The Outcome of Endoscopic Sinus Surgery in terms of Olfaction in Patients of Chronic Rhinosinusitis with Polyps

Objective: To assess the effectiveness of functional endoscopies sinus surgery in improving olfaction in patients diagnosed with chronic rhinosinusitis with nasal polyps, as measured by changes in Sniffin’s Stick scores and olfaction scores pre and post operatively. Methodology: The clinical observational study was conducted at the ENT department, Services Hospital, Lahore for 6 months from 01-03-2022 to 31-08- 2022. Sixty-six patients (66) diagnosed with chronic rhinosinusitis with nasal polyps were enrolled, and evaluated by using Sniffin’s Stick score and olfaction baseline score. The inclusion criteria were patients aged 10-60 years of age diagnosed with this condition and willing to undergo surgery. Operative time was noted. After surgery, patients were discharged and were followed-up in OPD for 3 months. After 3 months, patients were re-evaluated for Sniffin’s Stick score and olfaction score. Results: The mean age of the patients was 36.18±13.87 years, 49(74.24%) patients were male. On pre-op evaluation the mean Sniffin’s Stick score of the patients was 6.14±0.41 which improved to 7.34±0.41 on postop evaluation. Similarly on pre-op evaluation the mean olfaction score of the patients was 8.30±5.84 which improved to 21.12±5.95 on post-op evaluation. Conclusion: There is significant improved outcome observed in terms snuffiness and olfaction score for functional endoscopic sinus surgery in patents of chronic rhino-sinusitis with nasal polyp

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Structural, Magnetic, and Magnetothermal Properties of Co100−xNix Nanoparticles for Self-Controlled Hyperthermia

In this study, the structural and magnetic properties of a series of functionalized Co100−xNix (x = 20, 30, 40, 50, 60, 80, 85) nanoparticles (NPs) were analyzed with the objective of attaining a high specific absorption rate (SAR). The magnetic nanoparticles (MNPs) obtained by ball milling at 1425 rpm lie in the range of 03–29 nm and are studied as potential candidates for magnetic fluid hyperthermia. Magnetic measurements show that all samples possess soft ferromagnetic properties with the reduction in the Curie temperature (TC) by Ni substitution in Co100−xNix alloys and by ball milling. The specific absorption rate (SAR) and specific loss power (SLP) obtained from magnetothermal measurements for powder and fluid samples lie in the range 4.4–83 W/g and 19–382 W/g, respectively, showing strong dependence on structural and magnetic properties. The SAR/SLP values as a function of the applied field at 425 kHz display a square dependence on the applied magnetic field below 165 Oe, which is expected for single domain ferromagnetic nanoparticles, but deviate from this at higher values of the applied field. We also obtained the effective anisotropy constant Keff for ball-milled nanoparticles at 1425 rpm for 200, 300, and 500 min. within the framework of linear response theory, showing strong dependence on average crystallite size. Additionally, the toxicity of the prepared nanoparticles in the form of percentage hemolysis was controlled with oleic acid

<i>Syzygium aromaticum</i> Bud Extracted Core–Shell Ag–Fe Bimetallic Nanoparticles: Phytotoxic, Antioxidant, Insecticidal, and Antibacterial Properties

Today, there is the roar of sustainable material development around the globe. Green nanotechnology is one of the extensions of sustainability. Due to its sustainable approach, the green fabrication of nanoparticles has recently surpassed their classical synthesis in popularity. Among metal nanoparticles, contemporary findings have demonstrated that bimetallic nanoparticles possess more potential for different applications than monometallic nanoparticles due to the synergistic effects of the two metals. So, we are presenting facile, one-vessel, and one-step phyto-fabrication of Ag–Fe BMNPs using the bud extract of Syzygiumaromaticum. The synthesized nanoparticles were characterized by UV-VIS, XRD, EDX, FTIR, and SEM. The synthesized NPs and the extract underwent biological studies. The radical scavenging potential of the NPs and the extract was found to be 64% and 73%, and the insecticidal potential was found to be 80% and 100%, respectively. Similarly, the NPs and the extract both exhibited good antibacterial activity. The zone of inhibition using 100 mg/mL of extract and NPs was found to be 1 cm against all bacterial species, i.e., K. pneumonia, E. coli, and S. aureus. It was 1.5 cm, 1.3 cm, and 1 cm against K. pneumonia, E. coli, and S. aureus, respectively, showing that the antibacterial activity of the extract is higher than that of the NPs. So, this study unlocks the synthesis of Ag–Fe bimetallic nanoparticles using eco-safe, cost-effective, facile, and least-harmful green methodology with potential applications of both NPs and SA extract in medical and agricultural fields, a step towards sustainability

Accelerated Decoloration of Organic Dyes from Wastewater Using Ternary Metal/g-C3N4/ZnO Nanocomposites: An Investigation of Impact of g-C3N4 Concentration and Ni and Mn Doping

Wastewater from many sectors that contains hazardous organic pollutants exacerbates environmental contamination. Consequently, outstanding photocatalytic substances that can successfully degrade hazardous substances are needed to provide pollution-free water. From this perspective, zinc oxide/g-C3N4-based composites are desirable due to their low cost, strong reactivity, and environmental friendliness. So, in the current investigation, sequences of Mn/g-C3N4/ZnO (Mn/GZ) and Ni/g-C3N4/ZnO (Ni/GZ) nanocomposites (NCs) containing different concentrations (wt.%) of g-C3N4 were made via the co-precipitation process. The chemical makeup and morphological characteristics of the produced composites were ascertained via the techniques of transmission electron microscopy (TEM), scanning electron microscopy (SEM), energy-dispersive X-ray (EDX), Fourier transform infrared (FTIR), photoluminescence (PL), and UV spectrophotometry. Methyl orange (MO) and Eriochrome Black T (EBT) dyes were used as target pollutants to assess the composite materials&rsquo; photocatalytic effectiveness. Compared to g-C3N4/ZnO and g-C3N4, the produced Mn/GZ and Ni/GZ NCs displayed better photocatalytic activity. The improved photocatalytic efficiency of the Ni/GZ and Mn/GZ NCs might be credited to synergistic interactions at the g-C3N4 and ZnO interface that result in a more efficient separation and conduction of photo-induced charges. Furthermore, the Ni/Mn atoms act as the facilitators to improve electron&ndash;hole pair separation and conduction in NCs. The nanocomposites were found to be incredibly stable, with consistently high dye decoloration efficiency over five catalytic cycles. Hence, Ni/GZ and Mn/GZ could potentially be very effective and adaptable photocatalysts for the photocatalytic decoloration of wastewater pollutants

Accelerated Decoloration of Organic Dyes from Wastewater Using Ternary Metal/g-C₃N₄/ZnO Nanocomposites: An Investigation of Impact of g-C₃N₄ Concentration and Ni and Mn Doping

Wastewater from many sectors that contains hazardous organic pollutants exacerbates environmental contamination. Consequently, outstanding photocatalytic substances that can successfully degrade hazardous substances are needed to provide pollution-free water. From this perspective, zinc oxide/g-C3N4-based composites are desirable due to their low cost, strong reactivity, and environmental friendliness. So, in the current investigation, sequences of Mn/g-C3N4/ZnO (Mn/GZ) and Ni/g-C3N4/ZnO (Ni/GZ) nanocomposites (NCs) containing different concentrations (wt.%) of g-C3N4 were made via the co-precipitation process. The chemical makeup and morphological characteristics of the produced composites were ascertained via the techniques of transmission electron microscopy (TEM), scanning electron microscopy (SEM), energy-dispersive X-ray (EDX), Fourier transform infrared (FTIR), photoluminescence (PL), and UV spectrophotometry. Methyl orange (MO) and Eriochrome Black T (EBT) dyes were used as target pollutants to assess the composite materials’ photocatalytic effectiveness. Compared to g-C3N4/ZnO and g-C3N4, the produced Mn/GZ and Ni/GZ NCs displayed better photocatalytic activity. The improved photocatalytic efficiency of the Ni/GZ and Mn/GZ NCs might be credited to synergistic interactions at the g-C3N4 and ZnO interface that result in a more efficient separation and conduction of photo-induced charges. Furthermore, the Ni/Mn atoms act as the facilitators to improve electron–hole pair separation and conduction in NCs. The nanocomposites were found to be incredibly stable, with consistently high dye decoloration efficiency over five catalytic cycles. Hence, Ni/GZ and Mn/GZ could potentially be very effective and adaptable photocatalysts for the photocatalytic decoloration of wastewater pollutants

Burden of culture confirmed enteric fever cases in Karachi, Pakistan: Surveillance for enteric fever in Asia project (SEAP), 2016-2019

Background: The Surveillance for Enteric Fever in Asia Project (SEAP) is a multicenter, multicountry study conducted in Pakistan, Nepal, and Bangladesh. The objectives of the study were to characterize disease incidence among patients with enteric fever. We report the burden of enteric fever at selected sites of Karachi, Pakistan.Methods: During September 2016 to September 2019, prospective surveillance was conducted at inpatient, outpatient, surgical departments, and laboratory networks of Aga Khan University Hospital, Kharadar General Hospital, and surgery units of National Institute of Child Health and Jinnah Postgraduate Medical Centre. Socio-demographic, clinical, and laboratory data were obtained from all suspected or confirmed enteric fever cases.Results: Overall, 22% (2230/10 094) of patients enrolled were culture-positive for enteric fever. 94% (2093/2230) of isolates were Salmonella Typhi and 6% (137/2230) were S. Paratyphi. 15% of isolates multi-drug resistant (MDR) to first-line antibiotics and 60% were extensively drug-resistant (XDR), resistant to first-line antibiotics, fluoroquinolones and third generation cephalosporin.Conclusion: Enteric fever cases have increased during the last 3 years with large proportion of drug resistant S. Typhi cases. However, the burden of paratyphoid is still relatively low. Strengthening the existing surveillance system for enteric fever and antimicrobial resistance at the national level is recommended in Pakistan to inform prevention measures. While typhoid vaccination can significantly decrease the burden of typhoid and may also impact antimicrobial resistance, water, sanitation, and hygiene improvement is highly recommended to prevent the spread of enteric fever

Burden of Culture Confirmed Enteric Fever Cases in Karachi, Pakistan: Surveillance For Enteric Fever in Asia Project (SEAP), 2016-2019

Background: The Surveillance for Enteric Fever in Asia Project (SEAP) is a multicenter, multicountry study conducted in Pakistan, Nepal, and Bangladesh. The objectives of the study were to characterize disease incidence among patients with enteric fever. We report the burden of enteric fever at selected sites of Karachi, Pakistan. Methods: During September 2016 to September 2019, prospective surveillance was conducted at inpatient, outpatient, surgical departments, and laboratory networks of Aga Khan University Hospital, Kharadar General Hospital, and surgery units of National Institute of Child Health and Jinnah Postgraduate Medical Centre. Socio-demographic, clinical, and laboratory data were obtained from all suspected or confirmed enteric fever cases. Results: Overall, 22% (2230/10†094) of patients enrolled were culture-positive for enteric fever. 94% (2093/2230) of isolates were Salmonella Typhi and 6% (137/2230) were S. Paratyphi. 15% of isolates multi-drug resistant (MDR) to first-line antibiotics and 60% were extensively drug-resistant (XDR), resistant to first-line antibiotics, fluoroquinolones and third generation cephalosporin. Conclusion: Enteric fever cases have increased during the last 3 years with large proportion of drug resistant S. Typhi cases. However, the burden of paratyphoid is still relatively low. Strengthening the existing surveillance system for enteric fever and antimicrobial resistance at the national level is recommended in Pakistan to inform prevention measures. While typhoid vaccination can significantly decrease the burden of typhoid and may also impact antimicrobial resistance, water, sanitation, and hygiene improvement is highly recommended to prevent the spread of enteric fever

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population