Endoscopic Ultrasound for the Treatment of Gastric Variceal Bleeding in a Patient with Portal Cavernoma

"A 30-year-old lady was admitted with two weeks of fever and right upper quadrant pain. She had a background of non-malignant, non-cirrhotic portal vein thrombosis (PVT) with cavernoma formation. There was no detected underlying pro-thrombotic condition. She had established portal hypertension with esophageal varices. Her portal cavernoma was complicated by portal biliopathy and concurrent gallstone disease - with an endoscopic retrograde cholangio-pancreatography (ERCP) and stenting four weeks prior to admission. Drug history included carvedilol for primary prophylaxis of bleeding, anticoagulation had not been undertaken due to collateralisation. Admission computerised tomography (CT) revealed multiple small liver abscesses with a patent biliary stent and no progression of PVT and she was treated conservatively with intravenous antibiotics."--Case summary and discussionAlexander Boyd (1, 2, 3), Brinder S Mahon (2), Neil Rajoriya (2, 3) ; 1. NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham. 2. University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way. 3. University of BirminghamIncludes bibliographical reference

Cholesterol loaded cyclodextrin increases freezability of buffalo bull (Bubalus bubalis) spermatozoa by increasing cholesterol to phospholipid ratio

Aim: The study was conducted to investigate the effect of cholesterol loaded cyclodextrin (CLC) on freezability of buffalo spermatozoa. Materials and Methods: Murrah buffalo bull semen samples with progressive motility of 70% and greater were used. After the evaluation of motility and livability, four equal fractions of semen samples were made. Group I was kept as control and diluted with Tris, whereas Group II, III and IV were treated with CLC solution at the rate of 2.0, 3.0 and 4.0 mg/ml respectively to obtain 120 × 106 sperm/ml as final spermatozoa concentration. The aliquots of all the groups were incubated for action of CLC, followed by dilution and freezing. Evaluation at pre-freeze and post-thaw stage of progressive motility, viability and level of cholesterol and phospholipid was done. Results: The mean cholesterol content (μg/100 × 106 spermatozoa) of Group I, II, III and IV at pre-freeze stage was 21.55±0.63, 49.56±1.38, 55.67±0.45 and 47.79±1.01 and at post-thaw stage were 13.18±0.45, 34.27±0.71, 36.21±0.48 and 33.68±0.56, respectively. At pre-freeze stage, cholesterol content was significantly (p<0.01) higher in Group III in comparison to other groups. The mean cholesterol and phospholipids content of fresh sperm was 24.14±0.58 and 51.13±0.66 μg/100 × 106 sperm cells, respectively, and C/P ratio of spermatozoa at fresh stage was 0.47±0.067. Conclusion: CLC treatment maintains the C/P ratio and plays an important role in maintaining membrane architecture of spermatozoa. Hence, addition of CLC may be helpful in increasing freezability of buffalo spermatozoa by increasing the C/P ratio of spermatozoa

Experimental analysis and mathematical modelling of ginger using different solar drying systems

237-242Fruits and vegetables are perishable; they don’t have a shelf life. They contain so much water that their logistic become difficult. Drying is both heat and mass exchange energy activity, mainly utilized as a food preservation technique. Fresh collected ginger has effectively dried from starting moisture content of 86% wet basis (w.b.) to the safe storage moisture content of 13% - 14% (w.b.) in Open Sun Drying (OSD) and hot air oven solar dryers. It has been found that the hot air dryer of the glass-to-glass module took less time (8hrs) as compared to the hot air dryer of an opaque module (10hrs) and Open Sun Drying (OSD) (14hrs). The drying behavior of ginger slices have been analyzed using various mathematical models. Page model has explained the drying behavior of ginger precisely with maximum values of coefficient of determinationi.e.,0.996, 0.997, and 0.994for hot air dryer of glass-to-glass module, opaque module, and OSD respectively, and has minimum reduced chi-square, mean bias error, and root mean square error

Effect of low density lipoprotein on replacement of egg yolk in liquid preservation of mithun semen

This investigation explored the use of low density lipoproteins (LDL) from egg yolk (EY) in replacement EY on semen quality parameters (SQPs), velocity and motility parameters by Computer Assisted Sperm Analyzer (CASA) and biochemical parameters following liquid storage (5°C) of mithun semen. A total of 25 ejaculates collected from ten healthy mithun bulls and diluted with the standard tris citrate glycerol (TCG) extender were splited into three equal aliquots: Group 1, Control; EY, Group 2 and Group 3 contained 8 and 10% (w/v on dry weight basis) LDL, respectively. SQPs, CASA and biochemical parameters were evaluated following incubation of semen at 5°C. Results revealed a significant (P<0.05) improvement in these parameters in group 2 as compared to group 1 and 3. It was concluded that addition of 8% LDL (w/v) holds a clear advantage over EY or 10% LDL in preservation of mithun semen at liquid storage

Quality standards for the management of alcohol-related liver disease: consensus recommendations from the British Association for the Study of the Liver and British Society of Gastroenterology ARLD special interest group

Objective Alcohol-related liver disease (ALD) is the most common cause of liver-related ill health and liver-related deaths in the UK, and deaths from ALD have doubled in the last decade. The management of ALD requires treatment of both liver disease and alcohol use; this necessitates effective and constructive multidisciplinary working. To support this, we have developed quality standard recommendations for the management of ALD, based on evidence and consensus expert opinion, with the aim of improving patient care. Design A multidisciplinary group of experts from the British Association for the Study of the Liver and British Society of Gastroenterology ALD Special Interest Group developed the quality standards, with input from the British Liver Trust and patient representatives. Results The standards cover three broad themes: the recognition and diagnosis of people with ALD in primary care and the liver outpatient clinic; the management of acutely decompensated ALD including acute alcoholrelated hepatitis and the posthospital care of people with advanced liver disease due to ALD. Draft quality standards were initially developed by smaller working groups and then an anonymous modified Delphi voting process was conducted by the entire group to assess the level of agreement with each statement. Statements were included when agreement was 85% or greater. Twenty-four quality standards were produced from this process which support best practice. From the final list of statements, a smaller number of auditable key performance indicators were selected to allow services to benchmark their practice and an audit tool provided. Conclusion It is hoped that services will review their practice against these recommendations and key performance indicators and institute service development where needed to improve the care of patients with ALD

The Liverpool alcohol-related liver disease algorithm identifies twice as many emergency admissions compared to standard methods when applied to Hospital Episode Statistics for England

BackgroundEmergency admissions in England for alcohol-related liver disease (ArLD) have increased steadily for decades. Statistics based on administrative data typically focus on the ArLD-specific code as the primary diagnosis and are therefore at risk of excluding ArLD admissions defined by other coding combinations.AimTo deploy the Liverpool ArLD Algorithm (LAA), which accounts for alternative coding patterns (e.g., ArLD secondary diagnosis with alcohol/liver-related primary diagnosis), to national and local datasets in the context of studying trends in ArLD admissions before and during the COVID-19 pandemic.MethodsWe applied the standard approach and LAA to Hospital Episode Statistics for England (2013-21). The algorithm was also deployed at 28 hospitals to discharge coding for emergency admissions during a common 7-day period in 2019 and 2020, in which eligible patient records were reviewed manually to verify the diagnosis and extract data.ResultsNationally, LAA identified approximately 100% more monthly emergency admissions from 2013 to 2021 than the standard method. The annual number of ArLD-specific admissions increased by 30.4%. Of 39,667 admissions in 2020/21, only 19,949 were identified with standard approach, an estimated admission cost of £70 million in under-recorded cases. Within 28 local hospital datasets, 233 admissions were identified using the standard approach and a further 250 locally verified cases using the LAA (107% uplift). There was an 18% absolute increase in ArLD admissions in the seven-day evaluation period in 2020 versus 2019. There were no differences in disease severity or mortality, or in the proportion of admissions with decompensation of cirrhosis or alcoholic hepatitis.ConclusionsThe LAA can be applied successfully to local and national datasets. It consistently identifies approximately 100% more cases than the standard coding approach. The algorithm has revealed the true extent of ArLD admissions. The pandemic has compounded a long-term rise in ArLD admissions and mortality

Exergetic and Enviroeconomic analysis of a novel PVT array with triangular duct for building application

519-525Photovoltaic/thermal air collector has potential to execute electrical and thermal energy concurrently. This paper investigates carbon dioxide mitigation and enviroeconomic analysis on basis of overall, energy and exergy gain of semi-transparent PVT (SPVT), and opaque PVT (OPVT) arrays under natural convection in Bikaner, Rajasthan (India). The analysis has been carried out on an array configuration of opaque and semi-transparent arrays having 7 modules connected in series. Experimental work has been done in the month of September to December and comparison has been made on the basis of electrical and thermal gains. The results depict that average electrical, thermal and overall exergy gain of SPVT array is higher by 9.20%, 15.2% and 8.08% with respect to OPVT array. The CO2 mitigation for four months for semi-transparent array is higher by 0.67 tCO2 and 0.15 tCO2 as compared to OPVT array on the basis of overall thermal energy and overall exergy gain respectively. The environmental cost of SPVT array is higher by Rs. 710.53 and Rs. 160.50 than OPVT array for four months with respect to overall thermal energy and overall exergy gain

Immune-mediated and chronic inflammatory disease in people with sarcoidosis: disease associations in a large UK database.

BACKGROUND: Sarcoidosis is a multi-system disorder characterised by non-caseating granulomas. Coexistence of sarcoidosis with immune-mediated and chronic inflammatory diseases has been described in case series. However, the coexistence of two different diseases in individuals can occur by chance, even if each of the diseases is rare. AIM: To determine whether sarcoidosis necessitating hospital admission or day-case care coexists with a range of immune-mediated and chronic inflammatory diseases more commonly than expected by chance. DESIGN: Analysis of an epidemiological database of hospital admission and day-case statistics, spanning 30 years. RESULTS: 1510 patients with sarcoidosis were identified (mean age 44 years, median follow-up 19 years) who had been admitted to hospital or day-case care. Significant associations in the sarcoidosis cohort were identified with systemic lupus erythematosus (odds ratio (OR) 8.3; 95% CI 2.7 to 19.4), autoimmune chronic hepatitis (OR 6.7; 95% CI 1.8 to 17.1), multiple sclerosis (OR 3.3; 95% CI 1.7 to 5.6), coeliac disease (OR 3.1; 95% CI 1.01 to 7.3), thyrotoxicosis (OR 2.5; 95% CI 1.4 to 4.0), myxoedema (OR 2.2; 95% CI 1.2 to 3.7) and ulcerative colitis (OR 2.1; 95% CI 1.1 to 3.7). Weaker associations were found for diabetes mellitus with a first admission aged 30-49 years (OR 2.9; 95% CI 2.1 to 4.0) or age &gt;50 (OR 1.7; 95% CI 1.2 to 2.3), but not for people age &lt;30. No significant association with Crohn's disease (OR 1.52; 95% CI 0.61 to 3.14) or primary biliary cirrhosis (OR 3.75; 95% CI 0.77 to 11.0),was found. When all immune-mediated and chronic inflammatory diseases for which associations were sought were combined, the overall rate ratio associated with sarcoidosis was 2.2 (95% CI 1.9 to 2.6). CONCLUSION: This study adds epidemiological evidence to information from clinical reports that there is a connection between sarcoidosis and other immune-mediated and chronic inflammatory diseases