Analgesic efficacy of intravenous paracetamol versus intravenous tramadol after caesarean section: a single blind randomized controlled study

Background: Caesarean section is one of the commonest surgeries performed in obstetrics. Adequate management of postoperative pain leads to early mobilization and proper newborn care. The purpose of this study was to compare the analgesic efficacy and side effect profile of Paracetamol versus Tramadol in women undergoing caesarian section.Methods: A single-blind randomized controlled interventional study was conducted in Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi over a period of six months from May 2015 to Oct 2015. 100 women undergoing caesarean section under spinal anaesthesia were divided in two groups (50 in each group) using computer generated randomization. One group received Intravenous Paracetamol 1000 mg and another group Intravenous Tramadol 50 mg. The drugs were given 8 hourly for 24 hours. The primary outcome measures were the degree of pain relief during the entire observation period by doing visual analogue scale (VAS) scoring and need of rescue analgesia if any (administered if the VAS score >6); secondary outcome measures were side effects on mother and baby.Results: The pain scores were low in both groups across various time interval except at 6 hours in Paracetamol group (p=0.673) and at 8 hours in Tramadol group (p=0.194). Requirement for rescue analgesia was comparable in both the groups (16% vs. 10%, p = 0.372). However maternal side effects were more in Tramadol group (8% vs. 34%, p = 0.001).Conclusions: Both Paracetamol and Tramadol achieve satisfactory pain control after caesarean section but Tramadol causes significant side effects in mother compared to paracetamol

Chitosan Based Biodegradable Composite for Antibacterial Food Packaging Application

A recent focus on the development of biobased polymer packaging films has come about in response to the environmental hazards caused by petroleum-based, nonbiodegradable packaging materials. Among biopolymers, chitosan is one of the most popular due to its biocompatibility, biodegradability, antibacterial properties, and ease of use. Due to its ability to inhibit gram-negative and gram-positive bacteria, yeast, and foodborne filamentous fungi, chitosan is a suitable biopolymer for developing food packaging. However, more than the chitosan is required for active packaging. In this review, we summarize chitosan composites which show active packaging and improves food storage condition and extends its shelf life. Active compounds such as essential oils and phenolic compounds with chitosan are reviewed. Moreover, composites with polysaccharides and various nanoparticles are also summarized. This review provides valuable information for selecting a composite that enhances shelf life and other functional qualities when embedding chitosan. Furthermore, this report will provide directions for the development of novel biodegradable food packaging materials

Graphene-Based Aerogels for Biomedical Application

Aerogels are three-dimensional solid networks with incredibly low densities, high porosity, and large specific surface areas. These aerogels have both nanoscale and macroscopic interior structures. Combined with graphene, the aerogels show improved mechanical strength, electrical conductivity, surface area, and adsorption capacity, making them ideal for various biomedical applications. The graphene aerogel has a high drug-loading capacity due to its large surface area, and the porous structure enables controlled drug release over time. The presence of graphene makes it a suitable material for wound dressings, blood coagulation, and bilirubin adsorption. Additionally, graphene’s conductivity can help in the electrical stimulation of cells for improved tissue regeneration, and it is also appropriate for biosensors. In this review, we discuss the preparation and advantages of graphene-based aerogels in wound dressings, drug delivery systems, bone regeneration, and biosensors

EPEN-21. Developing a sensitive method for detection of minimal residual disease in ependymoma using metabolomic analysis of cerebrospinal fluid

Ependymoma (EPN) is the second most common malignant paediatric brain tumour with poor survival and significant neuro-cognitive impairment from current treatments (surgery and radiotherapy). Relapse occurs in 50% of patients within 2 years, despite no evidence of tumour on MRI. This suggests that they have minimal residual disease (MRD) at the end of treatment. Developing an accurate MRD detection method could help select patients who would benefit from further continuation chemotherapy, thereby improving survival. There is also an unmet need for an accurate test to diagnose relapse early when the disease could be more treatable. METHODS: Pilot untargeted liquid chromatography-mass spectrometry (LC-MS) analysis was carried out in cerebrospinal fluid (CSF) samples from patients with ependymoma. CSF from patients in remission from leukemia were used as controls. RESULTS: Pilot data from analysis of CSF using LC-MS demonstrates that this is a feasible approach to characterise CSF metabolomic profile. Also, EPN CSF profile is significantly different from control CSF, with significant elevation of few key metabolites (Vitamin D derivatives and betaine) in EPN CSF compared to control CSF. Immunohistochemical analysis of EPN tumour tissue microarrays confirms the expression of betaine / one-carbon pathway enzymes such as methionine synthase and betaine—homocysteine S-methyltransferase. Further validation of CSF profile with tumour metabolomic profile and serial CSF sample profiling is currently underway. Subgroup-specific differences and targeted analysis to develop a panel of biomarkers is also being explored. CONCLUSION: Early results suggest that CSF-based metabolite profiling using LC-MS is feasible and could help detect minimal residual disease in ependymoma. Further validation is required to analyse subgroup-specific differences and correlate quantitative changes in metabolites with changing disease burden

Inequalities in access to paid sick leave among workers in England and Wales

Background: It is poorly understood which workers lack access to sick pay in England and Wales. This evidence gap has been of particular interest in the context of the Covid-19 pandemic given the relationship between presenteeism and infectious disease transmission. // Method: This cross-sectional analysis (n = 8874) was nested within a large community cohort study based across England and Wales (Virus Watch). An online survey in February 2021 asked participants in work if they had access to paid sick leave. We used logistic regression to examine sociodemographic factors associated with lacking access to sick pay. // Results: Only 66% (n = 5864) of participants reported access to sick pay. South Asian workers (adjusted odds ratio [OR] 1.40, 95% confidence interval [CI] 1.06–1.83) and those from Other minority ethnic backgrounds (OR 2.93, 95% CI 1.54–5.59) were more likely to lack access to sick pay compared to White British workers. Older workers (OR range 1.72 [1.53–1.93]–5.26 [4.42–6.26]), workers in low-income households (OR 2.53, 95% CI 2.15–2.98) and those in transport, trade, and service occupations (OR range 2.03 [1.58–2.61]–5.29 [3.67–7.72]) were also more likely to lack access to sick pay compared respectively to workers aged 25–44, those in high income households and managerial occupations. // Discussion: Unwarranted age and ethnic inequalities in sick pay access are suggestive of labour market discrimination. Occupational differences are also cause for concern. Policymakers should consider expanding access to sick pay to mitigate transmission of Covid-19 and other endemic respiratory infections in the community, and in the context of pandemic preparation

Nucleocapsid and spike antibody responses post virologically confirmed SARS-CoV-2 infection: An observational analysis in the Virus Watch community cohort

Objectives: Seroprevalence studies can provide a measure of SARS-CoV-2 cumulative incidence, but a better understanding of spike (anti-S) and nucleocapsid (anti-N) antibody dynamics following infection is needed to assess longevity of detectability. / Methods: Adults aged ≥18 years old, from households enrolled in the Virus Watch prospective community cohort study in England and Wales, provided monthly capillary-blood samples which were tested for anti-S and anti-N. Participants self-reported vaccination dates and past medical history. Prior polymerase chain reaction (PCR) swabs were obtained through Second Generation Surveillance System (SGSS) linkage data. Primary outcome variables were seropositivity and total anti-N and anti-S levels after PCR confirmed infection. / Results: A total of 13,802 eligible individuals provided 58,770 capillary blood samples. 537 of these had a prior positive PCR confirmed SARS-CoV-2 infection within 0-269 days of antibody sample date, with 432 (80.45%) having a positive anti-N result. Median anti-N levels peaked between days 90 and 119 post PCR results and then began to decline. There is evidence of anti-N waning from 120 days onwards, with earlier waning for females and younger age categories. / Conclusion: Our findings suggests that anti-N have around 80% sensitivity for identifying previous COVID-19 infection and duration of detectability is affected by sex and age

Symptom profiles and accuracy of clinical case definitions for COVID-19 in a community cohort: results from the Virus Watch study

Background: Understanding symptomatology and accuracy of clinical case definitions for community COVID-19 cases is important for Test, Trace and Isolate (TTI) and future targeting of early antiviral treatment. Methods: Community cohort participants prospectively recorded daily symptoms and swab results (mainly undertaken through the UK TTI system). We compared symptom frequency, severity, timing, and duration in test positive and negative illnesses. We compared the test performance of the current UK TTI case definition (cough, high temperature, or loss of or altered sense of smell or taste) with a wider definition adding muscle aches, chills, headache, or loss of appetite. Results: Among 9706 swabbed illnesses, including 973 SARS-CoV-2 positives, symptoms were more common, severe and longer lasting in swab positive than negative illnesses. Cough, headache, fatigue, and muscle aches were the most common symptoms in positive illnesses but also common in negative illnesses. Conversely, high temperature, loss or altered sense of smell or taste and loss of appetite were less frequent in positive illnesses, but comparatively even less frequent in negative illnesses. The current UK definition had 81% sensitivity and 47% specificity versus 93% and 27% respectively for the broader definition. 1.7-fold more illnesses met the broader case definition than the current definition. Conclusions: Symptoms alone cannot reliably distinguish COVID-19 from other respiratory illnesses. Adding additional symptoms to case definitions could identify more infections, but with a large increase in the number needing testing and the number of unwell individuals and contacts self-isolating whilst awaiting results

Tracking Changes in Mobility Before and After the First SARS-CoV-2 Vaccination Using Global Positioning System Data in England and Wales (Virus Watch): Prospective Observational Community Cohort Study.

BACKGROUND: Evidence suggests that individuals may change adherence to public health policies aimed at reducing the contact, transmission, and spread of the SARS-CoV-2 virus after they receive their first SARS-CoV-2 vaccination when they are not fully vaccinated. OBJECTIVE: We aimed to estimate changes in median daily travel distance of our cohort from their registered addresses before and after receiving a SARS-CoV-2 vaccine. METHODS: Participants were recruited into Virus Watch starting in June 2020. Weekly surveys were sent out to participants, and vaccination status was collected from January 2021 onward. Between September 2020 and February 2021, we invited 13,120 adult Virus Watch participants to contribute toward our tracker subcohort, which uses the GPS via a smartphone app to collect data on movement. We used segmented linear regression to estimate the median daily travel distance before and after the first self-reported SARS-CoV-2 vaccine dose. RESULTS: We analyzed the daily travel distance of 249 vaccinated adults. From 157 days prior to vaccination until the day before vaccination, the median daily travel distance was 9.05 (IQR 8.06-10.09) km. From the day of vaccination to 105 days after vaccination, the median daily travel distance was 10.08 (IQR 8.60-12.42) km. From 157 days prior to vaccination until the vaccination date, there was a daily median decrease in mobility of 40.09 m (95% CI -50.08 to -31.10; P<.001). After vaccination, there was a median daily increase in movement of 60.60 m (95% CI 20.90-100; P<.001). Restricting the analysis to the third national lockdown (January 4, 2021, to April 5, 2021), we found a median daily movement increase of 18.30 m (95% CI -19.20 to 55.80; P=.57) in the 30 days prior to vaccination and a median daily movement increase of 9.36 m (95% CI 38.6-149.00; P=.69) in the 30 days after vaccination. CONCLUSIONS: Our study demonstrates the feasibility of collecting high-volume geolocation data as part of research projects and the utility of these data for understanding public health issues. Our various analyses produced results that ranged from no change in movement after vaccination (during the third national lock down) to an increase in movement after vaccination (considering all periods, up to 105 days after vaccination), suggesting that, among Virus Watch participants, any changes in movement distances after vaccination are small. Our findings may be attributable to public health measures in place at the time such as movement restrictions and home working that applied to the Virus Watch cohort participants during the study period