to assessment and monitoring of cases of carcinoid during pregnancy

Peri-operative and Endocrine Medicine Service (POEMS) - A pilot program for efficient and collaborative care of the surgical inpatient

Aim: The Peri-operative and Endocrine Medicine Service (POEMS) was established in 2024 at Footscray Hospital, Western Health in Melbourne, Victoria. It has been designed as a quality assurance project. Our aim is to institute a peri-operative and endocrine medicine service at a large secondary hospital to improve peri-operative outcomes. Methods: Surgical inpatients admitted under the urology and vascular surgery units undergoing an operative with a high-risk of physiological disturbance and an expected length of stay longer than 48 hours will undergo direct medical reviews to optimise existing medical co-morbidities in preparation for surgery, as well as assess for and prevent complications post-operatively. The POEMS unit consists of a general medicine and endocrinology physician, a geriatrician and a general medicine and endocrinology advanced trainee working in collaboration with the surgical inpatient units to provide holistic patient care. The primary composite outcome is rates of inpatient mortality and post-operative complications including hospital acquired infections, acute kidney injury, cardiac complications, stroke and transient ischaemic attacks. Key secondary outcomes include indicators of glycaemic control and total length of stay. Conclusions: The program is going well to date with outcomes analysis to be performed in 2025 following accumulation of one year of program data