Omphalocele and macroglossia: a case of Beckwith-Wiedemann syndrome

Beckwith-Wiedemann syndrome (BWS) is a pediatric overgrowth disorder which predisposes to tumor development. The following case study examined a prenatal finding of omphalocele with postnatal findings of macroglossia and cutaneous hemangioma, ultimately leading to a diagnosis of BWS. This case highlighted the features of BWS, the diagnostic principles and the importance of a multidisciplinary team approach to its management

Neurological Complications of Eclampsia

Objective: Neurological complications contribute significantly to maternal mortality in eclampsia. We studied neurological and obstetric outcome of such patients.Material and Methods: A descriptive study was done at Gynaecology, Neurosurgery and Neurology Units of PGMI Lady Reading Hospital Peshawar, from January 2008 to December 2008. A total of 132 cases of eclampsia were included. Twenty seven cases of eclampsia with neurological complications were studied. We excluded cases with primary neurological abnormalities.Results: During this period one hundred and thirty two patients were admitted with eclampsia. Among 132 cases 27 had neurological abnormalities. One hundred and eight cases were antenatal and twenty four were postnatal. None of them had any antenatal care. Management included initial stabilization followed by early delivery in antenatal cases. Primary anticonvulsant was magnesium sulphate. Phenytoin controlled convulsions in all cases with recurrent seizures. Neurological complications were seen in twenty seven patients. Minor complications like transient impairment of consciousness (97%), blurred vision (22.22%), and Bell’s palsy (07.40%) were observed. Serious neurological complications like CVA (11.11%), recurrent seizures (37.03%) and deep coma occurred in (22.02%) of cases. The cesarean section rate was 18%. Fifty four perinatal deaths and five maternal deaths were recorded. Neurological recovery was complete in all survivors.Conclusion: Critical care backup is essential at tertiary referral centers for a large proportion of neurological abnormalities in eclampsia. High mean arterial pressure and accompanying coagulation defects may be key factors in cerebral pathology. CT scan is a simple and effective investigation in these cases. Phenytoin is an effective second line anticonvulsant. Early delivery prevents worsening of systemic status

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

Impact of double-diffusive convection and motile gyrotactic microorganisms on magnetohydrodynamics bioconvection tangent hyperbolic nanofluid

The double-diffusive tangent hyperbolic nanofluid containing motile gyrotactic microorganisms and magnetohydrodynamics past a stretching sheet is examined. By adopting the scaling group of transformation, the governing equations of motion are transformed into a system of nonlinear ordinary differential equations. The Keller box scheme, a finite difference method, has been employed for the solution of the nonlinear ordinary differential equations. The behaviour of the working fluid against various parameters of physical nature has been analyzed through graphs and tables. The behaviour of different physical quantities of interest such as heat transfer rate, density of the motile gyrotactic microorganisms and mass transfer rate is also discussed in the form of tables and graphs. It is found that the modified Dufour parameter has an increasing effect on the temperature profile. The solute profile is observed to decay as a result of an augmentation in the nanofluid Lewis number

Comparing efficacy of Rifaximin plus Lactulose vs. Lactulose alone in treating Hepatic Encephalopathy

Background: Hepatic Encephalopathy is a syndrome observed in patients with liver cirrhosis. Various treatment modalities are in use for treatment of Porto Systemic Encephalopathy (PSE). Our study aimed to compare the efficacy of Rifaximin plus Lactulose vs.Lactulose alone in treating Hepatic Encephalopathy in local population. Materials & Methods: The study was conducted at a tertiary care hospital recruiting decompensated chronic liver disease(DCLD) patients with PSE. Using simple random sampling, patients were divided in two groups (A & B). Patients in group A received Lactulose plus Rifaximin while group B received Lactulose alone. Efficacy of treatment was assessed as return of the conscious level to pre-encephalopathy state as per clinical examination within 1 week after  start of the treatment. Results: A total of 124 patients were included in the study with each group (A & B) containing 62 patients. Frequency and percentage of efficacy among group A (Rifaximin plus Lactulose) verses group B (Lactulose alone) in treating Hepatic encephalopathy was 45 (72.6%) and 32 (51.6%) respectively. Conclusion: The study concluded that there is a significant difference in proportions of patients showing complete recovery from Hepatic encephalopathy treated with Lactulose plus Rifaximin as compared to Lactulose alone

Numerical Investigation of MWCNT and SWCNT Fluid Flow along with the Activation Energy Effects over Quartic Auto Catalytic Endothermic and Exothermic Chemical Reactions

A mathematical model is created to analyze the impact of Thompson and Troian slip boundaries over a contracting/expanding surface sustaining nanofluid-containing carbon nanotubes along a stagnation point flow. Both multi-wall (MWCNTs) and single-wall (SWCNTs) carbon nanotubes are taken into consideration, with water serving as the base liquid. The flow is obtained due to the stretching or contracting of the surface. The thermal radiation, activation energy, buoyancy impacts, and chemical processes called quartic autocatalysis are additionally added to the original mathematical model. The MATLAB-constructed bvp4c function involving the three-stage Lobatto IIIa formula for the numerical results of dimensionless velocity, concentration, and temperature profiles are used. By contrasting it against a published paper in this limited instance, it is determined whether the suggested mathematical model is legitimate. In this sense, a remarkable consensus is achieved. Graphical representations are used to depict the behavior of many non-dimensional flow variables, such as the slip velocity parameter, the inertia coefficient, the porosity parameter, and the solid volume fraction. Surface drag force computations are reported to examine the effects at the permeable stretching surface. It has been shown that increasing the slip velocity factor increases the fluid streaming velocity while decreasing the surface drag force. If the endothermic/exothermic coefficient increases, the local thermal transfer efficiency falls. For nanofluids, the changing viscosity factor increases axial velocity while decreasing temperature distribution. Additionally, the solid volumetric fraction improves the temperature distributions by lowering the concentration profile and speed

Numerical Investigation of MWCNT and SWCNT Fluid Flow along with the Activation Energy Effects over Quartic Auto Catalytic Endothermic and Exothermic Chemical Reactions

A mathematical model is created to analyze the impact of Thompson and Troian slip boundaries over a contracting/expanding surface sustaining nanofluid-containing carbon nanotubes along a stagnation point flow. Both multi-wall (MWCNTs) and single-wall (SWCNTs) carbon nanotubes are taken into consideration, with water serving as the base liquid. The flow is obtained due to the stretching or contracting of the surface. The thermal radiation, activation energy, buoyancy impacts, and chemical processes called quartic autocatalysis are additionally added to the original mathematical model. The MATLAB-constructed bvp4c function involving the three-stage Lobatto IIIa formula for the numerical results of dimensionless velocity, concentration, and temperature profiles are used. By contrasting it against a published paper in this limited instance, it is determined whether the suggested mathematical model is legitimate. In this sense, a remarkable consensus is achieved. Graphical representations are used to depict the behavior of many non-dimensional flow variables, such as the slip velocity parameter, the inertia coefficient, the porosity parameter, and the solid volume fraction. Surface drag force computations are reported to examine the effects at the permeable stretching surface. It has been shown that increasing the slip velocity factor increases the fluid streaming velocity while decreasing the surface drag force. If the endothermic/exothermic coefficient increases, the local thermal transfer efficiency falls. For nanofluids, the changing viscosity factor increases axial velocity while decreasing temperature distribution. Additionally, the solid volumetric fraction improves the temperature distributions by lowering the concentration profile and speed

A Study of Treatment of Reactive Red 45 Dye by Advanced Oxidation Processes and Toxicity Evaluation Using Bioassays

Advanced oxidation processes (AOPs) hold great promise to degrade and detoxify industrial-based effluents. The Reactive Red 45 dye aqueous solutions were treated with AOP using UV and gamma radiation alone and then in the presence of H2O2. The dye initial concentration, UV exposure time, and gamma-ray absorbed dose were optimized for maximum degradation. The degradation of dye was 88.85% and 77.7% using UV/H2O2 (1 mL/L) at a UV exposure time of 180 min for 50 mg/L and 100 mg/L, respectively. The degradation was noted as 100% and 93.82% as the solutions were subjected to a gamma/H2O2 (1 mL/L) absorbed dose of 2 kGy. The chemical oxygen demand was reduced to 77% and 85% by treating the dye samples with UV/H2O2 and gamma/H2O2, respectively. The removal efficiency (G-value), dose constant (k), D0.50, D0.90, and D0.99 for gamma-irradiated samples were also calculated. The reduction in toxicity for treated samples was monitored by using the Allium cepa, Hemolytic, and brine shrimp (Artemia salina) tests while the Ames test was performed for mutagenic assessment. The A. cepa test showed 39.13%, 36.36%, and 47.82% increases in root length (RL), root count (RC), and mitotic index (MI), respectively, in UV/H2O2-treated samples while 48.78%, 48.14%, and 57.14% increases were shown with gamma-ray in conjunction with H2O2. The hemolytic test showed 21.25% and 23.21% hemolysis after UV/H2O2 and gamma/H2O2 treatments, respectively. The brine shrimp (Artemia salina) test showed 84.09% and 90.90% decreases in the nauplii death after UV/H2O2 and gamma/H2O2 treatments, respectively. The mutagenicity of UV/H2O2-treated solutions was reduced up to 84.41% and 77.87%, while it was 87.83% and 80.88% using gamma/H2O2 using TA98 and TA100 bacterial strains, respectively. The advanced oxidation processes based on UV and gamma radiation in conjunction with H2O2 can be applied for the degradation and detoxification of textile waste effluents efficiently