A Comprehensive Review On Anti-Microbial And Antioxidant Properties Of Betel Leaf

Piper betel L. is a member of the Piperaceae family, which is sometimes referred to as Paan. In Sri Lanka, India, Thailand, Taiwan, and other Southeast Asian nations, it is widely grown.The leaves have a caustic, bittersweet, spicy, and somewhat sweet flavor. It contains a significant number of biomolecules with a range of pharmacological actions, including laxative, carminative, stomachic, anti-elminthic, tonic, and aphrodisiac properties. The leaves are used to treat a variety of conditions, including styptic, bronchitis, ozoena, cough, and foul-smelling mouth. They also clear the throat. In the current investigation, four distinct extracts of piper betel leaves (water, methanol, ethyl acetate, and petroleum ether) were evaluated against four distinct pathogenic bacteria: Escherichia coli, Proteus vulgaris, Staphylococcus aureus, and Streptococcus pyogenes. This current review showed that betel leaves extract, essential oil could inhibit microbial growth and kill various Gram-negative and Gram-positive bacteria as well as fungal species, including those that are multidrug-resistant and cause serious infectious diseases

A prospective comparative study of outcome between open lichtenstein versus laparoscopic repair of inguinal hernia

Background: Laparoscopic hernia repair is technically difficult and has long learning curve than open repair. Moreover, with increased cost of procedure do patient really get benefited in terms of intraoperative time duration, post-operative pain and complications, length of hospital stays, and time taken to return to usual activity needs to be studied.Methods: In this prospective observational study of 100 patients including unilateral, bilateral, direct and indirect inguinal hernia and excluding obstructed and strangulated hernia, 61 patients underwent open repair and 39 patients underwent laparoscopic hernia repair. Pain analysis was done with visual analogue scale. Unpaired student T test and Chi square test used (p<0.05).Results: Baseline characteristics age, sex of the two groups were similar. Mean operative time in laparoscopic group was 105.38±35.13 minutes and in open group was 79.95±31.12 minutes (p<0.001). There was statistically significant difference in mean pain score of laproscopic verses open techniques (p<0.001). Urinary retention was the most common post-operative complication in both groups but was statistically not significant. Mean hospital stay in laparoscopic group was 1.56±0.50 days and in open group was 1.9±0.50 days (p-0.002). Mean time taken to return to usual activity in open repair was 41.10±27.15 days and in laparoscopic group was 16.23±6.37 days (p-0.001).Conclusions: This study showed that in laparoscopic repair of inguinal hernia patients have less post-operative pain, shorter hospital stays and early return to work. However, the laparoscopic technique had longer operative time duration

Downregulated Expression of Ly-6-ThB on Developing T Cells Marks CD4+CD8+ Subset Undergoing Selection in the Thymus

Interaction of TCRs on CD4+CD8+ immature T cell with MHC-peptide complexes on stromal cells is required for positive and negative selection in the thymus. Identification and characterization of a subpopulation of CD4+CD8+ thymocytes undergoing selection in the thymus will aid in understanding the mechanisms underlying lineage commitment and thymic selection. Herein, we describe the expression of Ly-6 ThB on developing thymocytes. The majority of CD4+CD8+ thymocytes express Ly-6 ThB at high levels. Its expression is downregulated in a subset of CD4+CD8+ thymocytes as well as in mature CD4+CD8- and CD4-CD8+ T cells. More importantly, interaction of TCR/coreceptor with the self-MHC-peptide contributes to the downregulation of ThB expression on developing thymocytes. These findings indicate that downregulation of ThB on CD4+CD8+ thymocytes identifies a unique subset (CD4+CD8+ThBneg–low) of thymocytes that has received the initial signals for thymic selection but have not yet downregulated the CD4 and CD8 cell surface expression. In addition, these results also indicate that a high frequency (Ÿ20–40%) of CD4+CD8+ immature thymocytes receive these initial signals during thymic selection

Bacteriological analysis of bile in cholecystectomy patients

Background: Cholecystectomy is currently a frequently performed operation. The presence of gallstones within either the gallbladder or biliary tree is associated with the bacterial colonization of the bile. Acute cholangitis spans a continuous clinical spectrum and can progress from a local biliary infection to advanced disease with sepsis and multiple organ dysfunction syndrome. Therefore, it is important to know the microbiological flora of the gallbladder before prophylactic antibiotics are given. Aims & objectives: To evaluate the microbiological profile of bile from gall bladder in patients undergoing cholecystectomy. To determine the appropriate antibiotic for preoperative prophylaxis in cholecystectomy patients based on the microbiological profile of bile.Methods: The study was a prospective study carried out in SSG Hospital. A total of 78 patients undergone cholecystectomy who met the inclusion criteria were included in the study. 3cc bile was aspirated from all patients, this collected bile from gallbladder before cholecystectomy was transported to the laboratory in sterile test-tube. The specimen was evaluated to find out whether it is sterile or has any bacteria present. The types of bacteria are determined and whether the amount of isolate is significant or not. And sensitivity to antibacterial agents against antibiotics was determined.Results: 19 patients showed positive bile culture in which Escherichia coli was the most common isolated bacteria (63.16% among positive bile culture and 15.38% among all patients) and bile was sterile in 59 patients (75.64%). Other organisms isolated were Pseudomonas (3.85%), Klebsiella (2.56%), coagulase negative Staphylococcus and Staphylococcus viridans (1.28%). Positive bile culture was a more common finding (50% of patients were bile culture positive) in patients with acute cholecystitis in this study. Post-operative wound infection is more common (15.79%) in group of patients with isolated organism from bile. There is a strong correlation between bile culture and wound culture (75%).  Conclusions: It was found that sensitivity to third- and fourth-generation cephalosporins was higher as compared to aminoglycoside in acute as well as chronic cholecystitis. In this study levofloxacin also shows good sensitivity against isolated organism from bile. Piperacilin and tazobactum also shows good sensitivity against isolated organism from bile and they are more effective against pseudomonas. The resistance to second-generation cephalosporins and aminoglycoside has increased. For preoperative prophylaxis third and fourth-generation cephalosporins and levofloxacin show better promise and may be used as the first line of preoperative prophylaxis in operations for acute and chronic cholecystitis undergoing cholecystectomy.

A lived experience co-designed study protocol for a randomised control trial: the Attempted Suicide Short Intervention Program (ASSIP) or Brief Cognitive Behavioural Therapy as additional interventions after a suicide attempt compared to a standard Suicide Prevention Pathway (SPP)

BACKGROUND: Despite being preventable, suicide is a leading cause of death and a major global public health problem. For every death by suicide, many more suicide attempts are undertaken, and this presents as a critical risk factor for suicide. Currently, there are limited treatment options with limited underpinning research for those who present to emergency departments with suicidal behaviour. The aim of this study is to assess if adding one of two structured suicide-specific psychological interventions (Attempted Suicide Short Intervention Program [ASSIP] or Brief Cognitive Behavioural Therapy [CBT] for Suicide Prevention) to a standardised clinical care approach (Suicide Prevention Pathway [SPP]) improves the outcomes for consumers presenting to a Mental Health Service with a suicide attempt. METHODS: This is a randomised controlled trial with blinding of those assessing the outcomes. People who attempt suicide or experience suicidality after a suicide attempt, present to the Gold Coast Mental Health and Specialist Services, are placed on the Suicide Prevention Pathway (SPP), and meet the eligibility criteria, are offered the opportunity to participate. A total of 411 participants will be recruited for the study, with 137 allocated to each cohort (participants are randomised to SPP, ASSIP + SPP, or CBT + SPP). The primary outcomes of this study are re-presentation to hospitals with suicide attempts. Presentations with suicidal ideation will also be examined (in a descriptive analysis) to ascertain whether a rise in suicidal ideation is commensurate with a fall in suicide attempts (which might indicate an increase in help-seeking behaviours). Death by suicide rates will also be examined to ensure that representations with a suicide attempt are not due to participants dying, but due to a potential improvement in mental health. For participants without a subsequent suicide attempt, the total number of days from enrolment to the last assessment (24 months) will be calculated. Self-reported levels of suicidality, depression, anxiety, stress, resilience, problem-solving skills, and self- and therapist-reported level of therapeutic engagement are also being examined. Psychometric data are collected at baseline, end of interventions, and 6,12, and 24 months. DISCUSSION: This project will move both ASSIP and Brief CBT from efficacy to effectiveness research, with clear aims of assessing the addition of two structured psychological interventions to treatment as usual, providing a cost-benefit analysis of the interventions, thus delivering outcomes providing a clear pathway for rapid translation of successful interventions. TRIALS REGISTRATION: ClinicalTrials.govNCT04072666. Registered on 28 August 201

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Factors Affecting Consumer Purchasing Decision in Kenya’s Motor Industry: Case of Toyota Kenya Customers

A Project Report by Mehta Hitesh Nitin, Submitted to the Chandaria School of Business in Partial Fulfilment of the Requirements for the Masters of Business Administration (MBA).The general objective of the study was to examine factors affecting consumer purchasing decisions in Kenya’s motor vehicle industry. The study was guided by the following specific objectives: to determine the economic factors affecting consumer purchasing decisions in Kenya’s motor vehicle industry; to examine the psychological factors affecting consumer purchasing decisions in Kenya’s motor vehicle industry; to examine the social-cultural factors affecting consumer purchasing decisions in Kenya’s motor vehicle industry, and; to analyze the demographic factors affecting consumer purchasing decisions in Kenya’s motor vehicle industry. Descriptive research design was employed in the study. The target population included all 2,913 customers of Toyota Kenya in Nairobi. Simple random sampling techniques was employed while data collection was conducted with the help of a questionnaire. The data was analyzed using descriptive and inferential statistics with the help of the Statistical Package for Social Sciences (SPSS). The results were then presented in tables and figures. The study revealed that there was a positive significant relationship between economic factors and purchasing decision. Implying that the consumer purchasing decision is influenced by economic factors such as level of income, price, quality of car, maintenance costs, resale value of the car, payment options, ease of finding a mechanic to repair the specific car brand, interest rates as well as fuel prices. The study further revealed there was a positive significant relationship between psychological factors and purchasing decision. This findings imply that the consumer purchasing decision is influenced by psychological factors such as perception, motivation from friends and family, attitude towards the brand, innovative of the car and brand, personal beliefs as well as knowledge sharing from friends and colleagues. It was also revealed that there was a positive significant relationship between Social-cultural factors and purchasing decision. This finding implies that the consumer purchasing decision is influenced by Social-cultural factors such as perception, motivation from friends and family, attitude towards the brand, innovative of the car and brand, personal beliefs as well as knowledge sharing from friends and colleagues. Finally the study revealed that there was a positive significant relationship between demographic factors and purchasing decision. This finding implies that the consumer purchasing decision is influenced by demographic factors such as demographic factors such as personality, gender, Age, Changing life, level of education, lifestyle, lifecycle status and occupation. The study concludes that psychological factors, social-cultural factors, economic factors, as well as demographic factors affect consumer purchasing decisions in Kenya’s motor vehicle industry in Kenya. The study recommends that firms dealing with motor vehicle need to consider the various economic factors that influence consumer decision making such as interest rates, income as well as rising fuel prices. In this regard they need to design motor vehicle for different categories of customers in different income brackets in Kenya. There is a need to make sure that investments in quality occur in areas that will resonate with customers. Finally it was important to understand the little things that consumers use as the basis for making a judgment of when it comes to purchasing decisions. The study recommends the need for automobile companies to consider consumers’ demographic characteristics such as age, gender, marital status, occupation, education and income when designing the products to offer into the Kenyan market. This is because demography factors are vital and measurable statistics of a population that helps to locate target market, they are easier to measure and are suitable for psychographic and socio-cultural studies. Additionally demographic factors have a huge impact on the assessment of different features which are generally associated with consumer behaviour

A study of the utility of lactate dehydrogenase, total proteins, and adenosine deaminase in the diagnosis of pleural exudates: A new statistical approach

Background: Pleural fluid (PF) may be transudative or exudative. Total protein estimation from PF is used to detect exudative pleural effusion. Objectives: To determine the role of new suggested criteria consisting of lactate dehydrogenase (LDH), total proteins (TP), and adenosine deaminase (ADA) in diagnosis of pleural effusion and differentiate it into transudative and exudative and also to compare it with Light’s criteria. Materials and Methods: This was a cross-sectional study comprising 101 patients with pleural effusion, classified by previously established criteria as transudates or exudates. The study was carried out in a 550-bedded tertiary-care, ruralbased, teaching hospital for 1 year. Diagnostic parameters mentioned in Light’s criteria were performed from PF and serum, whereas parameters of the new criteria used in our study (LDH, TP, and ADA) were performed from PF. Receiveroperating characteristic curve was used to determine the cutoffs, multiple parallel tests were applied to combine individual test markers to optimize diagnostic accuracy and sensitivity, and specificity and diagnostic accuracy for each test were calculated. Results: After using multiple parallel tests, the sensitivity, specificity, and accuracy of Light’s criteria for diagnosing exudates were 98.9%, 75%, and 95% and those for transudates were 95.29%, 80%, and 93%, respectively. Whereas for the proposed new criteria, sensitivity, specificity, and accuracy for diagnosing exudates were 98.81%, 93.75%, and 98% and those for transudates were 95.23%, 87.5%, and 94%, respectively. The accuracy of new criteria was comparable to that of Light’s criteria (p = 0.0018). Conclusion: From our study, it can be concluded that PF analysis of LDH, TP, and ADA has high sensitivity and specificity for diagnosing pleural effusions and can be used as useful markers to suggest exudative effusions