Non-Invasive Panel for Prediction of Large Esophageal Varices in Patients with HCV-Related Cirrhosis after DAAS Therapy

To study sonographic and laboratory parameters as diagnostic non-invasive Indices for prediction and screening of large varices in liver cirrhotic patients post hepatitis C virus after direct Actin antiviral drugs (DAAS). Introduction: All cirrhotic patients should be screened for esophageal varices (EV) via endoscopy, as recommended by the guidelines. However, repeated endoscopy is not well accepted by patients and is a costly procedure that places a heavy burden on the endoscopic unit. Therefore, noninvasive predictors of EVs and size discrimination for EVs are of particular importance.After dividing DAAS into three arms: arm 1 with Non-EV, arm 2grad1&2 EV (Small Vriceal arm), and arm 3 grade 3&4 EV (Large Variceal arm). medical history, physical examination, standard laboratory tests, abdominal ultrasound, and sonographic parameters such as portal vein velocity (PVV). Splenic Index (SI) Splenoportal Index (SPI), platelet count/spleen diameter ratio (PCSDR) and upper gastrointestinal endoscopy were performed for all participants.Results: The Noninvasive sonographic and laboratory parameters for prediction of the presence of EVs have demonstrated that low platelet count/spleen diameter ratio (PC/SD) at cut-off (CO) ≤ 1121.43 cu/mm, then high SPI at CO >3.98 cm /sec then high FIB4 at CO > 2.68 then high APRI at CO > 0.6 then PVV at CO ≤ 22.2 cm/sec then high SI at CO > 89.7 and lastly Child’s – Pugh’s score at CO > 6 respectively.. The Non Invasive sonographic and laboratory parameters for discrimination of the size of EVs showed that high SPI was found to be the most accurate parameter at CO less than >7.75 cm/sec Then low PC/SD at CO ≤ 514.08 cu/mm then high APRI at CO > 1.4 then high FIB4 at CO > 7,6 then high SI with AUC 0.821 at CO > 122.4 then low PVV at CO < 15 and lastly Child’s –Pugh’s score at CO> 6 respectively.Conclusions: The sonographic and laboratory indices are non- invasive parameters for the prediction of EV & discrimination of its size. And to determine when Upper Endoscopy is done for liver cirrhotic patients post-C after DAA

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 &lt; 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

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Platelet count and level of paCO2 are predictors of CAP prognosis

Objective: The purpose of our study was to examine patients hospitalized with CAP association between abnormal platelet count and levels of paCO2 and ICU admission and 30 days mortality. Methods: This retrospective study was conducted on 173 patients diagnosed as CAP admitted to Mansoura University Hospital. Arterial blood gases and CBC were obtained at admission with the measurement of platelet count and paCO2. Data were collected and analyzed. Results: Patients with abnormal platelet count thrombocytopenia (19%) or thrombocytosis (28%) had a higher length of hospital stay, were more in the need for ICU admission, more use of mechanical ventilation invasive or non invasive more 30 days mortality rate with more association of pulmonary complication like pleural effusion. Both groups of hypercapnia (13%) and hypocapnia (42%) had a higher ICU admission and higher 30 day mortality rate. Conclusion: Patients with abnormality in platelet count and levels of paCO2 were associated with an increase in ICU admission and higher 30 day mortality. They should be considered for inclusion in future severity criteria to identify patients who are in need for a higher level of care

Integrated reservoir characterization of the Paleocene Farewell Formation, Taranaki Basin, New Zealand, using petrophysical and petrographical analyses

Abstract A reservoir characterization study, using petrophysical and petrographic analyses, has been made on the Paleocene Farewell Formation in the Taranaki Basin, New Zealand, based on five selected wells. Farewell Formation is largely a sandstone formation belonging to the Kapuni Group. The integrated study has shown that Farewell Formation is a good promising reservoir with average effective porosity of 17.7% and permeability of 415 mD. The petrographic study indicates the occurrence of abundant intergranular and secondary pores. It also proved that the Farewell Formation has been affected by several diagenetic features. Compaction, cementation and clay mineral authigenesis are the most common. Quartz and feldspar overgrowths have been recorded in many samples, and secondary porosity due to dissolution is also observed. In general, good reservoir quality features are dominant in the Farewell Formation and diagenesis has little effect on the reservoir quality. These findings are supported by well log interpretation results, which confirm good sand and net pay zones are available with very low average water saturation (24.9%)

Structural Modeling of the Maui Gas Field, Taranaki Basin, New Zealand

3D seismic and well log dataset were used jointly to build a structural model of the Late Cretaceous to Pliocene sedimentary sequence in the Maui Gas Field, to predict structural mechanics in the Taranaki Basin with geostatistics. Three phases of tectonic movements affected by faulting in this field were identified by this structural model: Late Cretaceous to Palaeocene rifting phase, Late Eocene to Miocene compressive faulting phase, and Plio-Pleistocene differential (compressive faulting in Maui South, normal fault activity in Maui North) faulting phase. Different phases of tectonic movements resulted in different structural patterns, Early Oligocene formations have abundant normal faults with slight slip and higher dip angles (40°-70°), and lower dip angle in the north (10°-15°) than in the south (15°-20°); Mid-Oligocene to Late Miocene formations contain low angle reverse faults (20°-40°), showing the structures in this period were affected by compressive stress on the whole; structural inversion occurred during mid-Oligocene to Pliocene, indicating the structural stress was contraction first and extension later in this period. Key words: Taranaki Basin, Maui Gas Field, 3D seismic, fault framework, extensional structure, inversion structure, variogram analysis, structure modelin

Vitamin D and markers of airway inflammation in asthma

Background: Vitamin D plays a role in the pathogenesis of asthma as it has a potent immunomodulatory effect acting on the cells of innate immunity. In asthmatic children low vitamin D levels are associated with poor asthma control, reduced lung function, increased medication intake, and exacerbations. Little is known about vitamin D in adult asthma patients or its association with asthma control and inflammatory markers of asthma. Objective: To establish the relationship between vitamin D serum levels, pulmonary function, asthma control, IgE level and exhaled FENo. Methods: This study comprised 55 subjects (15 healthy volunteers, 40 asthmatic patient) who underwent history taking, HRCT, pulmonary function test, FENO, total serum IGE level and serum 25(OH)D3 level. Results: Vitamin D deficiency and insufficiency were observed in uncontrolled asthmatic patients. Patients with vitamin D deficiency and insufficiency had lower pulmonary function, higher serum IgE level, FENO and higher number of exacerbations in the last year. Total serum IgE level, FENO, and number of exacerbations showed a negative correlation with serum 25(OH) vitamin D. Serum 25(OH)vitamin D showed a significant positive correlation with pulmonary function in asthmatic patients. Conclusion: The lower the vitamin D level deficiency or insufficiency, the more the asthma exacerbation, the less the asthma control, the higher the serum level of IgE and higher FENO. Also low vitamin D associated with airway remodeling is presented by small airway affection and HRCT findings

Depression, anxiety, distress and somatization in asthmatic patients

Objective: There is evidence that asthma is associated with an increase in psychiatric disorders (depression, anxiety, distress and somatization). The purpose of this study was to assess the presence of psychiatric disorders in adult asthmatic patients and to examine its relationship to asthma control. Methods: A cross-sectional case-control study was conducted on 134 subjects (65 healthy volunteers, 69 asthmatic patients). The asthmatic patients were divided into 3 groups, according to GINA guidelines (GINA, 2010) [2] criteria for asthma control, and were subsequently compared to control groups in terms of demographic, clinical, and spirometric data, as well as The Four-Dimensional Symptom Questionnaire to assess psychological symptoms. Results: The sample was predominantly female 49 patients (71%). Of the 69 patients, 32 (46%) were classified as having uncontrolled asthma. Somatization, anxiety, depression, distress levels were higher among asthma patients compared to control and the difference was statistically significant (p  0.05 and p > 0.05, respectively). High levels of anxiety were found among uncontrolled and partially controlled asthma cases compared to controlled cases with no statistically significant difference. Low grade depression levels were noticed among controlled cases. High levels of anxiety were found among uncontrolled and partially controlled asthma cases compared to controlled cases with no statistically significant difference (p > 0.05 and p > 0.05, respectively). There was a negative weak correlation between psychiatric symptoms and age, duration of asthma and forced expiratory volume in the first second (p > 0.05). Conclusions: Asthmatic patients are at high risk of psychiatric problems, particularly depression, anxiety and somatization. Asthmatic patients need psychotherapy besides their medication of asthma to obtain better asthma out come and management

Reservoir quality of the Late Cretaceous Volador Formation of the Latrobe group, Gippsland Basin, Australia: Implications from integrated analytical techniques

Increasing demand for energy due to the populous Eastern Australia has driven oil and gas industries to find new sources of hydrocarbons as they are the primary energy suppliers. Intensive study has been done on the Volador Formation in the Gippsland Basin by means of core-based petrophysical, sedimentological, and petrographic analyses as well as well log-based interpretation and capillary pressure test. Five wells from Kipper, Basker and Tuna fields with available dataset were investigated in this study: Kipper-1, Basker-1, Basker-2, Basker-5 and Tuna-4. Overall, the formation has good reservoir quality based on the high porosity and permeability values obtained through core and well log petrophysical analyses. The formation made up of mostly moderate to coarse quartz grains that has experienced strong anti-compaction and is poorly cemented. Montmorillonite and illite clays are seen dispersed in the rock formation, with the minority being mixed clays. These clays and diagenetic features including kaolinite cement and quartz overgrowth that can lead to porosity reduction only have insignificant impact on the overall reservoir quality. In addition, capillary pressure data shows that most samples are found in the transition to good reservoir zones (<50% saturation). The results obtained from this study have shown that the Volador Formation in the Gippsland Basin is worth for hydrocarbon exploration

Total serum IgE level in COPD patients

Objective: The Dutch Hypothesis has been used to suggest that Asthma and COPD may be considered as different expressions of one disease entity. The purpose of this study is to evaluate the levels of IgE in COPD patients and its relation with respiratory symptoms and lung functions this may be a suggestive of atopy as a mechanism for initiation of their exacerbations. Methods: A cross-sectional case-control study was conducted on 50 subjects recruited from the outpatient clinic (11 healthy volunteers, 39 diagnosed as COPD) COPD patients (31 males (79%) and 8 females (21%)) diagnosed as mild, moderate and severe. The studied groups were also divided according to total serum IgE levels and compared in demographic data, clinical data, spirometric data, and HRCT findings. Results: COPD patients with elevated IgE had a longer history of illness, high smoking index, higher number of exacerbation in the last year, and more lower FEV1. HRCT finding in both groups was hyperinflation was high in COPD patients with normal IgE levels, 10 cases (45%), while bronchiectasis was higher in COPD patients with elevated IgE, 7 cases (41%). Sputum culture was positive for aspergillosis in 5 cases (29%) in COPD patients with elevated IgE. Conclusions: There was a high prevalence of elevated serum T-IgE in patients with COPD but without obvious atopy. Serum T-IgE levels were found to be associated with symptoms such as dyspnea and impairment of lung function. Recurrent exacerbation of COPD is believed to accelerate disease progression and impairment of pulmonary function