Total knee arthroplasty: Risk factors for allogeneic blood transfusions in the South Asian population

Background: Total knee arthroplasty (TKA) is the recommended treatment for end-stage knee osteoarthritis. Considering the various risks associated with intra and postoperative blood transfusions, better understanding is required with respect to the risk factors contributing to a greater possibility of blood transfusion during or after surgery. Although literature highlights several such factors, our study is among the first to identify these risk factors in the South Asian population which differs from other populations in several ways. Methods: The study consists of a review of 658 patients undergoing TKA from 2005 to 2015. Data was obtained from patient medical records and was analysed using logistic regression analysis. The relationship between each predictor and the outcome variable was calculated as an Odds ratio (OR), the threshold of significance for which was p = 0.25 and p = 0.05 for univariate and multivariable analysis respectively. Results: The mean age of the patient population was 63 years (78% female), 25% of whom received one or more blood transfusions. Multivariable analysis revealed 5 significant independent predictors for increased risk of blood transfusions including bilateral knee surgery (OR:5.51), preoperative anemia (OR:4.15), higher ASA (American Society of Anaesthesiologists) status (3-4) (OR:1.92), female sex (OR:3.44) and BMI (Body mass index) ≤30 (OR:1.79) while increasing co-morbidities and age (\u3e60) were found to be insignificant. Conclusions: The factors identified for the South Asian population are largely similar to those for other populations. Identification of high risk patients will permit the application of an international multipronged approach which not only targets the modifiable risk factors but also the decision making process and blood management protocols in order to minimize the transfusion associated risks for a patient undergoing a TKA

IOT Based Approach On Aquarium Monitoring System With Fish Feeder Automation

Abstract— The monitoring system is known to be very useful for alleviating human activities and can been utilized in many ways. The idea to automate the monitoring system originated from a couple of problems. The time consuming process for manually checking and measuring every parameter at every part in an aquarium is one of the problem. The second problem is the lack of availability of time to keep the aquarium meeting the mandatory fish needs that need to be reviewed regularly. Along with these there are known that important parameters such as condition of pH water and the availability of food is essential to keep the habitat conducive for living. Therefore this paper proposed an aquarium monitoring system utilizing Internet of Thing (IoT) with automatic fish feeder. With the existence of IoT system, user can be continuously notified in real time. The monitoring system is utilized as a platform to remind the user to clean or filling food in the feeder when necessary. The system also equipped with automatic feeder fulfilling the fish mandatory needs. The result showed that the developed system able to display the current conditions of pH water value and the level of the fish food through Blynk application. This user friendly and compact fish tank design can be implemented almost anywhere

Baseline amplicon sequencing data for the ITS2 region in the green honey of Banggi Island, Sabah

Green honey, was discovered on Banggi Island, Sabah, showing high in essential amino acids and chlorophyll derivatives. Despite its lucrative market potential owing to its distinctive color, uncertainties persist regarding its nature. This study leverages amplicon sequencing by targeting micro- and macro-organisms present in honey environmental DNA (eDNA) using Internal Transcribed Spacer 2 (ITS2) region, enabling the identification of floral and microorganism sources that represent the honey's composition. The investigation into green honey from Banggi Island concerns the prevalence of honey adulteration and authenticity for economic gain. Adulteration methods, such as the addition of sugar syrups, compromise honey purity. Using a sequencing approach would help in determining the geographic origin and verifying the authenticity of the honey. The study aims to identify plant species or microorganisms in honey's eDNA. To authenticate honey, we utilized ITS2 with Illumina sequencing, exploring the diversity of green honey samples. Raw sequence reads obtained for the green honey sample revealed 1,438,627 raw reads, with a GC average of 49.22 %. A total of 44 amplicon sequence variances (ASVs) were identified, including three genera: Zygosaccharomyces with two species, Fraxinus with three species, and the genus Ficaria with only one species. Their respective relative abundances were 98.55%, 0.94%, and 0.51%. Zygosaccharomyces rouxii and Zygosaccharomyces mellis were identified as the pre-dominant yeast species in honey, while the Fraxinus and Ficaria genus represent common plant species in Sabah, particularly in Banggi Island. The dominance of Zygosaccharomyces species aligns with their known prevalence in honey, affirming the reliability of our findings. The presence of Fraxinus and Ficaria in the honey sample correlates with its abundance in the local environment. This amplicon sequencing approach not only contributes to our understanding of green honey composition but also serves as a valuable resource for authenticating honey origin in Malaysia, particularly for green honey from Banggi Island, Sabah. Our study pioneers the application of ITS2 amplicon sequencing for green honey amplicon sequencing, providing valuable insights into its composition and origin. This methodology, with a focus on eDNA, contributes to the authentication and quality determination of honey in Malaysia, addressing the pressing concerns of adulteration and variability in production practices

Green honey of Banggi Island: A preliminary anti-diabetic study on zebrafish model

Zebrafish is a developing vertebrate model with several advantages, including its small size, and high experimental efficiency. Malaysia exhibit one of the highest diabetes rates in the Western Pacific and incurring an annual cost of 600 million US dollars. The objective of the study is to determine the antidiabetic properties of green honey (GH) using a zebrafish model. Adult zebrafish, aged 3–4 months, were subjected to overfeeding and treated with streptozotocin (STZ) through intraperitoneal injection (IP) on days 7 and 9. The study assessed the oral sucrose tolerance test (OSTT) and the anti-diabetic effects of green honey. The evaluation was conducted at three time points: 30, 60, and 120 min after treatment and sucrose administration. The study utilised a model with a sample size of 5. The study was performed in six groups. These groups are (1) Normal control (non-diabetic, no intervention), (2) Normal control + GH (non-diabetic, supplemented with GH 3 μl), (3) DM control (diabetic, no intervention), (4) DM Gp1 (diabetic, 3 μL GH), (5) DM Gp2 (diabetic, 6 μ L GH), (6) DM Acarbose (diabetic, treated with acarbose). Fasting blood glucose levels for non-diabetic (non-DM) and diabetic (DM) groups were evaluated before and after the 10 days of diabetic induction. DM groups (excess of food and two injections of STZ) have caused a significant increment in the fasting blood glucose to 11.55 mmol/l (p < 0.0001). Both GH treatments effectively decreased postprandial blood glucose levels and the area under the curve in the oral glucose tolerance test (OSTT). Based on these results, it is concluded that green honey could play a role in hyperglycemia management and show potential as a natural alternative to conventional diabetes therapy. The underlying mechanisms need to be clarified, and their potential use in human diabetes therapy needs to be investigated

Hydrophobic mullite ceramic hollow fibre membrane (Hy-MHFM) for seawater desalination via direct contact membrane distillation (DCMD)

A low-cost hydrophobic mullite hollow fibre membrane (Hy-MHFM) fabricated via phase inversion/sintering technique followed by fluoroalkyl silane (FAS) grafting is presented in this study. The prepared CHFMs were characterized before and after the grafting step using different characterization techniques. The pore size of the CHFM surface was also determined using ImageJ software. The desalination performance of the grafted membrane was evaluated in direct contact membrane distillation (DCMD) using synthetic seawater of varying salt concentrations for 2 h at various feedwater temperatures. The outcome of the evaluations showed declines in the permeate flux of the membrane at increasing feed concentration, as well as increased flux with increased feed temperature. The long-term stability of the membrane was achieved at time 20 h, feed temperature 60 °C, and permeate temperature 10 °C, the membrane achieved a salt rejection performance of about 99.99 % and a water flux value of 22.51 kg/ m2 h

Novel ceramic hollow fibre membranes contactor derived from kaolin and zirconia for ammonia removal and recovery from synthetic ammonia

The adverse effects of ammonia found in wastewater streams lead to the development of advanced water treatment technology, i.e. membrane contactor (MC). In this study, single layer hollow fibre membrane (SLZK) and dual layer hollow fibre membrane (DLZK) were prepared from zirconia and kaolin and modified into hydrophobic membrane through simple grafting process via fluoroalkylsilane (FAS) agent. The properties of membranes such as morphology, surface roughness, mechanical strength, wettability and liquid entry pressure were analysed through scanning electron microscopy (SEM), atomic force microscopy (AFM), 3-point bending strength, contact angle and LEPw setup. Finally, the performance of the membranes was also investigated towards ammonia removal via membrane contactor system. Our findings showed that hydrophobicity properties significantly improved for both SLZK and DLZK membranes after grafting modification process as indicated by the increase of contact angle value from 5° and 1° to 132.7° and ~180.0° respectively. Based on the morphological analysis, the surface of DLZK showed more porous structure as compared to the SLZK. In addition, DLZK also displayed the highest mechanical strength and contact angle reading of 125 MPa and ~180° respectively. This suggests that the DLZK showed an excellent membrane contactor performance with highest value of mass transfer coefficient (3.77 x 10-5 ms-1) and almost complete removal of ammonia removal (91%). Overall, these results implied that dual layer ceramic membrane developed from kaolin and zirconia could provide the basis for the development of alternative ceramic membrane with excellent properties for membrane contactor system

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Exam related anxiety and its management amongst medical students

Introduction: To assess examination related anxiety amongst medical students by test anxiety inventory and to determine the factors contributing to exam anxiety and management of exam anxiety by medical students. Methods: A cross sectional study using structured self-administered questionnaire and an online questionnaire was carried out over four weeks in Dow Medical College using sample size of 300 students of the different years of study from first year to final year. Duration of study was four weeks in May 2013. Survey questionnaire consisted of Standard Test Inventory to measure intensity of exam anxiety and questions regarding Factors Causing Exam Anxiety and Management techniques to overcome Exam anxiety. The data was analyzed using SPSS 16.0. Result: A total of 300 filled in the questionnaire. There were 262 (87.3%) female and 38(12.7%) male students. The analysis revealed that the major factors contributing to exam anxiety was extensive course load 177 (59% ) whereas 98 (32%) students thought that inadequate rest during exams contributed to exam anxiety. 128 students (42.7%) reported sleep disturbances before the exam ,96 (32%) said that they could not relax physically.172 (57.3 %) students felt that praying was the best way to combat exam anxiety, 119 (39.7%) maintained a positive attitude while 19% felt that eating and drinking caffeinated drinks before the exam helped to perform better. Conclusion: This study indicates high prevalence of exam anxiety amongst students of Dow Medical College (DMC) and also highlights factors such as extensive course load, lack of exercise and long duration of exams which contribute to Exam Anxiety and techniques such as praying and maintaining a positive attitude to reduce anxiety. This also requires strategic planning, encouraging medical students to adapt a healthy lifestyle. Keywords: examphobia, medical students, examanxiety, extensivecourseloa