Acute-on-chronic Liver Failure: MELD Score 30-day Mortality Predictability and Etiology in a Pakistani Population

Background: Cirrhosis is a pathological condition that ultimately leads to liver failure. Acute on chronic liver failure (ACLF) has a high short term mortality rate. Viral hepatitis is the most common cause of liver failure in our local population. We carried out this study to identity the 30-day mortality and etiology of patients presenting with ACLF using Model for End-Stage Liver Disease (MELD) score predictability. Methodology: This was a descriptive case series, conducted at Sheikh Zayed Hospital, Lahore, Pakistan from January 31, 2018 to July 30, 2018. One hundred and eighty five patients who met the inclusion criteria were enrolled using 95% confidence level and 4% margin of error. Data was entered and analyzed with SPSS version 23.0. Numerical variables including age was presented by Mean ± S.D. Categorical variables i.e. gender, etiology of acute-on-chronic liver failure and 30-day mortality were presented by frequency and percentage. Data was stratified for age, gender, duration of chronic liver disease and MELD grade to address the effect modifiers. Post-stratification chi-square test was calculated using 95% significance (p≤0.05). Results: Majority of the enrolled patients were male (74.6%) while only 25.4% of the patients were female. One hundred and thirty patients (70.3%) had underlying viral hepatitis while twelve patients (6.5%) and forty three patients (23.2%) presented with alcoholic liver disease and drug-induced ACLF, respectively. Eighty patients (43.2%) died within 30 days of admission.The 30-day mortality with respect to MELD grade was statistically significant (p<0.001) with the highest mortality noted in grade-IV and thirty five patients (43.8%) dying within 30 days of admission (p<0.001). Grade-II and III MELD scores also contributed to the 30-day mortality with twenty three patients (28.8%) and nineteen patients (23.8%) dying within 30 days of admission (p<0.001). Conclusion: MELD scores are able to accurately predict the short-term mortality in patients with ACLF and viral hepatitis was the most common etiology in our population. Early detection and use of appropriate prognostic models may alleviate mortality and morbidity in paitents with ACLF

Multi-Response Optimisation for the Development of an Activated Carbon Web as Interlining for Higher Electrical Conductivity and EMI Shielding Using Grey Relational Analysis

This paper presents a simple and novel method of producing an activated carbon (AC) non-woven web from acrylic waste derived from discarded bathmats converted into a nonwoven web by a carding and needle punching machine. After stabilisation at lower temperature, carbonisation of the stabilised web was performed in a muffle furnace. The carbonisation temperature, the holding time of the activated carbon web at the final temperature, the heating rate to reach the final carbonisation temperature and the number of steps adopted for developing the carbon web were optimised using the grey relational analysis (GRA) approach to get optimum responses of the surface area of the web, electrical conductivity and electromagnetic shielding. The results demonstrated a large improvement in electrical conductivity as surface resistivity decreased from 134.21 Ω.mm to 0.28 Ω.mm, and the corresponding electromagnetic shielding increased to 82.63 dB when the temperature of the carbonisation, the holding time and number of steps were increased. The surface area in the AC web was increased from 73 m2g-1 to 210 m2g-1 with an increase in the carbonisation temperature, the holding time and number of steps to reach the final temperature. The optimisation technique used in this work could be successfully used in cost and error reduction while producing an AC web. The optimised AC web was characterised by Brunauer, Emmett and Teller (BET), X-ray diffraction characterisation and elemental analysis (EDX) in order to determine changes in its structure, surface area, degree of crystallinity, inter-layer spacing and proportion of different elements. The AC web developed can be effectively employed as interlining in apparels because of its flexibility and eco-friendly electromagnetic shielding, as it works on the principle of the absorption, reflections and internal reflections of electromagnetic radiations