Bioleaching of Lateritic Nickel Ore using Chemolithotrophic Micro Organisms(Acidithiobacillus ferrooxidans)

In this study, the recovery of nickel from a low grade ore was attempted employing a chemolithotrophic micro organism, a bacteria, named Acidithiobacillus ferrooxidans. The factors studies were pulp density of the ore for leaching and the effect of residence time on leaching of nickel from the ore at a constant total iron. The entire experiment was carried out at room temperature. The objective of the study was thus to calculate the amount of nickel leached or extracted from a low grade ore by bio leaching methods at different pulp densities of the ore as well as at different residence times. The first step in the procedure was the collection and activation of the bacterial strains of Acidithiobacillus ferrooxidans. The bacteria were raised in a culture of 9K+ media supplied with adequate calculated amount of nutrients and were shaken continuously in a shaker cum incubator to fully activate them. The activity and fully active conditions were determined by Ferrous Iron and Total Iron estimations. Pulp densities of 2%, 5%, 10% and 20% were prepared. For each residence time, 5 conical flasks were allocated for testing samples at 0 hour, 5 days, 10 days and 15 day and a control flask were prepared. Then the samples were analyzed by an Atomic Absorption Spectrophotometer at Regional Research Laboratory, Bhubaneswar for the percentage of nickel extracted from each sample of residence time and different pulp densities. The pH was maintained at around 1.5-2 for each sample for the optimum activity of the bacteria. The data obtained was tabulated and the required graphs were drawn to get the final result. The graphs were plotted between percentage of nickel extracted vs. residence time at various pulp densities and nickel extracted vs. pulp densities at various residence times. From the graphs, it was observed that the maximum nickel extraction was observed for a pulp density of 2% at 15 days. The percentage of nickel extraction decreases with increase in pulp densities for a particular residence time. The percentage of nickel extracted increases with the increase in residence time for a particular pulp density. The percentage of nickel extracted also depends a lot on the type of ore used, modifications made on the ore as well as on the activity of the bacteria. Higher is the activity of the bacteria, more is the extraction of nickel

Knowledge, attitude and practice of pharmacovigilance among medical students

Background: Spontaneous reporting of adverse drug reaction (ADR) is main part of pharmacovigilance. This study was done to assess knowledge, attitude and practice (KAP) of pharmacovigilance among 2nd year medical students.Methods: This was a questionnaire based cross sectional study. The study participants were 2nd year MBBS students at pacific institute of medical sciences. Total number of questions given was 20. The data was analyzed by MS excel.Results: Total 100 students were given 20 questions. Among 20 questions, 10 were based on knowledge, 4 were based on attitude and 5 were based on practice. One question was asked to determine the reasons for underreporting. 95% students gave correct definition of pharmacovigilance. 96% students were having knowledge about existing National pharmacovigilance programme of India. 97% gave correct answer of side effect occurring during pregnancy as teratogenicity. 99 % said that reporting ADR is necessary.Conclusions: In our study most of the students gave correct answers of knowledge based questions. So knowledge of pharmacovigilance is gradually improving among medical students

Formative assessment of the communication skills related to drug delivery systems on standardized patients through group objective structured clinical encounters in second year medical students

Background: Choosing an appropriate Drug Delivery System (DDS) influences the acceptability, adherence and better outcome of the therapy in the patients. The present study was planned to evaluate the second year MBBS students on standardized patients (SP) using Group Objective Structured Clinical Encounters (GOSCE) after content delivery by traditional power point class versus experiential teaching methodology.Methods: DDS practical class was held in two larger groups after adding two odd sub-groups (1+3) as ‘A’ (64 students) and even sub-groups (2+4) as ‘B’ (66 students). The formative GOSCE evaluation was done 2 weeks after the classes by the trained physician examiners as per the Medical Council of Canada pre-determined scoring instruments.Results: The average magnitude of change in GOSCE scoring is extremely statistical significant on t-test (P< 0.0001) in favour of experiential teaching methodology for all the skills. The statistical significant percentage of students were able to extract the treatment history in respect of eliciting problem, reasons for non-compliance, methods of intake, explain the technique and showed the courteous professional behaviours.Conclusions: The clinical cases as SP in pharmacology teaching for developing competency based communication skills and GOSCE are the appropriate methodology for evaluation of large student group for experiential DDS training

Experiential learning of ethnopharmacological sources of drugs through rotating trios micro discussion in MBBS students: an innovative I-tray teaching methodology

Background: Complementary and alternative medicine is very robust in some parts of the world. The study was done to impart the experiential learning related to sources of drugs in a pharmacy practical class for MBBS students.Methods: We used ingredient-tray (I-Tray) teaching tool consisting of two parts to generate experiential learning in MBBS students about ethno pharmacological sources of drugs. Innovatively designed I -tray filled with two sizes plastic containers (100 ml and 50 ml sizes used for collecting biological samples of sputum and urine) containing crude drug medicinal sources which were arranged in gutters of the tray. They were sorted into five categories such as plants (flowers of Vinca rosea, bark of Terminalia arjuna, roots of Rauwolfia serpentine and Eucalyptus leaves); animals (formalin preservatives freshwater leech, shells and vaccines); minerals (kaolin, potassium permanganate and charcoal); oils and others. Three charts of 4 square feet sizes were used for demonstration of synthetic, microbiological and genetically engineered drug sources.Results: The students’ approval rate of I-tray was mean yes value of 105.78 for a tool of active learning out of total 113 students. Around 100%, 98.23 % and 97.35% students utilised application of concept (cognition), faculty of smell (affective) and volunteering (psychomotor) in the class. However female students had statistically significant score against this set up of the class depicting gender specificity of the learning process.Conclusions: Thus teaching traditional sources of drugs through I-tray impart higher order social, place based and experiential learning of medicine

Comparison of ER, PR Reactivity Pattern with Histologic Grade, Tumor Size and Lymph Node Status in Breast Cancer

Background & Aims: There is positive correlation of ER and PR with degree of tumor differentiation and survival and response to hormone therapy are most favourable among women who are receptor positive. Materials and Method: The present study was carried out at our institute P.D.U. Medical college, Rajkot. A Total of 130 cases of breast carcinoma were taken into consideration which included of modified radical mastectomies and tru cut biopsies.Data including age, tumor size, and histological grade and lymph node status retrieved from pathology department. Results:Maximum number 42 of cases were seen in 41-50 years age group.128 cases of breast carcinomas were found affecting females and 02 were found affecting males. Out of 130 cases 66 cases have ER, PR receptor positive. Out of 130 cases 90 cases were stage 2 and out of them 50 were ER , PR positive,83 cases were grade 2 and of them 46 were ER,PR positive,75 cases were lymph node stage N0 and out of them 37 were ER ,PR positive. Conclusion: There is significant decrease in mortality and tumor recurrences with hormone therapy. There is positive correlation of ER,PR status with histological grade of tumor and lymph node metastasis. As the positivity was seen to decrease with advancing histological grade. It was also observed that the positivity decrease with increasing metastasis and the lymph node involvement. But there is no statistically significant correlation found between ER PR positivity and Histological Grade, Tumor Size & Lymph Node Status in this study

Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention

Background: Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Methods: We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. Results: The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, p \u3c 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, p \u3c 0.001) and diabetes mellitus (50% vs. 42%, p \u3c 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. p \u3c 0.001), moderate/severe calcification (68% vs. 40%, p \u3c 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, p \u3c 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, p \u3c 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, p \u3c 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, p \u3c 0.001) and procedural (88% vs. 96%, p \u3c 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, p \u3c 0.001). Several techniques were required for balloon uncrossable lesions. Conclusion: In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions

Transcatheter or surgical aortic-valve replacement in intermediate-risk patients

BACKGROUND: Previous trials have shown that among high-risk patients with aortic stenosis, survival rates are similar with transcatheter aortic-valve replacement (TAVR) and surgical aorticvalve replacement. We evaluated the two procedures in a randomized trial involving intermediate-risk patients. METHODS: We randomly assigned 2032 intermediate-risk patients with severe aortic stenosis, at 57 centers, to undergo either TAVR or surgical replacement. The primary end point was death from any cause or disabling stroke at 2 years. The primary hypothesis was that TAVR would not be inferior to surgical replacement. Before randomization, patients were entered into one of two cohorts on the basis of clinical and imaging findings; 76.3% of the patients were included in the transfemoral-access cohort and 23.7% in the transthoracic-access cohort. RESULTS: The rate of death from any cause or disabling stroke was similar in the TAVR group and the surgery group (P=0.001 for noninferiority). At 2 years, the Kaplan–Meier event rates were 19.3% in the TAVR group and 21.1% in the surgery group (hazard ratio in the TAVR group, 0.89; 95% confidence interval [CI], 0.73 to 1.09; P=0.25). In the transfemoralaccess cohort, TAVR resulted in a lower rate of death or disabling stroke than surgery (hazard ratio, 0.79; 95% CI, 0.62 to 1.00; P=0.05), whereas in the transthoracic-access cohort, outcomes were similar in the two groups. TAVR resulted in larger aortic-valve areas than did surgery and also resulted in lower rates of acute kidney injury, severe bleeding, and new-onset atrial fibrillation; surgery resulted in fewer major vascular complications and less paravalvular aortic regurgitation. CONCLUSIONS: In intermediate-risk patients, TAVR was similar to surgical aortic-valve replacement with respect to the primary end point of death or disabling stroke. (Funded by Edwards Lifesciences; PARTNER 2 ClinicalTrials.gov number, NCT01314313

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019