Isolation, fruiting and pathogenicity of marasmiellus palmivorus (Sharples) desjardin (comb. prov.) in oil palm plantations in West Malaysia

Malaysia`s golden crop, oil palm (Elaies guineensis), is susceptible to bunch rot disease caused by Marasmiellus palmivorus (Sharples) Desjardin (comb. prov.). Nonetheless, there is no published information on the morphology and pathogenicity of the species found in local oil palm plantations in Malaysia. Rhizomorphs and basidiocarps found on dead fronds or trunks were randomly sampled from the plantations located in the states of Perak and Selangor. Isolates were identified based on the morphology and molecular methods as Marasmiellus palmivorus and pure cultures subsequently produced similar fruit bodies (basidiocarps) by in vitro methods. Hyphal morphology was examined by light and scanning electron microscopy and found to be septate and produced clamp connections. White spore prints were obtained from each pileus. Naturally grown and induced basidiocarps were similar with diameter of pileus ranging from 1.0-2.8cm, slightly depressed at the centre, smooth, convex, with involute margin, orange-white fading to white and possessed a central, solid, cylindrical, tough, overall whitish stipes with length ranging from 0.8- 2.6cm. The gills were adnate, distant and have a non-distinctive odour. Basidiospores were ellipsoid in shape and spores were found to be viable with percentage germination of 80-85%. Upon germination, they produced germ tubes ranging from 64.3 – 82.5 µm after 24 h incubation at ambient temperature (27 ± 2°C) on water agar. Pathogenicity test of six isolates of Marasmiellus sp. positively produced necrotic symptoms on wounded leaves of oil palm seedlings

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

A simple neuro-Heuristic computational intelligence algorithm for thin film flow equation arising in physical models

16th IEEE International Conference on Machine Learning and Applications (ICMLA) -- DEC 18-21, 2017 -- Cancun, MEXICOWOS: 000425853000085In this study, computational method are used for finding the approximation in the solution of thin film flow problem using stochastic solver like genetic algorithm (GA) and pattern search (PS). the mathematical model is formulated by defining a fitness function and the process is working in artificial neural networks (ANNs). Proposed numerical results are optimized several times for various values of stoke numbers and material parameters. Different parameters are chosen and several independent number of runs are carried out to find the reliability and accuracy of results. A statistical analysis is presented for the reliability of designed scheme.IEE

Unilateral pulmonary artery agenesis: An unusual cause of hemoptysis

Introduction: Unilateral pulmonary artery agenesis (UPAA) is a rare congenital malformation of the pulmonary artery due to agenesis of the sixth aortic arch during embryogenesis. Diagnosis can be challenging due to variable clinical presentations. Case: A 29-year-old female at third trimester of twin pregnancy presented with massive hemoptysis. Computed tomography angiogram (CTA) showed unilateral absence of the right pulmonary artery with multiple dilated tortuous bronchial arteries supplying the right lung. Selective embolization of the bronchial artery was performed post-partum. Conclusion: Clinicians should have a high clinical suspicion of collateral artery bleeding in patients who present with unexplained hemoptysis and typical UPAA radiographic findings

Frequency of hepatocellular carcinoma in patients with hepatitis C received treatment with directly antiviral agents

Background and Aims: Hepatitis C infection is one of leading causes of liver cirrhosis and a considerable proportion of hepatocellular carcinoma worldwide. Despite the very high efficacy of Directly Acting Viral Agents (DAAs) on clearance of hepatitis C their role remains controversial on development of Hepatocellular Carcinoma. The Aim of this study is to analyze hepatocellular occurrence in hepatitis C patients after achieving Sustained virologic response on directly acting viral agent. Methods and Material: It is prospective study conducted on outpatients in the Hepato-gastroenterology department of Asian Institute of Medical Science Hospital Hyderabad from 21-10-2018 to 20-04-2019. All patients who fulfilled the criteria were enrolled, their baseline demographic characteristics, Child Pugh Class, MELD score, alpha-fetoprotein level and Ultrasound liver before and after treatment collected. Duration of DAAs treatment and type of DAAs used also noted. Hepatocellular carcinoma labelled when Triphasic CT scan liver shows typical characters of hepatocellular carcinoma i.e. arterial phase hyperenhancement and delayed washout on portal and venous phase or ultrasound liver shows focal liver lesion with alpha-fetoprotein level more than 300ng/ml. Results: One hundred fifty-seven patients of chronic hepatitis C enrolled in the study after exclusion criteria.&nbsp