Diagnosis and management of subarachnoid haemorrhage

Aneurysmal subarachnoid haemorrhage (aSAH) presents a challenge to clinicians because of its multisystem effects. Advancements in computed tomography (CT), endovascular treatments, and neurocritical care have contributed to declining mortality rates. The critical care of aSAH prioritises cerebral perfusion, early aneurysm securement, and the prevention of secondary brain injury and systemic complications. Early interventions to mitigate cardiopulmonary complications, dyselectrolytemia and treatment of culprit aneurysm require a multidisciplinary approach. Standardised neurological assessments, transcranial doppler (TCD), and advanced imaging, along with hypertensive and invasive therapies, are vital in reducing delayed cerebral ischemia and poor outcomes. Health care disparities, particularly in the resource allocation for SAH treatment, affect outcomes significantly, with telemedicine and novel technologies proposed to address this health inequalities. This article underscores the necessity for comprehensive multidisciplinary care and the urgent need for large-scale studies to validate standardised treatment protocols for improved SAH outcomes

Potential surface active agent production using very low grade and cheap substrate by Bacillus subtilis as microbial cell factory

Bio-surfactants are surface-active molecules which are produced by the wide range of microbes including bacteria, fungi, moulds, and yeast. This study was conducted to identify bio-surfactants by Bacillus subtilis combined with use of cheap substrates and industrial wastes (Mustard cake, Whey and Soya cake) which are found locally in Nepal. Bacillus subtilis, one of the most potential bio-surfactants producer; was isolated from soil sample of hydrocarbon contaminated site. Isolates were grown in a Minimal Salt Media (MSM) with 10% (v/v) mustard oil cake, whey and soya cake separately. The presence and potential of surfactant was determined by the oil spreading technique, emulsification index (%E24) and surface tension measurement. It was revealed that the surface tensions of cell free extract were 54.41, 60.02 and 56.64 mN/m for from mustard cake, whey and soya cake respectively as compared to distilled water (72.09) at 25oC. The emulsification index values was found to be highest in engine oil from the bio-surfactant extracted from mustard cake, soya cake and whey respectively. Similarly, mustard oil showed the lowest value of emulsification index. The highest emulsification activity was shown in mustard oil i.e. 1.13 from the cell free extract from mustard oil and lowest in engine oil i.e., 0.07, by the extract from soya cake medium, when measured in spectrophotometer at 540 nm. In conclusion, strain of Bacillus subtilis was found to be the potential surface active agent producers on the mustard oil cake, which can be useful medium for various environmental, food, medicinal and industrial processes

Regulation of immunity during visceral Leishmania infection

Unicellular eukaryotes of the genus Leishmania are collectively responsible for a heterogeneous group of diseases known as leishmaniasis. The visceral form of leishmaniasis, caused by L. donovani or L. infantum, is a devastating condition, claiming 20,000 to 40,000 lives annually, with particular incidence in some of the poorest regions of the world. Immunity to Leishmania depends on the development of protective type I immune responses capable of activating infected phagocytes to kill intracellular amastigotes. However, despite the induction of protective responses, disease progresses due to a multitude of factors that impede an optimal response. These include the action of suppressive cytokines, exhaustion of specific T cells, loss of lymphoid tissue architecture and a defective humoral response. We will review how these responses are orchestrated during the course of infection, including both early and chronic stages, focusing on the spleen and the liver, which are the main target organs of visceral Leishmania in the host. A comprehensive understanding of the immune events that occur during visceral Leishmania infection is crucial for the implementation of immunotherapeutic approaches that complement the current anti-Leishmania chemotherapy and the development of effective vaccines to prevent disease.The research leading to these results has received funding from the European Community’s Seventh Framework Programme under grant agreement No.602773 (Project KINDRED). VR is supported by a post-doctoral fellowship granted by the KINDReD consortium. RS thanks the Foundation for Science and Technology (FCT) for an Investigator Grant (IF/00021/2014). This work was supported by grants to JE from ANR (LEISH-APO, France), Partenariat Hubert Curien (PHC) (program Volubilis, MA/11/262). JE acknowledges the support of the Canada Research Chair Program

The ands-on guide to practical prescribing

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Anthocephalus cadamba shaped FeNi encapsulated carbon nanostructures for metal-air batteries as a resilient bifunctional oxygen electrocatalyst

Anthocephalus cadamba shaped carbon nanostructures comprising FeNi encapsulated in radially grown nitrogen-doped carbon nanotubes (NCNTs) are produced by controlled pyrolysis which exhibit advanced electrochemical oxygen evolution reaction (OER) performance with a low overpotential of similar to 290 mV at 10 mA cm(-2), small Tafel slope (37 mV dec(-1)) and endurance in an accelerated stability test. In addition to better surface electron transfer kinetics, the radial growth of NCNTs offers plenty of electrochemically active sites (high roughness factor similar to 340) in tiny spaces, better accessibility to reactant species and appropriate gas outlets to prevent bubble accumulation during OER. Besides OER, the preferential 4e(-) pathways for the oxygen reduction reaction (ORR) and excellent overall oxygen electrochemistry Delta E (E-j(OER)=10 - E-1/2(ORR) = 0.71 V) suggest excellent bifunctionality and advocate the practical importance of Anthocephalus cadamba shaped carbon nanostructures as a possible unitary oxygen electrocatalyst for metal-air battery systems

Maximizing the utilization of Fe-NxC/CNx centres for an air-cathode material and practical demonstration of metal-air batteries

Noble-metal free carbon-based electrocatalysts for oxygen reduction/evolution reaction (ORR/OER) in an alkaline medium have drawn significant attention in the search of suitable/potential replacement of commercial expensive Pt/Ru/Ir-based electrocatalysts. In this regard, nitrogen-doped carbon nanotubes (NCNTs) have emerged as potential candidates for ORR/OER and they emulate Pt/Ru-based catalysts. However, the unexposed/unused active sites rendered by N-doping, responsible for bamboo-shaped compartment formation, in NCNTs are hardly accessible to the reactant species and thus barely contribute to ORR/OER. To maximize the utilization of the active centres, Fe-Fe3C nanoparticles entrapped in the graphitic layers and hollow structures of NCNTs are fabricated by pyrolyzing melamine with excess of ferrocene. Annealing at 375 degrees C in an oxygen environment removes the protective graphitic layers around Fe-Fe3C, and acid-treatment provides an opening to the bamboo compartments of NCNTs (ANCNTs); this offers maximum accessibility of the active sites via the creation of more edges and roughness that enhances the ORR/OER activity. Interestingly, more positive ORR onset and halfwave potentials with excellent accelerated stability (similar to 98% current retention) and fuel tolerance along with lower onset and E-j=10(OER) potential with high OER current density as compared to those of commercial state-of-the-art electrocatalyst suggest the superior bifunctional behaviour of ANCNTs. The poisoning study with NaSCN on ANCNTs shows the direct involvement of Fe-based centres in oxygen electrochemistry. The overall oxygen electroactivity Delta E = E-j(OER)=10 - E-1/2(ORR) = 0.72 V for ANCNTs is much lower than that of the commercial and recently reported various state-of-the-art bifunctional catalysts. Finally, a prototype battery arrangement using NCNTs as a cathode electrode for powering a light-emitting diode has been demonstrated. Overall, NCNTs can serve as non-precious electrocatalysts for electrochemical energy devices

Additional cash Incentive within a conditional cash transfer scheme: A ′controlled before and during′ design evaluation study from India

Background : Conditional Cash Transfer (CCT) schemes have shown largely favorable changes in the health seeking behavior. This evaluation study assesses the process and performance of an Additional Cash Incentive (ACI) scheme within an ongoing CCT scheme in India, and document lessons. Material and Methods: A controlled before and during design study was conducted in Madhya Pradesh state of India, from August 2007 to March 2008, with increased in institutional deliveries as a primary outcome. In depth interviews, focus group discussions and household surveys were done for data collection. Results: Lack of awareness about ACI scheme amongst general population and beneficiaries, cumbersome cash disbursement procedure, intricate eligibility criteria, extensive paper work, and insufficient focus on community involvement were the major implementation challenges. There were anecdotal reports of political interference and possible scope for corruption. At the end of implementation period, overall rate of institutional deliveries had increased in both target and control populations; however, the differences were not statistically significant. No cause and effect association could be proven by this study. Conclusions: Poor planning and coordination, and lack of public awareness about the scheme resulted in low utilization. Thus, proper IEC and training, detailed implementation plan, orientation training for implementer, sufficient budgetary allocation, and community participation should be an integral part for successful implementation of any such scheme. The lesson learned this evaluation study may be useful in any developing country setting and may be utilized for planning and implementation of any ACI scheme in future

Medium-term outcome of severe to critically ill patients with SARS-CoV-2 infection.

BACKGROUND The medium and long-term effects of severe SARS-CoV-2 infection on survivors are unknown. Here we studied the medium term effects of COVID-19 on survivors of severe disease. METHODS This is a retrospective, case series of 200 patients hospitalised across three large Birmingham hospitals with severe-to-critical COVID-19 infection 4-7 months from disease-onset. Patients underwent comprehensive clinical, laboratory, imaging, lung function test, quality of life and cognitive assessments. RESULTS At 4-7 months from disease-onset, 63.2% of patients experienced persistent breathlessness, 53.5% complained of significant fatigue, 37.5% reduced mobility and 36.8% pain. Serum markers of inflammation and organ injuries that persisted at hospital discharge had normalised on follow-up indicating no sustained immune response causing chronic maladaptive inflammation. Chest radiographs showed a complete resolution in 82.8%; and significantly improved or no change in 17.2%. Lung function test (LFT) revealed gas transfer abnormalities in 80.0% and spirometry in 37.6% patients. Patients with breathlessness had significantly high incidence of comorbidities, abnormal residual chest X-ray and LFT (p<0.01 to all). In all parameters assessed and persisting symptoms there was no statically significant difference between patients managed on hospital wards and on ITU groups. All patients reported a significantly reduced quality of life in all domains of the EQ-5D-5L quality of life measures. CONCLUSIONS AND RELEVANCE A significant proportion of COVID-19 with severe illness experience ongoing symptoms of breathlessness, fatigue, pain, reduced mobility, depression and reduced quality of life at 4-7 months from disease-onset. Symptomatic patients tend to have more residual CXR and LFT abnormalities

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Not AvailableThe aim of the present study was to evaluate the cryoprotective effect of trehalose on stallion semen quality like progressive sperm motility, viability, acrosome integrity, membrane integrity. A total of 42 ejaculates from six Marwari stallion (seven ejaculate from each) were used. Immediately after gross evaluation, the semen was filtered into a pre warm, graduated measuring bottle to get gel free semen and it was diluted with primary extender to get sperm pellets. Secondary extender was added and divided into three equal aliquots served as control, treatment 1(50 mM treahalose) and treatment 2 (150mM trehalose). At post-thaw stage there was reduction in the progressive sperm motility, per cent viability, membrane integrity and acrosome integrity in all three groups. In T1 group per cent progressive sperm motility and viability was higher (P<0.05) than control. However, in control group percentage hypo-osmotic swollen spermatozoa were lower (P<0.05) than T1 and T2. In T1 group per cent spermatozoa with intact acrosome was higher (P<0.05) than control. The deleterious effect of group T2 on acrosome integrity and membrane integrity was significant. In conclusion, addition of 50 mM trehalose improved post-thawing semen quality.Not Availabl